Correlation between transcutaneous and serum bilirubin in preterm infants before, during, and after phototherapy

Cucuy, Mor; Juster-Reicher, Ada; Flidel, Orna; Shinwell, Eric S.

doi:10.1080/14767058.2017.1315662

Cited by 24 publications

(31 citation statements)

References 16 publications

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“…Our study has also shown a significant decrease in the correlation between TCB and TSB in light exposed skin, with mean differences exceeding 6-8 points. This happens even in preterm patients, contrary to that affirmed by other authors [5,17].…”

Section: ---------------------------------contrasting

confidence: 85%

“…Regarding the most premature patients there is controversy about the suitability of placing a patch (given the skin fragility) or not. There are authors such as Cucuy or Roshsiwatmo, who found a good correlation between TSB and TCB on exposed skin measured with the JM-103 bilirubinometer in the sternum, after the initiation of phototherapy in preterm infants [17,23]. Perhaps the immaturity of the cutaneous barrier of the very premature and its dermal kinetics influences these results, favouring that the reading in uncovered skin is more similar to the TSB.…”

Section: ---------------------------------mentioning

confidence: 99%

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Accuracy of transcutaneous bilirubin on covered skin in preterm and term newborns receiving phototherapy using a JM-105 bilirubinometer

et al. 2019

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Objective Determine the suitability of transcutaneous bilirubin (TCB) as a tool to assess the effectiveness of phototherapy on patched skin. Study design A prospective observational study was conducted. We covered a fragment of skin (sternum) with a photoopaque patch. Several simultaneous TCB and TSB measurements were performed with the JM-105 bilirubinometer. Bland and Altman test evaluated the agreement between bilirubin levels. Result A total of 217 patients were studied, 48.8% were preterm. The mean difference between TSB and TCB before the start of treatment was 1.07 mg/dL. During phototherapy, differences on covered skin were 0.52, 0.27, and 0.39 mg/dL at 24, 48, and 72 h of therapy respectively. The best correlation was observed at 48 h in preterm infants. Conclusion The measurement of TCB on patched skin (PTCB) is useful for monitoring the response to phototherapy in term and preterm infants. We use a patch with a removable flap that eases successive measures without disturbing the patients.

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confidence: 85%

Section: ---------------------------------mentioning

confidence: 99%

Accuracy of transcutaneous bilirubin on covered skin in preterm and term newborns receiving phototherapy using a JM-105 bilirubinometer

et al. 2019

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“…The AJO-Neo device is based on such a spectroscopy-based approach where the majority of the information is collected from the vascular bed underneath the nail plate 18 . Thus, we predicted that AJO-Neo will be able to overcome the limitations of the conventional TcB meters i.e., their limited accuracy in preterm infants 34,[36][37][38] , dark skin babies 14,[39][40][41] , neonates having phototherapy 39,[42][43][44][45][46][47] , newborns with low birth weight 48,49 , exclusively breastfed infants 34,[50][51][52] , neonates with higher postnatal age 34 and high TSB value 34,[53][54][55] , etc.…”

Section: Discussionmentioning

confidence: 99%

“…Almost all previous studies have shown the inaccuracy of commercially available bilirubinometers in the clinical setting of phototherapy 39,[42][43][44][45][46] . For example, Grabenhenrich et al 42 , have found that the commercially available TcB meters significantly underestimates bilirubin level (mean bias, − 0.6 mg/dL; limits of agreement, − 4.4 to 3.6 mg/dL) during phototherapy.…”

Section: Discussionmentioning

confidence: 99%

Large scale validation of a new non-invasive and non-contact bilirubinometer in neonates with risk factors

Halder

Adhikari

Ghosh

et al. 2020

Sci Rep

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The study was aimed to evaluate the performance of a newly developed non-invasive and noncontact bilirubin measurement device (AJo-neo) as an alternative to the conventional invasive biochemical method of total serum bilirubin (TSB) estimation in preterm and term neonates suffering from hyperbilirubinemia associated with risk factors, and/or undergoing phototherapy. The safety and efficacy of the device were assessed in 1968 neonates with gestational ages ranging from 28 to 41 weeks and suffering from incidences of hyperbilirubinemia. Linear regression analysis showed a good correlation between AJO-Neo and the conventional method of TSB (Pearson's coefficient, r = 0.79). The small bias (0.27 mg/dL) and limits of agreements (− 3.44 to 3.99 mg/dL) were within the range of clinical acceptance. The device was also precise in the measurement of bilirubin levels in all subgroups of the study. The receiver operator curve (ROC), that takes account of both sensitivity and specificity of a device showed high efficacy of the device (area under the curve, AUC = 0.83) in the detection of bilirubin. While monitoring the bilirubin level during phototherapy, the device indicated promising results showing good agreement with TSB. Specificities and sensitivities of the device indicated a much higher accuracy in neonates with associated risk factors for hyperbilirubinemia. Hence, the newly developed device (AJO-Neo) is reliable in measuring bilirubin level in preterm, and term neonates irrespective of gestational or postnatal age, sex, risk factors, feeding behavior or skin color. Neonatal jaundice or Icterus neonatorum affects more than 60% of the term and 80% of preterm newborns in the first week of life 1-3 due to excessive production of bilirubin, and the inability of the newly developed liver to excrete it 4. Although benign at low concentrations, persistently elevated levels of bilirubin can cause severe neurotoxicity termed as kernicterus, which may lead to significant morbidity and mortality 5,6. Thus, proper monitoring of the bilirubin level in newborns is mandatory as per the guideline of American Academy of Pediatrics (AAP) to ensure appropriate management 7. The contemporary method of detection of serum bilirubin

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“…It calculates phototherapy threshold for newborns that are not in a neonatal intensive care unit, displays values on phototherapy nomogram and then directly links to source guideline. 21 Other recent diagnostic tool includes assessment of the accuracy of a technology based on the analysis of digital images of newborns obtained using a smartphone application called Bilicam. 22 The measurement of free serum bilirubin and albumin ratio is also a newer way to assess the risk of neurotoxicity in a jaundiced infant.…”

Section: Assessment Of Bilirubin Induced Neurotoxicitymentioning

confidence: 99%

An Overview of Neonatal Unconjugated Hyperbilirubinemia and It’s Management

Begum

Afroze

2018

Bangladesh J Child Health

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Neonatal hyperbilirubinemia is the most common clinical condition in the newborn requiring hospital readmission. About 60% of term and 80% of preterm infants develop jaundice during 1st week of life. Unconjugated hyperbilirubinemia occurs mostly due to increased hemolysis, decreased hepatic clearance, enterohepatic circulation, immaturity, blood group incompatibility and infections. Evaluation of neonatal jaundice is done based on history, age of onset of jaundice and physical examination findings which is necessary for proper management. Otherwise significant hyperbilirubinemia may endanger life of the baby and may lead to acute and subsequently chronic bilirubin encephalopathy. There are many diagnostic tools those help to detect jaundice such as Kramer’s rule, transcutaneous bilirubinometer, Bilichecker apps and smartphone apps. Besides these BIND score added a new dimension in diagnosis of acute bilirubin encephalopathy which can be confirmed by measuring bilirubin – albumin ratio in blood. Management of unconjugated hyperbilirubinemia includes: Phototherepy, Exchange transfusion are two major effective therapeutic modalities available today. Additional options include Pharmacotherapy in the form of phenobarbital and intravenous immunoglobulin. Each therapy has its pros and cons. Even there is dilemma in many therapeutic conditions like role of prophylactic phototherapy in preterm neonates, role of sunlight etc. As pediatricians have to deal cases with unconjugated hyperbilirubinemia frequently, so an updated knowledge is required. From this concern we reviewed issues on neonatal unconjugated hyperbilirubinemia and compiled for better understanding of the condition.Bangladesh J Child Health 2018; VOL 42 (1) :30-37

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Correlation between transcutaneous and serum bilirubin in preterm infants before, during, and after phototherapy

Abstract: TcB is a reliable measure of jaundice before 35 weeks' gestation with a mean under-estimation of ≈1 mg%. TcB use may reduce unnecessary invasive blood tests.

Cited by 24 publications

References 16 publications

Accuracy of transcutaneous bilirubin on covered skin in preterm and term newborns receiving phototherapy using a JM-105 bilirubinometer

Accuracy of transcutaneous bilirubin on covered skin in preterm and term newborns receiving phototherapy using a JM-105 bilirubinometer

Large scale validation of a new non-invasive and non-contact bilirubinometer in neonates with risk factors

An Overview of Neonatal Unconjugated Hyperbilirubinemia and It’s Management

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