Evaluation of the Effectiveness of Transcutaneous Bilirubinometry in Reducing the Number of Serum Bilirubin Tests in Neonatal Jaundice

Background The gold standard for diagnosis of neonatal jaundice is total serum bilirubin (TSB) measurement. This method, however, is invasive, painful, and costly in terms of workload, time, and money. Moreover, repeated blood sampling may lead to significant blood loss, which is of particular concern in preterm infants. To overcome these drawbacks, non-invasive methods of bilirubin measurement have been proposed. Transcutaneous bilirubinometry (TcB) determines the yellowness of the subcutaneous tissue of a newborn infant by measuring the difference between optical densities for light in the blue and green wavelength regions.Objective To evaluate the accuracy of transcutaneous bilirubinometry for estimating TSB levels in neonatal jaundice.Methods Subjects were infants aged < 28 days with jaundice who had never been treated with phototherapy or exchange transfusion. The study was done from February to July 2016 in Mohammad Hoesin Hospital. Subjects underwent transcutaneous bilirubin (TcB) and TSB assays, with a maximum interval of 15 minutes between tests.Results One hundred fifty patients were included in this study. The TcB values > 5 mg/dL were correlated to TSB > 5 mg/dL, with 100% sensitivity and 83.3% specificity. This cut-off point was obtained from a receiver-operator characteristic (ROC) curve with AUC 99.3% (95%CI 97.9 to 100%; P< 0.001).The correlation coefficients (r) for TSB and TcB measurements on the forehead were 0.897 (P<0.001).Conclusion Transcutaneous bilirubinometry can be used to accurately estimate TSB levels in neonatal jaundice, and may be useful in clinical practice as a non-invasive method to reduce blood sampling.

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Transcutaneous Bilirubinometry: A New Light on an Old Subject

PEDIATRICS ◽

10.1542/peds.69.1.124 ◽

1982 ◽

Vol 69 (1) ◽

pp. 124-125 ◽

Cited By ~ 2

Author(s):

Thomas Hegyi

Keyword(s):

Central Nervous System ◽

Skin Color ◽

Serum Bilirubin ◽

Cellular Injury ◽

Bilirubin Concentration ◽

Specific Serum ◽

Relationship Of ◽

The Relationship ◽

Transcutaneous Bilirubinometry

The role of bilirubin as a cause of central nervous system morbidity in the newborn infant has been well recognized for several decades. The specific serum concentration that leads to cellular injury, as well as the precise mechanism of damage, are as yet unclear but general principles of therapy have been established. Early detection of hyperbilirubinemia is based on the clinical assessment of dermal icterus followed by appropriate serum tests to determine the degree of serum bilirubin elevation. The relationship of dermal icterus and serum bilirubin concentration has intrigued clinicians for more than a century.1 In an attempt to utilize skin color as an index of hyperbilirubinemia many techniques have been investigated.

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Smartphones’ Skin Colour Reproduction Analysis for Neonatal Jaundice Detection

Journal of Imaging Science and Technology ◽

10.2352/j.imagingsci.technol.2021.65.6.060407 ◽

2021 ◽

Author(s):

Mekides Assefa Abebe ◽

Jon Yngve Hardeberg ◽

Gunnar Vartdal

Keyword(s):

Neonatal Jaundice ◽

Reference Conditions ◽

Skin Colour ◽

Estimation Methods ◽

Total Serum ◽

Light Sources ◽

Data Set ◽

Reference Space ◽

Reduced Data ◽

Transcutaneous Bilirubinometry

In recent years, smartphone-based colour imaging systems are being increasingly used for Neonatal jaundice detection applications. These systems are based on the estimation of bilirubin concentration levels that correlates with newborns’ skin colour images corresponding to total serum bilirubin (TSB) and transcutaneous bilirubinometry (TcB) measurements. However, the colour reproduction capacity of smartphone cameras are known to be influenced by various factors including the technological and acquisition process variabilities. To make an accurate bilirubin estimation, irrespective of the type of smartphone and illumination conditions used to capture the newborns’ skin images, an inclusive and complete model, or data set, which can represent all the possible real world acquisitions scenarios needs to be utilized. Due to various challenges in generating such a model or a data set, some solutions tend towards the application of reduced data set (designed for reference conditions and devices only) and colour correction systems (for the transformation of other smartphone skin images to the reference space). Such approaches will make the bilirubin estimation methods highly dependent on the accuracy of their employed colour correction systems, and the capability of reducing device-to-device colour reproduction variability. However, the state-of-the-art methods with similar methodologies were only evaluated and validated on a single smartphone camera. The vulnerability of the systems in making an incorrect jaundice diagnosis can only be shown with a thorough investigation of the colour reproduction variability for extended number of smartphones and illumination conditions. Accordingly, this work presents and discuss the results of such broad investigation, including the evaluation of seven smartphone cameras, ten light sources, and three different colour correction approaches. The overall results show statistically significant colour differences among devices, even after colour correction applications, and that further analysis on clinically significance of such differences is required for skin colour based jaundice diagnosis.

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EFFECT OF PHOTOTHERAPY ON SERUM CALCIUM LEVELS IN NEONATAL JAUNDICE

10.36106/5118478 ◽

2021 ◽

pp. 17-19

Author(s):

Aradhana Gupta ◽

Anand Kumar Bhardwaj ◽

Anisha Aggarwal ◽

Gauri Chauhan

Keyword(s):

Serum Calcium ◽

Neonatal Intensive Care ◽

Neonatal Jaundice ◽

Serum Bilirubin ◽

Calcium Supplementation ◽

Clinical Signs ◽

Total Serum ◽

Medical Sciences ◽

Term Neonates ◽

Unconjugated Hyperbilirubinemia

Background :To study the effect of phototherapy on serum calcium levels in neonates with unconjugated hyperbilirubinemia. Methods : This hospital based longitudinal interventional study was conducted on 100 neonates with neonatal hyperbilirubinemia admitted to Neonatal Intensive Care Unit at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala. Total serum bilirubin and serum calcium levels of each participants were checked before and at the end of phototherapy. Neonates were also checked for the clinical signs of hypocalcemia i.e. jitteriness, irritability, lethargy, and convulsions. Results : Atotal of 100 neonates with neonatal jaundice were included with 55% boys and 45 % girls whose mean age was 3.0 ± 0.95 days. Mean S.Bilirubin level before phototherapy was 13.92 ± 2.32 mg/dl which was reduced to 8.87 ± 2.18 mg/dl. S.Calcium levels pre-phototherapy were 8.66 ± 0.65 mg/dl which were reduced to 7.94 ± 1.05 mg/dl. It was found that 32% of the participants in total exhibited symptoms related to hypocalcemia. More term neonates (56.3%) experienced symptoms related to hypocalcemia compared to pre-terms (43.8%). Conclusion : It can be deduced that phototherapy induced hypocalcemia is a signicant concern and hence, neonates requiring phototherapy may be considered for calcium supplementation.

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Effect of Addition of Probiotics to Standard Treatment on Neonatal Jaundice

Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University ◽

10.48036/apims.v17i2.494 ◽

2021 ◽

Vol 17 (2) ◽

pp. 199-203

Author(s):

Tehreem Afzal ◽

Naveed Butt ◽

Shahzad Munir ◽

Nazish Zia

Keyword(s):

Bilirubin Level ◽

Neonatal Jaundice ◽

Standard Treatment ◽

Serum Bilirubin ◽

Serum Bilirubin Level ◽

Combination Group ◽

Medical Institute ◽

Significant Difference ◽

The Mean ◽

Time Required

Objective: To compare the mean change in the bilirubin levels with addition of probiotics to standard treatment for the management of neonatal jaundice. Methodology: The randomized controlled trial was undertaken at the Neonatal Intensive Care Unit of the Paediatrics Department, Federal Government Polyclinic (Post Graduate Medical Institute), Islamabad from 1st April to 30th September 2019. Neonates with hyperbilirubinemia requiring phototherapy were randomly divided into two groups, each having 30 patients. Group A received probiotics along with phototherapy while group B received phototherapy alone. Primary outcome was serum total bilirubin, which was calculated on 0, 1 and 3 days of treatment. Duration of phototherapy and patient's outcome was also recorded. Data was analyzed statistically using SPSS v. 23. Results: The mean serum bilirubin level after 24 hours was 14.27 ± 4.35 mg/dl in combination group while 16.43 ± 4.36 mg/dl in phototherapy group (p > 0.05). After 48 hours, the mean serum bilirubin level was 12.37 ± 3.33 mg/dl in combination group while 14.09 ± 3.60 mg/dl in phototherapy group (p > 0.05). After 72 hours, the mean serum bilirubin level was 11.09 ± 2.87 mg/dl in combination group while 11.72 ± 2.96 mg/dl in phototherapy group (p > 0.05). The mean time required of blue light phototherapy was 43.47 ± 20.71 hours in combination group while 61.53 ±28.27 hours in phototherapy group (p < 0.05). All neonates were discharged. Conclusion: Addition of probiotics to standard treatment decreased the time required for the phototherapy in neonatal jaundice. However no statistically significant difference was seen in the bilirubin levels between the two groups.

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Transcutaneous Bilirubin Measurements: Variation in Meter Response

PEDIATRICS ◽

10.1542/peds.71.3.457 ◽

1983 ◽

Vol 71 (3) ◽

pp. 457-459

Author(s):

M. JEFFREY MAISELS ◽

CHERYL LEE

Keyword(s):

Neonatal Jaundice ◽

Serum Bilirubin ◽

Full Term ◽

Term Infants ◽

Transcutaneous Bilirubin ◽

Potential Variation ◽

Screening Device ◽

The Relationship

The transcutaneous bilirubin meter has been shown to be a useful screening device for the identification of significant neonatal jaundice in full-term infants.1-3 Investigators have, nevertheless, emphasized the necessity for each institution to establish the relationship between the transcutaneous bilirubin index, as measured with a particular instrument, and the serum bilirubin determination obtained from the institution's laboratory. 3 This is important, because of the known variation between laboratories in the measurement of serum bilirubin concentration4 and because no information has been published regarding the potential variation in the response of different transcutaneous bilirubin meters.

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Transcutaneous Bilirubin Measurements in Full-Term Infants

PEDIATRICS ◽

10.1542/peds.70.3.464 ◽

1982 ◽

Vol 70 (3) ◽

pp. 464-467 ◽

Cited By ~ 6

Author(s):

M. Jeffrey Maisels ◽

Sarah Conrad

Keyword(s):

Positive Predictive Value ◽

Predictive Value ◽

False Positive ◽

Neonatal Jaundice ◽

Serum Bilirubin ◽

False Negative ◽

Full Term ◽

Bilirubin Concentration ◽

Term Infants ◽

Transcutaneous Bilirubin

A total of 292 transcutaneous bilirubin (TcB) measurements were performed in 157 white full-term infants: 157 were obtained from the forehead and 135 from the midsternum. TcB measurements correlated well with serum bilirubin determinations (r = .93, P < .0001). The sensitivity of the test was 100% and the specificity 97%. It was possible to establish guidelines for the TcB measurement which identified all infants whose serum bilirubin concentrations exceeded 12.9 mg/100 ml (221 µmoles/liter) with no false-negative and only five false-positive determinations (3%). The positive predictive value for the TcB measurements was 58%. This implies that, in our population, an infant with a TcB index ≥24 has a 58% chance of having a serum bilirubin concentration >12.9 mg/100 ml. The negative predictive value was 100%. Thus, a negative test will correctly predict the absence of hyperbilirubinemia in all cases. As these measurements were obtained prospectively in a well-baby population with a prevalence of hyperbilirubinemia (>12.9 mg/100 ml) of 4.5%, the positive predictive value should be applicable to other similar populations and will, in fact, increase in populations with a higher prevalence of hyperbilirubinemia. TcB measurements can be recommended for the identification of significant neonatal jaundice in full-term infants. It is important to recognize, however, that because of potential variations in TcB meters as well as serum bilirubin measurements in different laboratories, each institution should establish its own criteria for the use of this instrument.

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Effectiveness of phototherapy with reflecting curtains on neonatal jaundice

Paediatrica Indonesiana ◽

10.14238/pi51.5.2011.256-61 ◽

2011 ◽

Vol 51 (5) ◽

pp. 256 ◽

Cited By ~ 2

Author(s):

Ari Kurniasih ◽

Guslihan Dasa Tjipta ◽

Muhammad Ali ◽

Emil Azlin ◽

Pertin Sianturi

Keyword(s):

Neonatal Jaundice ◽

Serum Bilirubin ◽

Low Cost ◽

Total Serum Bilirubin ◽

Spectral Irradiance ◽

Total Serum ◽

Control Group ◽

Study Group ◽

Term Newborns ◽

The Mean

Background Although phototherapy has been used in clinical practice for 40 years, there is still much debate on how to provide the most efficacious phototherapy. Phototherapy with white reflecting curtains may increase the average spectral irradiance provided, as well as decrease serum bilirubin concentrations at a faster rate in neonates with jaundice.Objective To determine if adding low cost, white, reflecting curtains to a standard phototherapy unit can increase the effectiveness of phototherapy for neonatal jaundice.Methods A randomized, controlled, open trial was conducted at H. Adam Malik and Pirngadi Hospitals, Medan, from May to December 2009. The criteria for inclusion in the study were full term newborns with neonatal jaundice presenting in their first week of life. Single phototherapy with white curtains hanging from the sides of the phototherapy unit (study group, n=30) was compared to single phototherapy without curtains (control group, n=30). The primary outcomes measured were the mean difference in total serum bilirubin levels and average spectral irradiation levels measured at baseline, and after 12 hours and 24 hours of phototherapy.Results The sum of average spectral irradiance in the curtained phototherapy unit was significantly higher than that of the standard phototherapy unit without curtains (P < 0.05). The decrease of total serum bilirubin levels after 12 and 24 hours of phototherapy was significantly greater in the study group (3.71 and 9.7 mg/dl, respectively) than in the control group (0.1 and 3.8 mg/dl, respectively), both P <0.05.Conclusion White, reflecting curtains in phototherapy units was significantly more effective than phototherapy without curtains for treatment of neonatal jaundice. [Paediatr Indones. 2011;51:256-61].

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Diurnal variation in serum bilirubin concentrations in infants with neonatal jaundice

The Journal of Pediatrics ◽

10.1016/s0022-3476(95)70176-1 ◽

1995 ◽

Vol 127 (5) ◽

pp. 801-803 ◽

Cited By ~ 3

Author(s):

Shimon Reif ◽

Amir Belson ◽

Yael Villa ◽

Boaz Milbauer ◽

Yoram Bujanover

Keyword(s):

Diurnal Variation ◽

Neonatal Jaundice ◽

Serum Bilirubin

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The Use of Icterometer in Assessing Neonatal Jaundice

Paediatrica Indonesiana ◽

10.14238/pi18.5-6.1978.158-63 ◽

2017 ◽

Vol 18 (5-6) ◽

pp. 158

Author(s):

M. Ruskandi ◽

H. Garna ◽

A. Alisjahbana

Keyword(s):

General Hospital ◽

Neonatal Jaundice ◽

Serum Bilirubin ◽

Bilirubin Concentration ◽

Grade 3 ◽

Serum Bilirubin Concentration

A study was made to assess neonatal jaundice by icterometer compared with serum bilirubin concentration, which was determined by Mercko photometric test, on 98 newborns with jaundice born in the Dr. Hasan Sadikin General Hospital, Bandung, throughout October 1975 until March 1976. A good correlation between bilirubin concentration as determined by the icterometer and actual serum bilirubin concentration was found, so that the icterometer could be used in Indonesian newborns. None of the icterometer values grade 3 or less had actual serum bilirubin concentrations more than 15 mg.%, so that grade 3 or less did not necessarily require additional serum bilirubin determination. On the contrary 46.7% and 81.8% of newborns with icterometer values of grades 3½ and 4 respectively have bilirubin concentrations more than 15 mg.%. Therefore, grade 3½ or more required further photometric bilirubin determination with a view to possible treatment.

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