Comparison of transcutaneous and serum bilirubin before, under, and after phototherapy in term and late‐preterm infants

Abstract

This study aimed to determine the correlation of transcutaneous bilirubin (TcB) with total serum bilirubin (TSB) in infants receiving phototherapy and the accuracy of TcB for deciding the time to discontinue phototherapy. Paired TcB and TSB levels were assessed in 52 term and 56 late-preterm infants receiving phototherapy. TcB was measured in the unexposed skin of the middle forehead using a noninvasive bilirubin analyzer, BiliChek. TSB was measured every morning, and TcB was measured 2 hours after TSB measurements. Bland-Altman plots, linear regression, multivariate pair wise correlation, and receiver operating characteristic curve (ROC) analyses were performed. Bland-Altman plots before, under, and 24 hours after phototherapy in term and late-preterm infants revealed that TcB and TSB have higher consistency. TcB and TSB showed positive linear correlation before, under, and after phototherapy in both infant groups. In the multivariate pair wise correlations, differences between TcB and TSB were negatively correlated with phototherapy duration in term (correlation coefficient = −0.233, P value = .001) and late-preterm (correlation coefficient = −0.198, P value = .002) infants. Cutoff levels of TcB for discontinuing phototherapy based on the ROC analysis were 13.8 (sensitivity of 90%, specificity of 84%, area under the curve [AUC] 0.94) and 11.8 mg/dL (sensitivity of 84%, specificity of 88%, AUC 0.92) in term and late-preterm infants, respectively. TcB and TSB before, under, and after phototherapy in both term and late-preterm infants showed good correlation and higher consistency with jaundice. To reduce repetitive blood sampling for TSB, TcB measurement may be a reliable method for term and latepreterm infants undergoing phototherapy.

Transcutaneous bilirubin reliability during and after phototherapy depending on skin color

“…Therefore, jaundice meters may be less reliable in neonates receiving phototherapy or < 24 h after interrupting it [ 3 ]. TcB measurements are not widely accepted as a surrogate measure of SB during phototherapy, although not all the authors agree in this statement [ 10 , 13 , 18 , 20 – 23 , 25 , 34 – 37 ]. There seems to be a better TcB/SB correlation when TcB is measured in covered skin [ 13 , 17 , 21 – 24 , 26 – 28 , 35 , 38 – 41 ].…”

“…Some data show that the TcB/SB correlation worsens with decreasing gestational age, at the same time that the threshold for phototherapy decreases [ 5 , 43 ]. Despite the controversies, there seems to be a strong correlation in preterm babies, that may vary depending on gestational age [ 7 , 8 , 10 , 11 , 13 , 21 , 23 , 35 , 39 , 44 – 46 ]. In line with this last statement we found that the SB-cTcB bias during phototherapy depended on gestational age as shown in Table 2 .…”

Aplicación del bilirrubinómetro no invasivo en recién nacidos

“…Otros reportes como los realizados por Hulzebos y Yang utilizaron BTc en prematuros con y sin fototerapia (FT). En pretermino bajo FT la BTc podría subestimar los valores séricos de bilirrubina de acuerdo a algunos resultados de estudios en esta población, mientras que otros reportan muy buena correlación en pretérminos similar a la observada en (21,22) neonatos de termino .…”

Transcutaneous Bilirubin Accuracy Before, During, and After Phototherapy: A Meta-Analysis

“…22,24,25,39 Concerning flow and timing, 4 of 54 studies (7.4%) had high risk of bias because the time between TcB and TSB measurement was 60 minutes or more. [40][41][42][43] In another 4 studies, time between TcB and TSB measurement was not mentioned and risk of bias was therefore unclear. 28,38,44,45…”

“…1 1 1 Ying et al (2020) 40 ? 1 1 -Yang et al (2019) 41 ? 1 1 -Hulzebos et al (2019) 35 1 1 1 1 Raba et al (2020) 50 1 1 1 1 Raba et al (2020) 39 1 1 ?…”