A Prospective Comparison of Serum and Transcutaneous Bilirubin in Indian Neonates

Kumar, Durgesh; Kumar, Dinesh

doi:10.1055/s-0040-1721067

Cited by 6 publications

(11 citation statements)

References 32 publications

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“…Transcutaneous bilirubin assessments are routinely used in many Western Countries and in hospital settings of some tropical countries. Their reliability in populations with more pigmented skin has not been tested widely (19-21) and was evaluated against capillary TSB levels in neonates of Karen and Burman ethnicity here for the first time. Results from this study indicate that TcB values, with an appropriate simple correction, can be used reliably against TSB nomograms to identify neonates who need confirmatory laboratory blood tests to detect clinically significant bilirubin levels.…”

Section: Discussionmentioning

confidence: 99%

“…Transcutaneous bilirubin assessments are routinely used in many Western Countries and in hospital settings of some tropical countries. Their reliability in populations with more pigmented skin has not been tested widely (19)(20)(21) represents an initial insurmountable investment for most constrained-resource settings, but other transcutaneous devices might be as accurate and more affordable (24). Other cheaper screening tools have been tested, such as icterometers (25,26) and phone-based apps (27)(28)(29), and when properly evaluated could be used by health workers at birthing centers and in remote settings, and even by parents (30) after discharge from the hospital.…”

Section: Discussionmentioning

confidence: 99%

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Non-invasive detection of bilirubin concentrations during the first week of life in a low-resource setting along the Thailand-Myanmar border

Bancone,

Gilder,

Win

et al. 2024

Preprint

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Background: Neonatal hyperbilirubinaemia (NH) is a common problem worldwide and causes morbidity and mortality especially in low-resource settings. Methods: A study was carried out at Shoklo Malaria Research Unit clinics along the Thailand-Myanmar border to evaluate a non-invasive test for diagnosis of NH in a low-resource setting. Performance of transcutaneous bilirubinometer Draäger Jaundice Meter JM-105 was assessed against routine capillary serum bilirubin testing before phototherapy during neonatal care in the first week of life. Results were analysed by direct agreement and by various bilirubin thresholds used in clinical practice. Total serum bilirubin was also measured in cord blood at birth and tested for prediction of hyperbilirubinaemia requiring phototherapy in the first week of life. Results: Between April 2020 and May 2023, 742 neonates born at SMRU facilities were included in the study. A total of 695 neonates provided 1 to 9 capillary blood samples for analysis of serum bilirubin (total 1244 tests) during the first week of life and performance of the transcutaneous bilirubinometer was assessed in 307 neonates who provided 687 paired transcutaneous-capillary blood tests. Bilirubin levels were also measured in 738 cord blood samples. Adjusted values of the transcutaneous bilirubinometer showed excellent agreement with capillary serum bilirubin concentration (intraclass correlation coefficient=0.923) and high sensitivity (>98%) at all clinical thresholds analysed across three years of sampling and multiple users. Concentrations of bilirubin detected in cord blood were not useful in identifying neonates at risk of hyperbilirubinaemia requiring treatment. Conclusions: The transcutaneous bilirubinometer is a reliable tool to screen neonates and identify those needing confirmatory blood testing. Bilirubin concentrations in cord blood are not predictive of hyperbilirubinemia in neonates.

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Section: Discussionmentioning

confidence: 99%

“…Transcutaneous bilirubin assessments are routinely used in many Western Countries and in hospital settings of some tropical countries. Their reliability in populations with more pigmented skin has not been tested widely (19)(20)(21) represents an initial insurmountable investment for most constrained-resource settings, but other transcutaneous devices might be as accurate and more affordable (24). Other cheaper screening tools have been tested, such as icterometers (25,26) and phone-based apps (27)(28)(29), and when properly evaluated could be used by health workers at birthing centers and in remote settings, and even by parents (30) after discharge from the hospital.…”

Section: Discussionmentioning

confidence: 99%

Non-invasive detection of bilirubin concentrations during the first week of life in a low-resource setting along the Thailand-Myanmar border

Bancone,

Gilder,

Win

et al. 2024

Preprint

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“…There have been concerns about the reliability of TcB among darkly pigmented infants based on how the bilirubinometer uses a light source (xenon) to compute for wavelength differences between skin and subcutaneous tissue ( 27 ). However, recent studies have shown TcB readings are not affected by skin color ( 28 ). High correlation between TcB and TsB has also been shown among infants of Asian descent such as Japanese ( 29 ), Chinese ( 24 ), Mongolian ( 30 ) and specifically those of Malay descent (darker skin)—Indonesian ( 31 ), Myanmar ( 12 ) and Thai ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Applicability of the hour of life approach in hyperbilirubinemia among Filipino term infants

Villanueva-Uy

Amarillo

2022

Front. Pediatr.

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BackgroundHyperbilirubinemia remains a common morbidity among infants. Additional research on bilirubin kinetics and associated risk factors will contribute to providing a more targeted management approach for the Filipino infant.ObjectiveTo develop a Filipino bilirubin nomogram by studying bilirubin patterns during the first 5 days of life.MethodologyThis prospective study recruited 1,412 stable, full-term infants (≥37 weeks age of gestation) born at the Philippine General Hospital (PGH). Using the Dräger-Minolta JM-103 jaundice meter, transcutaneous bilirubin (TcB) levels were determined at the 3rd, 6th, 12th, 24th, 36th, 48th, 72nd, 96th, and 120th hour of life (HOL). A bilirubin nomogram was created using the averages of 3 TcB forehead and sternal measurements at each time epoch. Simultaneous measurement of TcB and total serum bilirubin (TsB) on a subset of 106 infants was done to determine correlation.ResultsCorrelation coefficients were high between TsB and forehead TcB (r2 = 0.88), and between TsB and sternal TcB (r2 = 0.91). The Filipino bilirubin nomogram reflected a steep rise until the 48th hour, followed by plateauing of values. Inadequate nursing and bilirubin levels at 12th and 48th HOL were risk factors for developing significant hyperbilirubinemia at 72nd HOL.ConclusionTcB is a reliable, non-invasive bilirubin screening tool. Among healthy, full-term, Filipino infants, their nomogram features a sudden increase in bilirubin values during the first 48 h, followed by a plateau. To aid in identification of infants at risk for significant hyperbilirubinemia, healthcare providers can assess breastfeeding adequacy and perform bilirubin screening at the 24th−48th HOL. Registration No. (RGAO-2016-0686).

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“…Researchers and healthcare professionals should be aware of the potential impact of ambient light and take measures to standardize the measurement conditions to obtain reliable TcB readings. Effect of TSB Level: TcB measurements tend to be less accurate and may underestimate TSB levels at higher concentrations ( 203 ). Consequently, as TSB levels increase, the rate of false-negative TcB results may rise.…”

Section: Non-invasive Approaches For Jaundice Screening and Their Lim...mentioning

confidence: 99%

“…Nevertheless, when employing suitable cutoff values, TcB measurements remain effective as a screening tool, even when TSB levels exceed 15 mg/dl. Effect of Phototherapy on TcB Measurements: The use of phototherapy can lighten an infant's skin, potentially compromising the reliability of visual assessments of jaundice and TcB measurements ( 181 , 203 ). However, if specific areas of the skin remain shielded during phototherapy, TcB measurements from those areas can be employed to monitor treatment response.…”

Section: Non-invasive Approaches For Jaundice Screening and Their Lim...mentioning

confidence: 99%

Demystifying non-invasive approaches for screening jaundice in low resource settings: a review

Abiha,

Banerjee,

Mandal

2023

Front. Pediatr.

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All national and international pediatric guidelines universally prescribe meticulous bilirubin screening for neonates as a critical measure to mitigate the incidence of acute bilirubin encephalopathy (ABE) and Kernicterus. The prevailing gold standard for jaundice detection in neonates necessitates invasive blood collection, followed by subsequent biochemical testing. While the invasive procedure provides dependable bilirubin measurements and continues to be the sole gold standard diagnostic method for assessing bilirubin concentration. There exists a pressing need to innovate non-invasive screening tools that alleviate the sampling stress endured by newborns, mitigate iatrogenic anemia, and expedite the turnaround time for obtaining results. The exploration of non-invasive modalities for bilirubin measurements is gaining momentum, driven by the overarching goal of minimizing the number of pricks inflicted upon neonates, thereby rendering screening a swift, efficient, comfortable, and dependable process. This comprehensive review article delves extensively into the array of non-invasive approaches and digital solutions that have been proposed, implemented, and utilized for neonatal bilirubin screening, with a particular emphasis on their application in low-resource settings. Within this context, the review sheds light on the existing methodologies and their practical applications, with a specific focus on transcutaneous bilirubin meters. Moreover, it underscores the prevailing open challenges in this domain and outlines potential directions for future research endeavors. Notably, the review underscores the imperative need for robust educational programs targeted at both families and healthcare personnel to expedite the process of seeking timely care for neonatal jaundice. Additionally, it underscores the necessity for the development of enhanced screening and diagnostic tools that can offer greater accuracy in clinical practice.

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A Prospective Comparison of Serum and Transcutaneous Bilirubin in Indian Neonates

Cited by 6 publications

References 32 publications

Non-invasive detection of bilirubin concentrations during the first week of life in a low-resource setting along the Thailand-Myanmar border

Non-invasive detection of bilirubin concentrations during the first week of life in a low-resource setting along the Thailand-Myanmar border

Applicability of the hour of life approach in hyperbilirubinemia among Filipino term infants

Demystifying non-invasive approaches for screening jaundice in low resource settings: a review

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