Accuracy of transcutaneous bilirubin on covered skin in preterm and term newborns receiving phototherapy using a JM-105 bilirubinometer

Costa-Posada, U.; Concheiro-Guisán, Ana; Ledo, M. F. Táboas; Gónzalez-Colmenero, Eva; González-Duran, María Luisa; Suárez-Albo, María; Fernández-Feijóo, Cristina Durán; Pumarada-Prieto, Marcelino; Martínez-Reglero, Cristina

doi:10.1038/s41372-019-0557-9

Cited by 20 publications

(14 citation statements)

References 23 publications

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“…After initiation of phototherapy and at a greater degree of prematurity, TcB-TSB agreement worsened. This is consistent with previous research that showed greater agreement between TcB and TSB prior to initiating phototherapy using the JM-103 and JM-105 devices [12, 20, 21]. As in prior studies, we saw no appreciable difference whether TcB was measured at the forehead or sternum prior to phototherapy [11, 14]; however, after the initiation of phototherapy, the current study suggests that the forehead may be the more preferred site for TcB measurement when using the JM-105 device.…”

Section: Discussionsupporting

confidence: 93%

“…As such, TSB measurements should be used to make clinical decisions after the initiation of phototherapy, especially since most preterm infants start phototherapy after the first or second day of life. As a potential solution to the underperformance of TcB after initiation of phototherapy, for example, some small studies in term and preterm infants explored the effectiveness of measuring TcB on covered skin [20, 24]. A similar approach, with a larger sample size, should be considered in preterm infants, to determine the effectiveness of TcB after phototherapy.…”

Section: Discussionmentioning

confidence: 99%

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Transcutaneous versus Total Serum Bilirubin Measurements in Preterm Infants

et al. 2021

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Introduction: Transcutaneous bilirubin (TcB) measurement offers a noninvasive approach for bilirubin screening; however, its accuracy in preterm infants is unclear. This study determined the agreement between TcB and total serum bilirubin (TSB) among preterm infants. Methods: A multisite prospective cohort study was conducted at 3 NICUs in Ontario, Canada, September 2016 to June 2018. Among 296 preterm infants born at 240/7 to 356/7 weeks, 856 TcB levels were taken at the forehead, sternum, and before and after the initiation of phototherapy with TSB measurements. Bland-Altman plots and 95% limits of agreement (LOA) expressed agreement between TcB and TSB. Results: The overall mean TcB-TSB difference was −24.5 μmol/L (95% LOA −103.3 to 54.3), 1.6 μmol/L (95% LOA −73.4 to 76.5) before phototherapy, and −31.1 μmol/L (95% LOA −105.5 to 43.4) after the initiation of phototherapy. The overall mean TcB-TSB difference was −15.2 μmol/L (95% LOA −86.8 to 56.3) at the forehead and −24.4 μmol/L (95% LOA −112.9 to 64.0) at the sternum. The mean TcB-TSB difference was −31.4 μmol/L (95% LOA −95.3 to 32.4) among infants born 24–28 weeks, −25.5 μmol/L (95% LOA −102.7 to 51.8) at 29–32 weeks, and −15.9 μmol/L (95% LOA −107.4 to 75.6) at 33–35 weeks. Measures did not differ by maternal ethnicity. Conclusion: Among preterm infants, TcB may offer a noninvasive, immediate approach to screening for hyperbilirubinemia with more careful use in preterm infants born at <33 weeks’ gestation, as TcB approaches treatment thresholds. Its underestimation of TSB after the initiation of phototherapy warrants the use of TSB for clinical decision-making after the initiation of phototherapy.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Transcutaneous versus Total Serum Bilirubin Measurements in Preterm Infants

et al. 2021

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“…Previous studies have noted variability between TcB and TSB in preterm infants undergoing phototherapy, but it was not significantly affecting management decisions in most studies [ 5 , 14 , 15 ]. Studies that assessed TcB on patched sternal skin vs. light-exposed skin of preterm infants undergoing phototherapy noted that patch TcB is more accurate and reliable to predict TSB [ 9 , 17 , 21 , 22 ]. Some studies found TcB tends to drift away from TSB levels when the TSB level exceeds 15 mg/dL even if measured in unexposed skin [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

The Accuracy of Transcutaneous Bilirubin as a Screening Test in Preterm Infants

Ng,

Maul,

Viswanathan

et al. 2023

Cureus

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Objective: To determine the accuracy of transcutaneous bilirubin (TcB) to predict total serum bilirubin (TSB) in preterm infants across gestational age (GA) ranges and to calculate the cost-effectiveness of TcB as the primary screening test of choice for neonatal jaundice in neonatal intensive care unit (NICU) settings.Methods: Single-center retrospective study of infants aged ≤ seven days admitted to the NICU over a sixmonth period with a paired TSB and TcB, with or without phototherapy as part of their routine clinical care. Infants were divided into GA-specific groups as term, late preterm, moderate preterm, and very preterm. Measurement bias (bias=TSB-TcB) was calculated on the paired TSB and TcB values, and a Bland-Altman analysis was carried out. The impacts of additional infant-specific variables on the bias were assessed with univariate and multivariate linear regression techniques. The potential direct cost savings associated with the use of TcB as the primary screening test were calculated.Results: A total of 263 paired TSB and TcB samples from 95 patients were included (130 paired samples from term (n=60), 75 from late preterm (n=21), 27 from moderate preterm (n=7), and 31 from very preterm (n=7)). The mean paired measurement bias across all the GA groups was -0.9 ± 2.9 mg/dL. The sensitivity and specificity of TcB in GA < 35 weeks were 92% and 62%, respectively. A conservative estimate of a one-third reduction in TSB measurement by using TcB as the primary screening test will have a direct cost saving of $3,148 over a six-month period. Conclusion: Our data suggest that TcB is a safe and potentially cost-effective screening test for jaundice across GA groups.

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“…This corroborates that there is a strong agreement present. The mean difference between TSB and TcB in preterm neonates before phototherapy is 0.64 mg/dl [95%: 0.13-1.14] in Posada et al using JM-105 [ 14 ]. The slightly higher accuracy of Posada et al could be secondary to the difference in the gestational age distribution and racial difference.…”

Section: Discussionmentioning

confidence: 99%

A Comparison Between Transcutaneous Bilirubin and Total Serum Bilirubin Levels for the Management of Jaundice in Preterm Neonates by Bland-Altman Plot

Panda

Gaurav

Das

et al. 2021

Cureus

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To compare the bilirubin levels measured by transcutaneous bilirubinometer and serum samples for the management of jaundice in preterm neonates. MethodsThe study was a prospective comparative observational study conducted in a tertiary care neonatal unit of Odisha from January 2019 to June 2020. All inborn and outborn neonates with a gestational age of 28 0/7 weeks to 36 6/7 weeks with the clinical diagnosis of neonatal jaundice were included in the study. Transcutaneous bilirubin (TcB) was estimated by Dragger jaundice meter JM-105 and simultaneously venous blood and total serum bilirubin levels (TSB) were measured by diazonium method. The comparison between TcB and TSB values was analyzed by direct linear correlation in scatter plot and Bland-Altman plot. ResultsA total of 167 preterm neonates (66, 28-33 6/7 and 111, 34-36 6/7 ), with a mean gestational age 33.55 ±2.36 weeks and a mean birth weight of 1960 ± 613 grams, were analyzed. The mean TSB and TcB levels were 12.99 ± 3.47 mg/dl (min-max 4.9-18.3 mg/dl) and 14.156 ± 4.71 mg/dl (min-max 4-20.1 mg/dL), respectively. The TcB is excellently correlated with TSB with a correlation coefficient of r =0.948, p ≤0.001. The bias difference between TcB and TSB is -1.16 (95% CI: 2.35, -4.6) mg/dl. The correlation coefficients between 28-33 6/7 weeks gestational age groups (r = 0.944) and 34-36 6/7 gestational age (r = 0.950) were similar. ConclusionTcB is well correlated with TSB level in preterm neonates. Hence, TcB can be used for the guidance of management in these neonates.

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Accuracy of transcutaneous bilirubin on covered skin in preterm and term newborns receiving phototherapy using a JM-105 bilirubinometer

Cited by 20 publications

References 23 publications

Transcutaneous versus Total Serum Bilirubin Measurements in Preterm Infants

Transcutaneous versus Total Serum Bilirubin Measurements in Preterm Infants

The Accuracy of Transcutaneous Bilirubin as a Screening Test in Preterm Infants

A Comparison Between Transcutaneous Bilirubin and Total Serum Bilirubin Levels for the Management of Jaundice in Preterm Neonates by Bland-Altman Plot

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