Reliability of Transcutaneous Bilirubin Devices in Preterm Infants: A Systematic Review

Abstract

BACKGROUND AND OBJECTIVE: Transcutaneous bilirubin (TcB) devices are widely used for the estimation of serum bilirubin levels in term and near-term infants. Our objective was to review the diagnostic accuracy of TcB devices in preterm infants.METHODS: Medline, Embase, Cochrane library, Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched (from database inception date until December 2012). Additional citations were identified by using the bibliographies of selected articles and from conference proceedings. The studies were included if they compared TcB with total serum bilirubin in preterm infants before phototherapy and presented data as correlation coefficients or as BlandAltman difference plots. Data were extracted by 1 reviewer and checked for accuracy by the second reviewer. An assessment tool (quality assessment of diagnostic accuracy studies) was used for risk of bias assessments. RESULTS:Twenty-two studies met the inclusion criteria; 21 studies reported results as correlation coefficients, with pooled estimates of r = 0.83 for each site of measurement. Pooled estimates in infants ,32 weeks' gestation were similar to the overall preterm population (r = 0.89 [95% confidence interval: 0.82-0.93]). For the 2 commonly used TcB devices (ie, JM103 and BiliCheck), the results were comparable at the forehead site, although the JM103 device exhibited better correlation at the sternum. Analysis of the BlandAltman plots (13 studies) revealed negligible bias in measurement at the forehead or sternum site by using either the JM-103 or BiliCheck device; however, the JM-103 device exhibited better precision than the BiliCheck (SD for TcB -total serum bilirubin differences: 24.3 and 31.98 mmol/L, respectively). CONCLUSIONS:The TcB devices reliably estimated bilirubin levels in preterm infants and could be used in clinical practice to reduce blood sampling.

Screening neonatal jaundice based on the sclera color of the eye using digital photography

“…It can be seen that the linear correlation coefficient r for other studies ranges between 0.83 and 0.86 while for this study it is lower at 0.75. The standard deviations of the mean differences reported in [6] are 24.06 µmol/l for the sternum site and 29.46 µmol/l for the forehead site [6], in comparison to ours at 41.60 µmol/l for the sclera site. Our database lacks subjects with TSB values in both the high (>250 µmol/l) and low (<100 µmol/l) ends of the range, which may in turn affect the r value.…”

“…Numerous studies have compared the agreement between TcB and TSB [5][6][7][8][9][10][11][12][13][14][15][16]. One review in 2013 summarised the results from 22 studies conducted between 1982 and 2012 ( [5][6][7][8][9][10][11][12][13][14][15][16]), mainly on BiliChek and JM-103 (and its earlier versions) [6].…”

“…One review in 2013 summarised the results from 22 studies conducted between 1982 and 2012 ( [5][6][7][8][9][10][11][12][13][14][15][16]), mainly on BiliChek and JM-103 (and its earlier versions) [6]. Two other studies adopted digital photography to predict TSB based on the skin colour in the sternum and forehead [18,31].…”

“…Currently, the two most popular commercial TcBs include BiliChek (Philips Healthcare) and Jaundice Meter JM102/JM103 (Draeger Medical Inc., previously marketed by Konica Minolta Inc.) [5][6][7][8][9][10][11][12][13][14][15][16]. The skin pigment is the most influential confounding factor for the skin colour approach.…”

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“…Some degrees of elevated level of serum bilirubin in all newborns are expected (more than 2 milligrams per deciliter) but term newborn jaundice could only be visible in half of them with the bilirubin levels higher than 5 milligrams per deciliter [2]. There are two main categories of jaundice in newborns including indirect hyperbilirubinemia and direct hyperbilirubinemia [3]. Among the causes of rising indirect bilirubin, physiological jaundice, Krigler-Najar syndrome, Gilbert's syndrome, breast milk jaundice, ABO blood group and RH incompatibility, and G6PD deficiency are noted [4].…”