BiliCheck vs JM-103 in identifying neonates not at risk of hyperbilirubinaemia

Abstract

BackgroundTranscutaneous bilirubinometry is widely used to predict hyperbilirubinemia by using several devices. The aim of this study was to compare the predictive ability of BiliCheck vs JM-103 in identifying neonates not at risk of significant hyperbilirubinemia, putting the data obtained with the two instruments on our transcutaneous bilirubin nomogram built with the BiliCheck.MethodsTranscutaneous bilirubin (TcB) measurement was performed when jaundice appeared in newborn babies and/or just before discharge from the hospital. It was performed at the forehead with the two instruments within 5 minutes by two experienced neonatologists, each one blind to the value obtained by the other. Blood samples were drawn to obtain total serum bilirubin (TSB) levels soon after TcB measurements.ResultsA total of 627 paired-sample measurements were obtained from 298 newborn babies. Out of the total population studied, 16 newborn babies (5.4%) showed significant hyperbilirubinemia defined as TSB value >17 mg/dL, or as need for phototherapy treatment according to the AAP guidelines. TcB measurements showed false negative results in the first 60 hours of life using both devices. After the 60th hour of life, TcB measurements using both devices successfully predicted newborn babies not at risk of significant hyperbilirubinemia, being the JM-103 more reliable than BC because of fewer false positive results.ConclusionsOur study shows that both BC and JM-103 can exclude subsequent significant hyperbilirubinemia when the measurements are performed after the 60th hour of life. Nevertheless, the transcutaneous pre-discharge screening should be considered only as the first step, and it has to be followed by a follow-up through the first days after discharge.

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“…According to the statistical significant difference (P = 0.074) in this study, it can be concluded that measuring the level of bilirubin depends on the age of the baby; so this finding was inconsistent with our results, considering the lack of a significant correlation between the two variables [16].…”

“…Unfortunately this is an invasive and painful method which compared to portable bilirubinometer devices is associated with some delays in revealing data and requires serial blood sampling [8]. The first attempt to measure bilirubin through the skin was carried out in 1960 [9]. Early devices were not accurate enough to detect bilirubin level effectively, but they improved gradually and nowadays these machines are used as a noninvasive, safe, painless and simple way to estimate the bilirubin level through the skin.…”

Transcutaneous bilirubin nomograms in African neonates

“…The high NPV for the 75 th and 95 th percentiles also suggest that our nomograms for the two instruments can reliably estimate infants who are unlikely to develop significant hyperbilirubinemia from 24 to 96 hours of age. Romagnoli and colleagues were perhaps the only researchers that have explored the predictive ability of nomograms derived from both JM-103 and Bilichek [ 29 ]. The measurements below 75 th percentiles from both instruments were found to be highly predictive of infants who were unlikely to develop significant hyperbilirubinemia between 24 and 96 hours of age (NPV: 98.4 to 100%).…”

Italian guidelines for management and treatment of hyperbilirubinaemia of newborn infants ≥ 35 weeks’ gestational age

“…Transcutaneous bilirubin (TcB) can be used as first step in order to reduce the number of invasive and painful blood sampling. BiliCheck TM (Respironics, Marietta, GA – USA) and JM-103 (Drager Medical Inc, Telford, Pennsylvania) are the two most used bilirubinometers in the studies conducted in the Italian population and both had good correlation with TSB values [ 21 , 22 , 32 , 33 ]. TSB measurement is always necessary when the level of bilirubin is high and for therapeutic decisions (evidence level 1b).…”