Transcutaneous Bilirubinometry in Preterm Infants Receiving Phototherapy

ABSTRACT

The accuracy of transcutaneous bilirubin (TcB) measurements obtained with a Bilicheck device in 70 preterm neonates before phototherapy and during phototherapy from the exposed and unexposed skin of the forehead (under the eye patch) was evaluated by comparing the TcB with the total serum bilirubin (TSB) that was performed within ± 30 minutes of the TcB measurements. The correlation and proportion of similar, overestimated, and underestimated paired TcB/TSB measurements was calculated. A TSB point estimate of ± 1.5 mg/dL was used for comparison of differences between the TcB and TSB. There was weaker correlation between TcB and TSB when the TcB was obtained from the exposed skin (r = 0.70; p > 0.05) as compared with an unexposed area (r = 0.77; p < 0.04) or before initiation of phototherapy (r = 0.86; p < 0.01). The TcB measurements from the area unexposed to phototherapy were predominantly (97.2%) in the similar (57%) or overestimation categories (40.2%). A significantly lower proportion of the paired TcB/TSB measurements obtained from exposed area were similar (42%) or overestimated (27%; p < 0.001). More importantly, in 31% of the measurements, the TSB levels were underestimated by the TcB. We conclude that the Bilicheck can be used for the evaluation of bilirubin levels in preterm neonates receiving phototherapy by using the unexposed skin of the forehead (under the eye patch) for TcB measurements; this may significantly reduce the number of blood draws.

KEYWORDS

Preterm infants - transcutaneous bilirubinometry - phototherapy

REFERENCES

• 1 Dai J, Krahn J, Parry D M. Clinical impact of transcutaneous bilirubinometry as an adjunctive screen for hyperbilirubinemia.  Clin Biochem. 1996;  29 581-586
• 2 Yap S H, Mohammad I, Ryan C A. Avoiding painful blood sampling in neonates by transcutaneous bilirubinometry.  Ir J Med Sci. 2002;  171 188-190
• 3 Briscoe L, Clark S, Yoxall C W. Can transcutaneous bilirubinometry reduce the need for blood tests in jaundiced full term babies?.  Arch Dis Child Fetal Neonatal Ed. 2002;  86 F190-F192
• 4 Maisels M J, Kring E. Transcutaneous bilirubinometry decreases the need for serum bilirubin measurements and saves money.  Pediatrics. 1997;  99 599-601
• 5 Hegyi T, Hiatt I M, Gertner I M, Zanni R, Tolentino T. Transcutaneous bilirubinometry II. Dermal bilirubin kinetics during phototherapy.  Pediatr Res. 1983;  17 888-891
• 6 Tan K L, Dong F. Transcutaneous bilirubinometry during and after phototherapy.  Acta Paediatr. 2003;  92 327-331
• 7 Fok T F, Lau S P, Hui C W, Fung K P, Wan C W. Transcutaneous bilirubinometer: its use in Chinese term infants and the effect of haematocrit and phototherapy on the TcB index.  Aust Paediatr J. 1986;  22 107-109
• 8 Tudehope D I, Chang A. Non-invasive method of measuring bilirubin levels in newborn infants.  Med J Aust. 1982;  1 165-168
• 9 Bertini G, Rubaltelli F F. Non-invasive bilirubinometry in neonatal jaundice.  Semin Neonatol. 2002;  7 129-133
• 10 Rubaltelli F F, Gourley G R, Loskamp N et al.. Transcutaneous bilirubin measurement: a multicenter evaluation of a new device.  Pediatrics. 2001;  107 1264-1271
• 11 Bhutani V K, Gourley G R, Adler S, Kreamer B, Dalin C, Johnson L H. Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia.  Pediatrics. 2000;  106 E17
• 12 Nanjundaswamy S, Petrova A, Mehta R, Bernstein W, Hegyi T. The accuracy of transcutaneous bilirubin measurements in neonates: A correlation study.  Biol Neonate. 2004;  85 21-25
• 13 Bilicheck: Clinical Indications for Use .User Instruction Manual. Norcross, GA; SpectRx 1997
• 14 Robertson A, Kazmierczak S, Vos P. Improved transcutaneous bilirubinometry: comparison of SpectRx BiliCheck and Minolta jaundice meter JM-102 for estimating total serum bilirubin in a normal newborn population.  J Perinatol. 2002;  22 12-14
• 15 American Academy of Pediatrics . Practice parameter. Management of hyperbilirubinemia in the healthy term newborn. Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia.  Pediatrics. 1994;  94 558-565
• 16 Ozkan H, Oren H, Duman N, Duman M. Dermal bilirubin kinetics during phototherapy in term neonates.  Acta Paediatr. 2003;  92 577-581