Transcutaneous measurement of bilirubin is being used for neonatal jaundice. Its utility during phototherapy in preterm babies is not established. Objective of our study was to assess the e cacy of transcutaneous bilirubin (TcB) measurement in comparison to total serum bilirubin in preterm newborns at admission and during phototherapy at covered skin area (glabella). It was a prospective observational study and conducted at neonatal intensive care unit of a tertiary care hospital from January 2017 to January 2019. One hundred eligible preterm neonates were enrolled. Babies who were very sick, with poor peripheral circulation, edematous, having conjugated hyperbilirubinemia, with major congenital malformations, already received phototherapy or exchange transfusion were excluded. Paired total serum bilirubin and transcutaneous bilirubin were measured at admission, at 6 hours and 24 hours during phototherapy. TcB was measured from area (glabella) covered by eye protector during phototherapy.Sample for TsB was taken within 10 minutes of TcB measurement. The mean difference between TsB and TcB values at admission, 6 hours and 24 hours of phototherapy were -0.005 (0.353), --0.350 (0.611), and -0.592 (0.353) respectively. At admission or before starting of phototherapy the difference (TsB-TcB) was statistically not signi cant (p=.125), while the difference in these values were statistically signi cant at 6 hours and 24 hours of phototherapy. Conclusion: TcB measurements from covered skin area in jaundiced preterm infants during phototherapy were not correlated with TsB and cannot be used as an alternate of serum bilirubin levels.
What Is KnownTotal serum bilirubin (TB) measurement in jaundiced neonates by high performance liquid chromatography is a "gold standard".There is evidence for use of transcutaneous bilirubinometry for assessment of bilirubin in term newborn.
What is NewTcB measurements from a covered skin area in jaundiced preterm newborns under phototherapy were not correlated signi cantly at 6 hours and 24 hours of phototherapy, but correlated before phototherapy.TcB cannot be used as an alternate of serum bilirubin levels however, it reduces the frequency of blood sampling, iatrogenic blood loss, pain associated with prick and improves quality of neonatal care.
Objective To compare the effect of self-inflating bag (SIB) vs. T-piece resuscitator (TPR) on PaCO 2 levels, when used for brief manual ventilation during administration of first dose of surfactant. Methods Preterm neonates were randomized to receive positive pressure ventilation with either self-inflating bag or T-piece resuscitator during administration of first dose of surfactant. Arterial blood gases were obtained at baseline and 1 h after the intervention. Primary outcome was the mean change in PaCO 2 levels 1 h after the intervention. Results Eighty neonates were enrolled (40 in each group). The drop in PaCO 2 at 1 h was significantly greater in the self inflating bag group as compared to the T-piece resuscitator group [8.96 ± 9.06 mmHg vs. 1.37 ± 9.06 mmHg, Mean difference = 7.58 mmHg, (95% CI: 3.78 to 11.4); P < 0.01]. The PaCO 2 change was also statistically significant in the subgroup of infants that required only non-invasive ventilation. The need for second dose of surfactant was higher in the self-inflating bag group [77% vs. 55%, RR-1.41 (95% CI: 1.02 to 1.94); P = 0.03]. Conclusions T-piece resuscitator results in smaller reduction in PaCO 2 levels compared to the self inflating bag, when used for brief manual ventilation during surfactant administration.
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