Use of Transcutaneous Bilirubin to Determine the Need for Phototherapy in Resource-Limited Settings

Abstract

Background: Routine and timely determination of total serum bilirubin (TSB) remains a challenge in many resource-limited countries with substantial burden of severe neonatal hyperbilirubinemia. Limited evidence exists on the potential usefulness of transcutaneous bilirubin (TcB) to identify infants who may require phototherapy based on possible treatment criteria in such settings. Objective: To compare the number of infants requiring phototherapy across different TSB criteria and determine the predictive performance of TcB under each criterion. Methods: Infants with paired TcB and TSB measurements in a maternity hospital in Lagos, Nigeria, were assessed for phototherapy based on TSB criteria by the American Academy of Pediatrics (AAP), National Institute for Health and Clinical Excellence (NICE) UK, and World Health Organization (WHO), and an absolute threshold of ≥12 mg/dL. The predictive performance of TcB across treatment criteria was evaluated with receiver operating curve analysis. Results: A total of 1,011 infants with a mean TcB of 10.54 ± 3.19 (range: 2.7-19.9) mg/dL and TSB of 9.63 ± 2.61 (range: 0.3-19.5) mg/dL were assessed. Some 60 (5.9%) infants required phototherapy by 1 or more TSB criteria, with TSB ≥12 mg/dL identifying 55 (91.7%) and AAP 27 (45%) of these infants. All infants identified by the NICE and WHO criteria were equally detected by the AAP criterion. TcB showed negative predictive values of 99.0-99.9%, and positive predictive values of 7.7-15.5% across all criteria. Conclusions: The number of infants requiring phototherapy varies significantly across treatment criteria. TcB may be useful in identifying infants who do not require phototherapy, but may also identify a high proportion of false positives that is burdensome in resource-limited settings.

Neonatal Phototherapy and Clinical Characteristics: The Danish National Patient Registry 2000–2016

“… 22 A study from Nigeria estimated the proportion of neonates born at term that met the criteria for phototherapy, according to different guidelines that were based on total serum bilirubin measured between 24 and 120 h after birth. 23 Those findings showed that 2.7%, 1.1%, 0.4%, and 5.4% of neonates, respectively, required phototherapy based on the criteria from the American Academy of Pediatrics (AAP), the National Institute for Health and Clinical Excellence, UK, the World Health Organization, or an absolute threshold of ≥12 mg/dl (205 µmol/l). 23 Another study showed that “clinicians provided phototherapy to only 54% of term infants with hyperbilirubinemia for whom it was recommended by the AAP”.…”

Screening methods for neonatal hyperbilirubinemia: benefits, limitations, requirements, and novel developments

“…40 Similar results have been observed by Olusanya and Emokpae. 41 The TcB values inform the health care professional about two questions: "Should I worry about this infant?" and "Should I obtain a TSB in this infant?".…”

Extreme neonatal hyperbilirubinaemia in refugee and migrant populations: retrospective cohort

“…However, publications reporting outcomes of neonates treated following these dynamic treatment thresholds are still rare. 16 The Shoklo Malaria Research Unit (SMRU) set up a special care baby unit (SCBU) in 2008 in Mae La, the most populous refugee camp along the Thailand-Myanmar border, to provide basic care for neonates including oxygen, intravenous antibiotics, nasogastric feeding, phototherapy and basic laboratory tests. 17 Starting 2011, another two SCBUs were set up in clinics for migrant populations.…”