Transcutaneous Bilirubin Levels in the First 96 Hours in a Normal Newborn Population of ≥35 Weeks' Gestation

Abstract

We provide data on neonatal bilirubinemia, based on TcB levels determined in a large, predominately white and breastfed, North American population. Infants who require closer evaluation and observation initially are those whose bilirubin levels are > or =95th percentile, ie, increasing more rapidly than 0.22 mg/dL per hour in the first 24 hours, 0.15 mg/dL per hour between 24 and 48 hours, and 0.06 mg/dL per hour after 48 hours. These data should be useful for detecting aberrant trends, identifying infants who need additional evaluation, and planning appropriate follow-up for jaundiced newborns.

Routine transcutaneous bilirubin measurements combined with clinical risk factors improve the prediction of subsequent hyperbilirubinemia

“…All measurements are obtained from the mid sternum as described earlier 9 using the Konica Minolta Dräger Air-Shields Transcutaneous Jaundice Meter, 9 and a TSB was ordered whenever the TcB exceeded the 95th percentile. Pediatricians could also order TSB levels at their discretion.…”

Managing the jaundiced newborn: a persistent challenge

“…26,28,32 Because transcutaneous bilirubin measurement tends to underestimate the total serum bilirubin level at higher serum levels, various techniques have been adopted to avoid missing a high total serum bilirubin level (i.e., a false-negative transcutaneous measurement). Investigators recommend measuring the total serum bilirubin level if the transcutaneous level is at 70% of the serum level recommended for the use of phototherapy; 33 the transcutaneous level is above the high intermediate risk line (75th percentile) on the Bhutani nomogram (Figure 1) or the 95th percentile on a transcutaneous bilirubin nomogram; 16,34 or the transcutaneous level at follow-up after discharge is above 222 μmol/L (13 mg/dL). 26,32 In two outpatient studies, no infant who had a transcutaneous bilirubin level of 222 μmol/L or less had a total serum bilirubin level equal to or greater than 290 μmol/L (17 mg/dL).…”

Universal bilirubin screening for severe neonatal hyperbilirubinemia

“…The accuracy and precision of TcB assays >15 mg per 100 ml is unproven because of erratic performance at higher bilirubin levels in comparison to laboratory assay of TSB. Figure 1 Modified Kramer scale to assess and plot progression of newborn jaundice according to demarcated skin zones and intensity of color as correlated to transcutaneous bilirubin (TcB) levels (adapted from Maisels and Kring 38 ). This figure describes the cephalo-caudal progression of jaundice in term infants.…”