ACCURACY OF TRANSCUTANEOUS BILIRUBIN MEASUREMENTS DURING PHOTOTHERAPY IN JAUNDICED PRETERM NEONATES

2021 ◽  
pp. 7-9
Author(s):  
Rajveer Singh Yadav ◽  
Nikita Singh ◽  
Gaurav Agrawal ◽  
Madhu Mathur ◽  
Munish Kumar Kakkar
Keyword(s):  
Risk Factors ◽  
Preterm Infants ◽  
Gestational Age ◽  
Serum Bilirubin ◽  
Preterm Neonates ◽  
Total Serum ◽  
Preterm Baby ◽  
Transcutaneous Bilirubin ◽  
Non Invasive ◽  
Invasive Method

Aim: It is very difcult to nd veins and also seems unethical to withdraw blood daily in a preterm baby for the monitoring of jaundice during the course of phototherapy. So it becomes essential that we nd out a method which is non-invasive and at the same time accurate to assess jaundice. Jaundice is the most common morbidity in the rst week of life, reported in 60% of term, 80% of preterm (1, 2) & also being the commonest cause of readmission. Materials and Method: Study was planned to assess the accuracy of transcutaneous bilirubin in comparison to total serum bilirubin in premature jaundiced neonates of gestational age (28-32 weeks v/s 32-37 weeks) during phototherapy. Result: Study has demonstrated reliability of TCB measurements in preterm infants during phototherapy. Gestational age, comorbidities and risk factors for jaundice did not inuence the correlation. Summary: This study reveals that Transcutaneous Bilirubin Estimation by bilirubin meter can be used as a non-invasive method for monitoring of jaundice treatment during phototherapy in preterm neonates.

scholarly journals Evaluation of Jaundice meter in the assessment of jaundice among Nigerian preterm neonates

1970 ◽  
Vol 42 (3) ◽  
pp. 194-198
Author(s):  
BO Kayode-Adedeji ◽  
JA Owa ◽  
GO Akpede ◽  
SO Alikah
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Serum Bilirubin ◽  
Objective Assessment ◽  
Total Serum Bilirubin ◽  
Preterm Neonates ◽  
Total Serum ◽  
Transcutaneous Bilirubin ◽  
The Mean ◽  
Transcutaneous Bilirubinometry

Background: The objective assessment of the severity of neonatal jaundice is Total Serum Bilirubin (TSB) determination, which requires multiple blood sampling. This has inherent problems, including risks of anaemia and infection. Transcutaneous Bilirubinometry (TcB) is a reliable, non-invasive alternative, however there is paucity of data on its performance in black preterm neonates.Objectives: To evaluate the correlation between transcutaneous bilirubin (TcB) and total serum bilirubin (TSB) among Nigerian preterm neonates, and to determine the parameters affecting the relationship.Method: Jaundiced preterm neonates delivered between 28 and 36 weeks of gestation admitted at the Irrua Specialist Teaching Hospital (ISTH), Nigeria were recruited . The TSB levels were determined by spectrophotometry while the corresponding TcB levels were obtained using Jaundice Meter (JM-103). The neonates were stratified into gestational age and birth weight groups.Results: A total of 189 paired TcB and TSB levels were obtained from 60 neonates. The Mean (sd) TcB level of 11.4 (3.1) mg/dl was significantly higher than the mean TSB level of 10.2 (2.8)mg/dl (p= 0.028). The overall correlation coefficient between TcB and TSB was 0.98 and it was not significantly affected by the gestational age, birth weight and bilirubin levels.Conc lusion: Transcutneous bilirubin strongly correlates with total serum bilirubin levels among Nigerian preterm neonates, irrespective of gestational age, birth weight and the degree of jaundice.Keywords: hyperbiliruinaemia, jaundice meter, Nigerian, preterm, neonates, transcutaneous bilirubinometry

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.

Usefulness of transcutaneous bilirubin assessment measured in non-photo-exposed skin to guide the length of phototherapy: an observational study

2019 ◽  
Vol 47 (5) ◽  
pp. 568-573 ◽  
Author(s):  
Abdón Castro ◽  
Carlos Zozaya ◽  
Mª Teresa Cuesta ◽  
Marina González ◽  
Gema Villar ◽  
...  
Keyword(s):  
Serum Bilirubin ◽  
Total Serum ◽  
Skin Area ◽  
Correct Treatment ◽  
Transcutaneous Bilirubin ◽  
Non Invasive ◽  
Exposed Skin ◽  
Wide Range ◽  
The Difference ◽  
Mean Differences

Abstract Background Transcutaneous bilirubinometers are a non-invasive tool to estimate serum bilirubin. However, once on phototherapy (PHT) and after PHT, its usefulness is precluded. The objective of this study was to prove the hypothesis that transcutaneous bilirubin (TcB) assessment in a covered skin area during PHT could be used to guide the duration of PHT in term and moderate-late preterm infants with non-isoimmune hyperbilirubinemia. Methods A small area of parasternal skin was covered before starting on PHT. Total serum and TcB (both in exposed and non-exposed areas) were determined before starting treatment, every 12 h once on PHT and 12 h after its discontinuation. Pearson’s correlation coefficient and paired mean differences between TcB and total serum bilirubin (TSB) were calculated. Bland-Altman plots were obtained. The percentage of correct treatment decisions made based on non-exposed TcB values was calculated. Results During PHT, there was a relatively good correlation between TSB and non-exposed TcB (0.74) estimates, in contrast to exposed TcB estimates (0.52). However, even when comparing non-exposed TcB with TSB, there was a wide range of agreement limits (−3.8 to 4.6 mg/dL). Decisions based on non-exposed TcB values would have been incorrect in 26.6% of the cases. Conclusion Although there is a relatively strong correlation between total serum and TcB in non-PHT-exposed regions, the difference is not narrow enough to be utilized in guiding clinical decisions on the duration of PHT.

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 Transcutaneous versus Total Serum Bilirubin Measurements in Preterm Infants

Neonatology ◽  
2021 ◽  
pp. 1-11
Author(s):  
Thivia Jegathesan ◽  
Douglas M. Campbell ◽  
Joel G. Ray ◽  
Vibhuti Shah ◽  
Howard Berger ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Clinical Decision Making ◽  
Serum Bilirubin ◽  
Clinical Decision ◽  
Total Serum Bilirubin ◽  
Total Serum ◽  
Transcutaneous Bilirubin ◽  
Treatment Thresholds ◽  
Before And After ◽  
The Mean

<b><i>Introduction:</i></b> Transcutaneous bilirubin (TcB) measurement offers a noninvasive approach for bilirubin screening; however, its accuracy in preterm infants is unclear. This study determined the agreement between TcB and total serum bilirubin (TSB) among preterm infants. <b><i>Methods:</i></b> A multisite prospective cohort study was conducted at 3 NICUs in Ontario, Canada, September 2016 to June 2018. Among 296 preterm infants born at 24<sup>0/7</sup> to 35<sup>6/7</sup> weeks, 856 TcB levels were taken at the forehead, sternum, and before and after the initiation of phototherapy with TSB measurements. Bland-Altman plots and 95% limits of agreement (LOA) expressed agreement between TcB and TSB. <b><i>Results:</i></b> The overall mean TcB-TSB difference was −24.5 μmol/L (95% LOA −103.3 to 54.3), 1.6 μmol/L (95% LOA −73.4 to 76.5) before phototherapy, and −31.1 μmol/L (95% LOA −105.5 to 43.4) after the initiation of phototherapy. The overall mean TcB-TSB difference was −15.2 μmol/L (95% LOA −86.8 to 56.3) at the forehead and −24.4 μmol/L (95% LOA −112.9 to 64.0) at the sternum. The mean TcB-TSB difference was −31.4 μmol/L (95% LOA −95.3 to 32.4) among infants born 24–28 weeks, −25.5 μmol/L (95% LOA −102.7 to 51.8) at 29–32 weeks, and −15.9 μmol/L (95% LOA −107.4 to 75.6) at 33–35 weeks. Measures did not differ by maternal ethnicity. <b><i>Conclusion:</i></b> Among preterm infants, TcB may offer a noninvasive, immediate approach to screening for hyperbilirubinemia with more careful use in preterm infants born at &#x3c;33 weeks’ gestation, as TcB approaches treatment thresholds. Its underestimation of TSB after the initiation of phototherapy warrants the use of TSB for clinical decision-making after the initiation of phototherapy.

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):  
Serum Bilirubin ◽  
Preterm Neonates ◽  
Total Serum ◽  
Close Monitoring ◽  
Transcutaneous Bilirubin ◽  
The Third ◽  
Group I ◽  
Group Ii ◽  
Severe Hyperbilirubinemia ◽  
Transcutaneous Bilirubinometry

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 the use of a transcutaneous bilirubinometry (TcB) are existing methods that 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: This cohort study was conducted at Dr. Soetomo General Hospital from September 2018 to January 2019 a total of 90 neonates born ≤35 weeks. They were divided into two groups (Group I: 1000-1500 grams; Group II: 1501-2000 grams). The bilirubin levels were measured on the sternum using TcB at the ages of 12, 24, and 72 hours. TSB measurements were taken on the third day or if the TcB level reached phototherapy threshold ± 1.24 mg/dL 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 the neonates in Group I (45%) suffered from hyperbilirubinemia at the age of 48 hours, along with 46% of Group II at 72 hours. The best 24-hour-old TcB cut-off values to predict hyperbilirubinemia at 48 hours were calculated to be 4.5 mg/dL for Group I and 5.8 mg/dL for Group II. The determined 24-hour-old TcB value to predict hyperbilirubinemia at 72 hours was 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 Efficacy of Transcutaneous Bilirubinometry as Compared to Serum Bilirubin in Preterm Newborn During Phototherapy

2021 ◽  
Author(s):  
Sunil Gothwal ◽  
Neelam Singh ◽  
Sadasivam Sitaraman ◽  
Ramesh Choudhary ◽  
Kailash Kumar Meena ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Serum Bilirubin ◽  
Tertiary Care ◽  
Total Serum Bilirubin ◽  
Preterm Neonates ◽  
Total Serum ◽  
Skin Area ◽  
Care Hospital ◽  
Transcutaneous Bilirubin ◽  
The Difference

Abstract Transcutaneous measurement of bilirubin is being used for neonatal jaundice. Its utility during phototherapy in preterm babies is not established. Objective of our study was to assess the efficacy of transcutaneous bilirubin (TcB) measurement in comparison to total serum bilirubin in preterm newborns at admission and during phototherapy at covered skin area (glabella). It was a prospective observational study and conducted at neonatal intensive care unit of a tertiary care hospital from January 2017 to January 2019. One hundred eligible preterm neonates were enrolled. Babies who were very sick, with poor peripheral circulation, edematous, having conjugated hyperbilirubinemia, with major congenital malformations, already received phototherapy or exchange transfusion were excluded. Paired total serum bilirubin and transcutaneous bilirubin were measured at admission, at 6 hours and 24 hours during phototherapy. TcB was measured from area (glabella) covered by eye protector during phototherapy. Sample for TsB was taken within 10 minutes of TcB measurement. The mean difference between TsB and TcB values at admission, 6 hours and 24 hours of phototherapy were -0.005 (0.353), --0.350 (0.611), and -0.592 (0.353) respectively. At admission or before starting of phototherapy the difference (TsB-TcB) was statistically not significant (p=.125), while the difference in these values were statistically significant at 6 hours and 24 hours of phototherapy. Conclusion: TcB measurements from covered skin area in jaundiced preterm infants during phototherapy were not correlated with TsB and cannot be used as an alternate of serum bilirubin levels.

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.

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