Transcutaneous Bilirubinometry II. Dermal Bilirubin Kinetics during Phototherapy

Hegyi, Thomas; Hiatt, I Mark; Gertner, Ian; Zanni, R; Tolentino, T

doi:10.1203/00006450-198311000-00010

Cited by 36 publications

(30 citation statements)

References 4 publications

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“…Total serum bilirubin measured by conventional laboratory methods is not dis tinguished from its photoisomers and photo products [16][17][18], Therefore, total serum bil irubin concentrations remain unchanged during the first 4 h of phototherapy. This confirms in part the previous observations by Cifuentes et al [ 19] and Hegyi et al [20], who studied only early changes of skin bilirubin kinetics during 4 h of phototherapy.…”

Section: Discussionsupporting

confidence: 81%

Transcutaneous Bilirubinometry: Bilirubin Kinetics of the Skin and Serum during and after Phototherapy

Yamauchi¹,

Yamanouchi²

1989

Neonatology

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Skin bilirubin (transcutaneous bilirubinometry, TcB, reading) and serum bilirubin kinetics were studied in 20 full-term hyperbilirubinemic infants during and after phototherapy. TcB readings at the chest site decreased after 2 h of phototherapy from 28.0 to 21.3 (25% of initial TcB reading, p < 0.001) and thereafter continued to decrease in a nonlinear fashion through the first 24 h of phototherapy. However, TcB readings after 12 h of phototherapy were about 50% of the initial readings (p < 0.001), declining minimally during the second 12 h of phototherapy, suggesting saturation kinetics. While serum bilirubin levels remained unchanged during the first 4 h of phototherapy, thereafter they showed a rapid decline to 12 h of phototherapy. The rate of decline decreased during the second 12 h of phototherapy, but serum bilirubin levels still decreased significantly from 16.9 to 14.9 mg/dl. Although TcB readings showed saturation kinetics during the second 12 h of phototherapy, the serum bilirubin levels were shown to decrease significantly. This suggests that the main site of action of phototherapy may be intravascular at this stage, rather than the skin and subcutaneous capillary bed as in the early stage of phototherapy.

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Section: Discussionsupporting

confidence: 81%

Transcutaneous Bilirubinometry: Bilirubin Kinetics of the Skin and Serum during and after Phototherapy

Yamauchi¹,

Yamanouchi²

1989

Neonatology

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“…Rebound effect was defined as a rise of bilirubin of 17 gmol/1 or more after treatment was discontinued. In both groups transcutaneous (Minolta-Bilirubinometer) [11] and capillary bilirubin levels were measured before PT. Serum bilirubin levels were then controlled every 6 h with a Diazometric Method (Testomarbilirubin, Behring-Werke Marburg, FRG) until two successive readings were below 200 gmol/1.…”

Section: Methodsmentioning

confidence: 99%

Clinical usefulness of high intensity green light phototherapy in the treatment of neonatal jaundice

Amato

Inaebnit

1991

Eur J Pediatr

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Two matched groups of term newborn infants with idiopathic jaundice were subjected to intensive double direction green or blue light phototherapy (PT). The efficacy of treatment was expressed as rate of decline of serum bilirubin concentration after 6, 12 and 24 h of light exposure. More rapid response was obtained using conventional blue lamps (Philips TL/20W/52) than green lamps (Sylvania F20T12/G). Whole duration of PT was significantly shorter using blue lamps (P less than 0.05). However, less postphototherapy rebound was observed in babies treated with green light PT. It can be concluded that green light PT is useful but not preferable to blue light PT for clinical use in the treatment of neonatal jaundice.

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“…11 With the initiation of phototherapy, a rapid decrement in dermal bilirubin is caused by photoisomerization of albumin-bound bilirubin in interstitial places and subcutaneous capillaries into lumirubin and other photoisomers. 12 Two theoretical kinetics for post-phototherapy TcB have been contrasted recently (plateau versus rebound). 13 In short, TcB levels were found significantly lower than TSB 6 hours after cessation of light exposure, 14 but TcB may resume preexposure validity 18 to 24 hours after phototherapy.…”

mentioning

confidence: 99%

Transcutaneous Bilirubin After Phototherapy in Term and Preterm Infants

Grabenhenrich¹,

Grabenhenrich

Bührer³

et al. 2014

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Phototherapy decreases bilirubin concentration in skin more rapidly than in blood. During and after phototherapy, transcutaneous bilirubin measurements are considered unreliable and therefore discouraged. WHAT THIS STUDY ADDS:Transcutaneous bilirubin underestimates total serum bilirubin by 2.4 mg/dL (SD, 2.1 mg/dL) during the first 8 hours after phototherapy. This gives a safety margin of ∼7 mg/dL below the treatment threshold to omit confirmatory blood sampling. abstract OBJECTIVES: To compare transcutaneous bilirubin (TcB) readings with total serum bilirubin (TSB) after phototherapy, estimating the range of TcB where confirmation through blood sampling can be avoided. METHODS:Preterm and term neonates receiving in-hospital phototherapy underwent TcB measurements (device JM-103, TcB) alongside routine TSB before and after treatment. We calculated time-dependent safety margins for transcutaneous readings to correctly assign 99% of infants not to receive phototherapy. RESULTS:Between August 2011 and December 2012, 86 newborn infants (47 preterm, 39 term) underwent a total of 189 parallel measurements. Mean difference (TcB 2 TSB) before treatment was 20.6 mg/dL (SD, 1.9 mg/dL). Within the first 8 hours after phototherapy, TcB levels were 22.4 mg/dL (SD, 2.1 mg/dL) below TSB. Thereafter the difference gradually returned to pretreatment values (21.8 mg/dL in 8-16 hours, 21.1 mg/dL in 16-24 hours, and 20.8 mg/dL after 24 hours), while variations remained stable over time (SD, 1.4-1.8 mg/dL). In the first 8 hours after treatment, TcB levels of 27.3 mg/dL below the individual phototherapy threshold allowed safe rejection of confirmatory blood sampling. After 8 hours, that safety margin was reduced to approximately 25.0 mg/dL. CONCLUSIONS: TcB measurements remain a valuable tool after phototherapy when time-dependent underestimation of TcB is being accounted for.

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Transcutaneous Bilirubinometry II. Dermal Bilirubin Kinetics during Phototherapy

Cited by 36 publications

References 4 publications

Transcutaneous Bilirubinometry: Bilirubin Kinetics of the Skin and Serum during and after Phototherapy

Transcutaneous Bilirubinometry: Bilirubin Kinetics of the Skin and Serum during and after Phototherapy

Clinical usefulness of high intensity green light phototherapy in the treatment of neonatal jaundice

Transcutaneous Bilirubin After Phototherapy in Term and Preterm Infants

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