Effectiveness of Transcutaneous Bilirubin Measurement in High-Risk Neonates and to Evaluate Validity of Transcutaneous Bilirubin With Total Serum Bilirubin Levels in Both Low and High-Risk Neonates at a Tertiary Care Center in a Developing Country

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.

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Efficacy of Transcutaneous Bilirubinometry as Compared to Serum Bilirubin in Preterm Newborn During Phototherapy

10.21203/rs.3.rs-380978/v1 ◽

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.

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Comparison of transcutaneous bilirubin with serum bilirubin measurements in neonates at tertiary care center in western part of India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20172683 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1445 ◽

Cited By ~ 1

Author(s):

Amita U. Surana ◽

Shefali Patel ◽

Rajeev Prasad ◽

Sandeep Tilwani ◽

Ambrin Saiyad ◽

...

Keyword(s):

Roc Analysis ◽

Serum Bilirubin ◽

Care Center ◽

Tertiary Care ◽

Average Error ◽

Good Sensitivity ◽

Tertiary Care Center ◽

Mean Values ◽

Transcutaneous Bilirubin ◽

Attractive Option

Background: Noninvasive transcutaneous bilirubin measurement is an attractive option for jaundice evaluation in newborns. But variable accuracy had been reported in different studies. The aim of the study was to find out the correlation and agreement between TcB and TSB measurements in neonates.Methods: Prospective analytic study carried out in neonatal unit of tertiary care center. Newborns up to 10th postnatal DOL with visually found jaundice were enrolled in study. TcB was measured over forehead with Dragor JM 103 device. Simultaneous TSB measurements were done for all readings. Pearson’s correlation coefficient calculation and Bland Altaman analysis were done. ROC curve of mean TcB at different TSB level were constructed.Results: Total 160 newborns with male: Female ratios of 1.3:1 were enrolled. Mean values: gestational age 38.23±2.01; birth weight 2.403±0.61; age in hour at first reading 83.76±26.62; TSB11.65±4.58 mg/dl and TcB 11.73±3.53 mg/dl. A strong, positive and significant correlation was found between TcB and TSB measurements (r=0.836, r2=0.69, p <0.001). The average error in evaluating hyperbilirubinemia with TcB as compared to TSB was 0.856 with limits of agreement between -3.41 to +5.48. The AUOC at three TSB levels (>10mg/dl, >12 mg/dl, >15 mg/dl) of TcB were 0.899, 0.937 and 0.963 respectively. ROC analysis showed good sensitivity for all. Specificity was found to fall with increasing TSB concentration.Conclusions: In our study TcB correlated well with TSB measurements and showed good sensitivity and satisfactory specificity, thus validating its use as a screening tool for evaluation of jaundice in newborns.

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Transcutaneous billirubinometry to estimate total serum bilirubin in neonatal jaundice

Paediatrica Indonesiana ◽

10.14238/pi57.1.2017.8-11 ◽

2017 ◽

Vol 57 (1) ◽

pp. 8 ◽

Cited By ~ 2

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.

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