Transcutaneous Bilirubin Monitoring in Preterm Infants of 23 to 34 Weeks' Gestation

Abstract

Objective The study aimed to evaluate the validity of transcutaneous bilirubin (TcB) measurements at three sites in premature infants born at 23^0/7 to 34^6/7 weeks' gestational age (GA) compared with total serum bilirubin (TSB) measurements.

Study Design A prospective study was conducted at Banner – University Medical Center Phoenix, where informed consent was obtained from the infant's parent or legally authorized representative. Cohort A was comprised of infants 23^0/7 to 28^6/7 weeks' GA and Cohort B contained subjects 29^0/7 to 34^6/7 weeks' GA. Baseline TSB measurements were collected at approximately 24 hours of life, as the standard of care and the TcB measurements were obtained from the sternum, interscapular, and buttock areas at approximately ± 30 minutes from collection of the TSB. Statistical analysis of measurements including sensitivity, specificity, positive, and negative predictive values, and the area under the receiver operator characteristic curve (AUROC) were performed.

Results A total of 166 infants were included in the study population. Cohort A consisted of 41 subjects and Cohort B contained 125 subjects. The results showed that baseline TcB measurements from the interscapular area were the most sensitive and specific with TSB levels >5.0 mg/dL in Cohort A. Baseline TcB measurements from the sternum demonstrated greatest sensitivity and specificity when the TSB level was >8.0 mg/dL in Cohort B. In general, each of the three sites in both cohorts demonstrated excellent AUROCs and negative predictive values.

Conclusion The use of a TcB meter in preterm infants can be a reliable noninvasive screening tool for hyperbilirubinemia, and it may be beneficial in decreasing painful stimuli and iatrogenic blood loss when used as an adjunct to TSB monitoring.

Key Points

• Interscapular TcB is sensitive/specific in 23 to 29 weeks' GA.

• Sternal TcB is sensitive/specific in 29 to 35 weeks' GA.

• TcB readings are reliable in preterm infants.

• TcB is reliable when serum bilirubin is >5.0 mg/dL.

Keywords

transcutaneous bilirubin - hyperbilirubinemia - prematurity - neonatal jaundice - neonatal intensive care

Publication History

Received: 05 April 2021

Accepted: 10 May 2021

Article published online:
14 June 2021

• References

• 1 Anand P. , Mangalabharathi S, Aparna C, et al. Screening, prevention, and management of neonatal hyperbilirubinemia. J Neonatol 2020; 34 (03) 153-169
• 2 Anand KJ. Pain, plasticity, and premature birth: a prescription for permanent suffering?. Nat Med 2000; 6 (09) 971-973
• 3 Sajjadian N, Shajari H, Saalehi Z, Esphahani F, Alizadeh Taheri P. Transcutaneous bilirubin measurement in preterm neonates. Acta Med Iran 2012; 50 (11) 765-770
• 4 Cucuy M, Juster-Reicher A, Flidel O, Shinwell E. Correlation between transcutaneous and serum bilirubin in preterm infants before, during, and after phototherapy. J Matern Fetal Neonatal Med 2018; 31 (10) 1323-1326
• 5 Dräegar. Konica Minolta JM-103 User Manual. Manuals Library. Published September 11, 2010. Accessed March 5, 2021 at: https://www.manualslib.com/manual/1181959/Konica-Minolta-Jm-103.html
• 6 Yasuda S, Itoh S, Isobe K. et al. New transcutaneous jaundice device with two optical paths. J Perinat Med 2003; 31 (01) 81-88
• 7 Namba F, Kitajima H. Utility of a new transcutaneous jaundice device with two optical paths in premature infants. Pediatr Int 2007; 49 (04) 497-501
• 8 Hassan Shabuj M, Hossain J, Dey S. Accuracy of transcutaneous bilirubinometry in the preterm infants: a comprehensive meta-analysis. J Matern Fetal Neonatal Med 2019; 32 (05) 734-741
• 9 Radfar M, Hashemieh M, Shirvani F, Madani R. Transcutaneous bilirubinometry in preterm and term newborn infants before and during phototherapy. Arch Iran Med 2016; 19 (05) 323-328
• 10 Fonseca R, Kyralessa R, Malloy M, Richardson J, Jain SK. Covered skin transcutaneous bilirubin estimation is comparable with serum bilirubin during and after phototherapy. J Perinatol 2012; 32 (02) 129-131
• 11 Kurokawa D, Nakamura H, Yokota T. et al. Screening for hyperbilirubinemia in japanese very low birthweight infants using transcutaneous bilirubinometry. J Pediatr 2016; 168: 77-81.e1
• 12 Yaser A, Tooke L, Rhoda N. Interscapular site for transcutaneous bilirubin measurement in preterm infants: a better and safer screening site. J Perinatol 2014; 34 (03) 209-212
• 13 Schmidt ET, Wheeler CA, Jackson GL, Engle WD. Evaluation of transcutaneous bilirubinometry in preterm neonates. J Perinatol 2009; 29 (08) 564-569
• 14 Nagar G, Vandermeer B, Campbell S, Kumar M. Reliability of transcutaneous bilirubin devices in preterm infants: a systematic review. Pediatrics 2013; 132 (05) 871-881
• 15 De Luca D, Zecca E, de Turris P, Barbato G, Marras M, Romagnoli C. Using BiliCheck for preterm neonates in a sub-intensive unit: diagnostic usefulness and suitability. Early Hum Dev 2007; 83 (05) 313-317
• 16 Agrawal G, Garg K, Sitaraman S, Sarna A. Comparison of diagnostic accuracy of different sites for transcutaneous bilirubin measurement in early preterm infants. Indian J Pediatr 2019; 86 (01) 32-37
• 17 Maisels MJ, Coffey MP, Kring E. Transcutaneous bilirubin levels in newborns <35 weeks' gestation. [published correction appears in J Perinatol. 2015 Sep;35(9):776] J Perinatol 2015; 35 (09) 739-744
• 18 Zecca E, Barone G, De Luca D, Marra R, Tiberi E, Romagnoli C. Skin bilirubin measurement during phototherapy in preterm and term newborn infants. Early Hum Dev 2009; 85 (08) 537-540