scholarly journals The Impact of Phototherapy on the Accuracy of Transcutaneous Bilirubin Measurements in Neonates: Optimal Measurement Site and Timing

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1729
Author(s):  
Shau-Ru Ho ◽  
Yu-Chen Lin ◽  
Chi-Nien Chen
Keyword(s):  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
Pearson Correlation ◽  
Neonatal Hyperbilirubinemia ◽  
Total Serum ◽  
Transcutaneous Bilirubin ◽  
Optimal Measurement ◽  
The Impact ◽  
Transcutaneous Bilirubinometer ◽  
Time Point

Transcutaneous bilirubinometer devices are widely applied to assess neonatal hyperbilirubinemia. However, the optimal skin site and timing of transcutaneous bilirubin (TCB) measurements for the strongest correlation with total serum bilirubin (TSB) levels after phototherapy are still unclear. We conducted a retrospective observational study evaluating the correlation of TCB and TSB levels in neonates postphototherapy. The TCB measurements on the forehead and mid-sternum at 0 and 30 min postphototherapy were assessed by using a JM-103 bilirubinometer. Paired TCB and TSB measurements were assessed by Pearson correlation and Bland–Altman plots. We analyzed 40 neonates with 96 TSB and 384 TCB measurements. The TSB level correlated moderately with the forehead TCB level at 30 min postphototherapy (r = 0.65) and less strongly with the midsternum TCB level at 0 min postphototherapy (r = 0.52). The forehead at 30 min after cessation of phototherapy was the best time point and location of TCB measurement for the assessment of neonatal jaundice status. The reliability of TCB measurements varied across skin sites and durations after phototherapy. The effectiveness of TCB measurement to assess neonatal hyperbilirubinemia is much better on covered skin areas (foreheads) 30 min postphototherapy. The appropriate application of transcutaneous bilirubinometers could aid in clinical practice and avoid unnecessary management.

scholarly journals Quality improvement initiative using transcutaneous bilirubin nomogram to decrease serum bilirubin sampling in low-risk babies

2019 ◽  
Vol 3 (1) ◽  
pp. e000403 ◽  
Author(s):  
Muhammad Hussain Shah ◽  
Shabina Ariff ◽  
Syed Rehan Ali ◽  
Rayaan Asad Chaudhry ◽  
Maryam Pyar Ali Lakhdir ◽  
...  
Keyword(s):  
Serum Bilirubin ◽  
Total Serum ◽  
Quality Improvement Initiative ◽  
Transcutaneous Bilirubin ◽  
Implementation Phase ◽  
Postnatal Ward ◽  
Before And After ◽  
The Impact ◽  
Before And After Study ◽  
Transcutaneous Bilirubinometer

BackgroundScreening for neonatal hyperbilirubinaemia in the postnatal ward has traditionally been performed using serum bilirubin sampling, but this has significant drawbacks such as risk of infection and slower reporting time.ObjectiveWe aimed to assess the impact of introducing transcutaneous bilirubin (TcBR) testing using TcBR nomogram on the number of serum bilirubin samples sent.MethodsA before-and-after study was performed following the introduction of a protocol integrating the use of the Dragger JM-105 transcutaneous bilirubinometer in the postnatal ward. Only babies born at ≥37 weeks of gestation, weighing ≥2500 g who presented with jaundice after the first 24 hours and within the first 7 days of life were included in the study. The number of total serum bilirubin samples (TSBRs) sent were compared for the 6-month periods before and after (a total of 12 months) implementation of the new protocol.ResultsIn the pre-implementation phase, a total of 882 (49%) out of 1815 babies had at least one serum bilirubin sample taken as opposed to a total of 236 (17%) out of 1394 babies in the post-implementation phase. The odds of performing TSBRs at least one time among babies in post-implementation phase were 79% lower than in pre-implementation phase (OR 0.21, 95% CI 0.18 to 0.25). We also estimated a significant cost saving of approximately US$1800 over a period of 6 monthsConclusionTcBR testing used in conjunction with our proposed nomogram significantly reduces the need for serum bilirubin sampling.

scholarly journals Transcutaneous billirubinometry to estimate total serum bilirubin in neonatal jaundice

2017 ◽  
Vol 57 (1) ◽  
pp. 8 ◽  
Author(s):  
Andra Kurnianto ◽  
Herman Bermawi ◽  
Afifa Darmawanti ◽  
Erial Bahar
Keyword(s):  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
Subcutaneous Tissue ◽  
Correlation Coefficients ◽  
Total Serum Bilirubin ◽  
Blood Sampling ◽  
Total Serum ◽  
Transcutaneous Bilirubin ◽  
Non Invasive ◽  
Transcutaneous Bilirubinometry

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.

scholarly journals Transcutaneous bilirubin level to predict hyperbilirubinemia in preterm neonates

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 300
Author(s):  
Dewi Rahmawati ◽  
Mahendra Tri Arif Sampurna ◽  
Risa Etika ◽  
Martono Tri Utomo ◽  
Arend F. Bos
Keyword(s):  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Preterm Neonates ◽  
Total Serum ◽  
Close Monitoring ◽  
Transcutaneous Bilirubin ◽  
Group I ◽  
Group Ii ◽  
Severe Hyperbilirubinemia ◽  
Transcutaneous Bilirubinometer

Background: Hyperbilirubinemia is common in neonates, with higher prevalence among preterm neonates, which can lead to severe hyperbilirubinemia. Assessment of total serum bilirubin (TSB) and use of a transcutaneous bilirubinometer (TcB) are existing methods to identify and predict hyperbilirubinemia. This study aimed to determine TcB cut-off values during the first day for preterm neonates to predict hyperbilirubinemia at 48 and 72 hours. Methods: A total of 90 neonates born ≤35 weeks were included in the study. They were divided into two groups (Group I: 1000-1500 grams; Group II: 1501-2000 grams). The bilirubin level was measured on the sternum using TcB at the ages of 12, 24, and 72 h. TSB measurements were taken on the third day or if TcB level reached ± 1.24 mg/dL phototherapy threshold and if TcB showed abnormal results (Group I: 5.76-8.24 mg/dL; Group II: 8.76-11.24 mg/dL). Hyperbilirubinemia was defined as TSB ≥7 mg/dL for group I and >10 mg/dL for group II. Results: In total, 38 group I neonates and 48 group II neonates were observed. Almost half of neonates in group I (44.7%) were suffering from hyperbilirubinemia at the age of 48 hours, with 45.8% of group II at the age of 72 hours. To predict hyperbilirubinemia at the age of 48 hours, the best 24-hour-age TcB cut-off values were calculated to be 4.5 mg/dL for group I and 5.8 mg/dL for group II. To predict hyperbilirubinemia at the age of 72 hours, we determined 24-hour-age TcB value of 5.15 mg/dL for group II. Conclusion: TcB values in the early days of life can be used as hyperbilirubinemia predictors on the following days for preterm neonates. Close monitoring should be managed for those with TcB values higher than the calculated cut-off values.

scholarly journals A Study of Neonatal Hyperbilirubinemia in Mid-Western Part of Nepal

2017 ◽  
Vol 15 (2) ◽  
pp. 41-43 ◽  
Author(s):  
K.M. Roma ◽  
Piush Kanodia ◽  
Manita Pyakurel ◽  
Veena Gupta
Keyword(s):  
Neonatal Jaundice ◽  
Hospital Admissions ◽  
Serum Bilirubin ◽  
Study Data ◽  
Neonatal Hyperbilirubinemia ◽  
Treatment Modalities ◽  
Total Serum ◽  
Common Cause ◽  
Abo Incompatibility ◽  
Satisfactory Outcome

Introduction: Neonatal hyperbilirubinemia is a common cause of hospital admissions. Serum Bilirubin depends on birth weight and gestational age. Common causes of neonatal jaundice are physiological jaundice, breast feeding/milk jaundice, prematurity and pathological causes. Surmount total serum bilirubin over critical level, crosses the blood brain barrier leading to kernicterus. Prompt identification and proper management is of great importance otherwise there is a risk of bilirubin encephalopathy. Objectives: To find out the prevalence and causes of neonatal jaundice in our setting and treatment modalities undertaken. Materials and methods: A hospital based descriptive study was done among total newborns including both inborn and out born admitted in NICU, NGMC over the period of one year. A total 288 newborns with jaundice were enrolled in the study .Data were entered in excel and th analyzed in SPSS 18 version. Descriptive data were presented through pie, bar graph, and table with frequency and percentage. Results: Prevalence of neonatal jaundice was 31%. Causes of neonatal jaundice were physiological and pathological in 56% and 44% cases respectively. Among the pathological causes ABO incompatibility was the most common cause seen in 11.4% cases followed by sepsis seen in 8.7% cases. Conclusions: Phototherapy is very effective treatment modality to reduce the serum bilirubin in most of the cases neonatal hyperbilirubinemia and if the bilirubin crosses the cut off limit according to Bhutani's chart then we have to consider exchange transfusion. Appropriate management in time leads to satisfactory outcome.

scholarly journals Clinical utility of hand held, non invasive transcutaneous bilirubinometer in neonatal jaundice: a prospective observational study

2021 ◽  
Author(s):  
Bibhudatta Mishra ◽  
Bishwajit Mishra ◽  
Guruveera Jeyasingh Malini ◽  
Arjit Mohapatra ◽  
Prafulla Kumar Biswal ◽  
...  
Keyword(s):  
Clinical Utility ◽  
Neonatal Jaundice ◽  
Prospective Observational Study ◽  
Screening Tool ◽  
Serum Bilirubin ◽  
Blood Sampling ◽  
Viable Option ◽  
Transcutaneous Bilirubin ◽  
Non Invasive ◽  
Transcutaneous Bilirubinometer

Background: Neonatal Jaundice is the most common morbidity in the first week of life, occurring in 60% of term and 80% of preterm newborn. However, visual inspection, being subjective, usually inaccurate and unreliable and will result in a number of unnecessary blood sampling. Taking all these in to considerations, transcutaneous bilirubinometer (TCB) may provide a solution which is an objective, noninvasive, fast and painless method of bilirubin estimation.Methods: Transcutaneous bilirubinometer levels were measured at forehead and sternum and blood samples for TSB were collected by venepuncture within 30 minutes and sent to biochemistry lab. After getting serum bilirubin reports, TCB and TSB values were compared by using Bhutani’s hour specific nomogram. Results: The correlation between serum bilirubin and transcutaneous bilirubin measured at forehead and sternum is very good at serum bilirubin <15 mg/dl, r value (Karl Pearson’s Correlation co-efficient) is 0.93 and 0.94 respectively.Conclusions: The findings of the present study indicate that the TCB is a reliable screening tool for hyperbilirubinemia in newborns >35 weeks of gestation, especially with bilirubin levels ≤15 mg/dl in 2-7 days of life. TCB can be a viable option for universal screening. Incorporating the use of TCB devices in clinical practice, can reduce the need for blood sampling for the management of neonatal jaundice.

scholarly journals Kramer’s scale or transcutaneous bilirubinometry: the ideal choice of a pediatrician? can we trust our eyes?

2019 ◽  
Vol 6 (5) ◽  
pp. 1794 ◽  
Author(s):  
Pearl Mary Varughese
Keyword(s):  
Bilirubin Level ◽  
Serum Bilirubin ◽  
Roc Curves ◽  
Serum Bilirubin Level ◽  
Total Serum ◽  
Neonatal Septicemia ◽  
Transcutaneous Bilirubin ◽  
Non Invasive ◽  
Transcutaneous Bilirubinometer ◽  
Transcutaneous Bilirubinometry

Background: Neonatal hyperbilirubinemia, though benign in 80% cases, can lead to kernicterus if not diagnosed and treated early. The golden method of estimation is measuring serum bilirubin levels. Both Kramer’s scale and Transcutaneous bilirubinometer are non -invasive methods. Its high time the pediatricians choose an ideal non-invasive and reliable method to detect hyperbilirubinemia. Objective of this study is to find out which has a better correlation with serum bilirubin - transcutaneous bilirubinometer reading (TcB) or Kramer's scale.Methods: The study was conducted in a tertiary newborn center from November 2014 to June 2016. The inclusion criteria included all babies above 34 weeks gestation and exclusion criteria included babies with established direct hyperbilirubinemia, neonatal septicemia, major congenital/ gastrointestinal malformations and those on phototherapy. The sample size was 450 and the correlation was analyzed using ROC curves and plots of agreement was done using Bland Altman charts.Results: The incidence of significant Hyperbilirubinemia is 12%. Transcutaneous bilirubin level had a better correlation and prediction level compared to Kramer at both 24 hours and 48 hours. Bland Altman analysis showed that transcutaneous values were closer to the total serum bilirubin level compared to Kramer values.Conclusion: Transcutaneous bilirubinometry is a better and more ideal choice to replace serum bilirubin levels. In settings where TcB is not feasible, it’s always best to screen for jaundice using Kramer’s scale rather than estimating serum bilirubin values in all babies. In babies where TcB levels are above the cut off range, it’s better to do serum bilirubin levels.

scholarly journals Correlation of serum bilirubin and transcutaneous bilirubin in newborns

2021 ◽  
Vol 8 (9) ◽  
pp. 1547
Author(s):  
Pavitra V. Arunachalmath
Keyword(s):  
Serum Bilirubin ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Total Serum ◽  
Care Hospital ◽  
Time Data ◽  
Cross Sectional ◽  
Transcutaneous Bilirubin ◽  
Transcutaneous Bilirubinometer ◽  
Transcutaneous Bilirubinometry

Background: Hyperbilirubinemia is a very common entity in newborns. Screening all the babies for hyperbilirubinemia is must. Serum bilirubin is the standard method of checking the bilirubin in newborns. This is very cumbersome, invasive and time consuming method. Hence many newborns will be discharged without screening. Transcutaneous bilirubinometry would help us in making this task easy and safe. Hence the present study was planned.Methods: This is an institutional cross sectional study conducted in a tertiary care hospital for a period of 6 months. After a written informed consent from parents/ guardians and considering selection criteria, 500 newborns with clinical jaundice were included in study. Each newborn was examined, transcutaneous bilirubin checked at forehead and sternum and serum bilirubin was done at the same time. Data was statistically analyzed to see the correlation between TcB and TSB.Results: Out of 500 newborns, 316 were males, 184 were females and 475 were term gestation and 25 were preterm. Coefficient of correlation was 0.73 and 0.72 for total serum bilirubin versus forehead and sternum respectively which were statistically significant.Conclusions: Transcutaneous bilirubinometer readings closely correlate with that of serum bilirubin. Hence TcB can be used as a safer, economical and effective tool in screening newborns for hyperbilirubinemia. 

scholarly journals EFFECTIVENESS OF TRANSCUTANEOUS BILIRUBIN (TCBR) MEASUREMENT IN HIGH RISK NEONATES AND TO EVALUATE THE VALIDITY OF TRANSCUTANEOUS BILIRUBIN (TCBR) WITH TOTAL SERUM BILIRUBIN (TSBR) LEVELS IN BOTH LOW AND HIGH RISK NEONATES AT A TERTIARY CARE CENTER OF....

2021 ◽  
Vol 71 (1) ◽  
pp. 357-63
Author(s):  
Durre Shahwar ◽  
Sabina Ariff ◽  
Batha Tariq ◽  
Arjumand Rizvi ◽  
Syed Rehan ◽  
...  
Keyword(s):  
High Risk ◽  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
Risk Group ◽  
Tertiary Care ◽  
Low Risk ◽  
Total Serum Bilirubin ◽  
University Hospital ◽  
Total Serum ◽  
Transcutaneous Bilirubin

Objective: To evaluate the utility of a Transcutaneous Bilirubin nomogram in high risk neonates and to evaluate the validity of Transcutaneous Bilirubin and Total serum bilirubin in both low and high-risk neonates. Study Design: Cross-sectional study. Place and Duration of Study: Postnatal Ward, Aga Khan University Hospital, Karachi, from May to Oct 2019. Methodology: The participants will include all neonates born and admitted in the well baby nursery withjaundice. All neonates with gestational age of <35 weeks, requiring admission in Neonatal intensive care unit, and neonates with conjugated hyperbilirubinemia will be excluded. We will stratify our neonates into high and low risk population based on predefined criteria. Eighty five neonates in low risk group and 122 neonates in high risk group will be included. Results: We aim to assess the effectiveness of Transcutaneous Bilirubin nomogram in high risk neonates asan effective and non-invasive tool in the management of neonatal jaundice in high risk neonates. We will alsoassess the sensitivity and specificity of Transcutaneous Bilirubin and Total serum bilirubin measurementsand the analysis would be performed separately for high risk and low risk neonates to evaluate the validity ofTranscutaneous Bilirubin independently in both groups. Conclusion: We hope to establish a validated phototherapy guideline based on the Transcutaneous Bilirubinnomogram, as a cost effective and noninvasive tool in the management of neonatal jaundice in both high and low risk groups in Pakistan.

Sign in / Sign up

Export Citation Format

Share Document