Correlation of serum bilirubin and transcutaneous bilirubin in newborns

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.

Smartphones’ Skin Colour Reproduction Analysis for Neonatal Jaundice Detection

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.

Predictability of transcutaneous bilirubinometry in late preterm and term infants at risk for pathological hyperbilirubinemia

BACKGROUND: The aim was to assess the predictability of transcutaneous bilirubinometry in late preterm and term neonates at risk for pathological hyperbilirubinemia, and to identify the neonatal population in which transcutaneous bilirubin most accurately predicts serum bilirubin level (SB, mg/dl). METHODS: The correlations between transcutaneous bilirubin (TCB, mg/dl) and SB in different neonatal population subsets; and between ΔTSB (TCB-SB) and relevant neonatal variables and clinical groups were analyzed. RESULTS: TCB correlated with SB (r = 0.82, p < 0.05) in the cohort (n = 350) and in population subsets (r = 0.81–0.9, p < 0.001). Black infants with gestational age (GA) >35 weeks and chronological age (CA) >3 days recorded strongest correlation (r = 0.9, p < 0.001) followed by Blacks, and non-Black infants with CA >3 days and GA >35 weeks. ΔTSB was positive in Blacks, and in infants with CA <3 days, or with no phototherapy. ΔTSB was negative in non-Blacks, in infants with positive direct Coombs test (DC+) or those receiving phototherapy. Black race [beta (SE) = 1.3(0.33), p < 0.001] had positive, while CA [beta (SE) =−1.74 (0.36), p < 0.001], DC + status [beta (SE) =−0.72 (0.25), p = 0.004] and receipt of phototherapy [beta (SE) =−0.84 (0.21), p < 0.001] each had negative correlation with ΔTSB. ΔTSB for Blacks was >Whites, Hispanics and Asians. CONCLUSION: SB is best predicted by TCB in Black infants with CA over 3 days and GA over 35 weeks. Variability in SB estimation by TCB is race, CA and immune mediated hemolysis specific.

Transcutaneous bilirubin level to predict hyperbilirubinemia in preterm neonates

Background: Hyperbilirubinemia commonly occurs in neonates, with a higher prevalence among preterm neonates, which can lead to severe hyperbilirubinemia. Assessment of total serum bilirubin (TSB) and the use of transcutaneous bilirubinometry (TcB) are existing methods which can identify and predict hyperbilirubinemia. This study aimed to determine TcB cut-off values during the first day for preterm neonates, in order 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, studying a total of 90 neonates born at ≤35 weeks. They were divided into two groups (Group I: 1000-1500 grams; Group II: 1501-2000 grams). The bilirubin levels were measured at 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. Approximately onehalf of the neonates in Group I (45%) suffered from hyperbilirubinemia at 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 on the first day 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.

Transcutaneous bilirubin level to predict hyperbilirubinemia in preterm neonates

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.

Transcutaneous bilirubinometry during and after phototherapy in preterm infants: a prospective observational study

ObjectiveTo examine the accuracy of transcutaneous bilirubinometry (TCB) measurements during and after phototherapy (PT) in preterm infants.DesignProspective observational cohort study.SettingLevel III neonatal centre.PatientsPreterm infants (from 23+0 to 36+6 weeks of gestation) born between June 2017 and May 2018 requiring PT.InterventionsTCB was measured from an exposed area of the skin (the sternum; TCBU) and the covered area of the skin under the nappy (the bony part of the upper outer quadrant of the buttock; TCBC) within an hour of obtaining total serum bilirubin (TSB).Main outcome measuresCorrelation and agreement between TCB (TCBU and TCBC) and TSB during and after PT.ResultsWe have enrolled 196 preterm infants. There was a significant correlation between TSB and TCB during PT (r=0.72, 95% CI 0.66 to 0.77 in covered area; r=0.75, 95% CI 0.70 to 0.80 in uncovered area) and after PT (r=0.87, 95% CI 0.83 to 0.91). TCB underestimated TSB level during PT, with a mean TCBC–TSB difference of −25±43 (95% agreement limits of 62 to −112) and a mean TCBU–TSB difference of −48±46 (95% agreement limits of 45 to −140). The agreement between TCB and TSB after cessation of PT improved, with TCB underestimating TSB by a mean TCB–TSB difference of −10±31 (95% agreement limits of 52 to −72).ConclusionTCB measurements correlated strongly with TSB levels during and after PT. However, there was a wide and clinically relevant disagreement between TCB and TSB measurements during the PT phase, improving significantly after PT.