Comparison of Diagnostic Accuracy of Different Sites for Transcutaneous Bilirubin Measurement in Early Preterm Infants

Agrawal, Garima; Garg, Kapil; Sitaraman, Sadasivan; Sarna, Anurag

doi:10.1007/s12098-018-2739-4

Cited by 12 publications

(22 citation statements)

References 17 publications

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“…Some studies have tested a singular site, 4,6,7,9,10 while others have examined multiple sites for comparison. 3,[11][12][13][14][15][16] The recommendation of the optimal site for TcB measurements in premature infants is conflicting in the literature. The question is further complicated by many variables such as GA, birth weight, and ethnicity.…”

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confidence: 99%

Transcutaneous Bilirubin Monitoring in Preterm Infants of 23 to 34 Weeks' Gestation

Weber

Vadasz-Chates²,

Wade

et al. 2021

Am J Perinatol

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Objective The study aimed to evaluate the validity of transcutaneous bilirubin (TcB) measurements at three sites in premature infants born at 230/7 to 346/7 weeks' gestational age (GA) compared with total serum bilirubin (TSB) measurements. Study Design A prospective study was conducted at Banner – University Medical Center Phoenix, where informed consent was obtained from the infant's parent or legally authorized representative. Cohort A was comprised of infants 230/7 to 286/7 weeks' GA and Cohort B contained subjects 290/7 to 346/7 weeks' GA. Baseline TSB measurements were collected at approximately 24 hours of life, as the standard of care and the TcB measurements were obtained from the sternum, interscapular, and buttock areas at approximately ± 30 minutes from collection of the TSB. Statistical analysis of measurements including sensitivity, specificity, positive, and negative predictive values, and the area under the receiver operator characteristic curve (AUROC) were performed. Results A total of 166 infants were included in the study population. Cohort A consisted of 41 subjects and Cohort B contained 125 subjects. The results showed that baseline TcB measurements from the interscapular area were the most sensitive and specific with TSB levels >5.0 mg/dL in Cohort A. Baseline TcB measurements from the sternum demonstrated greatest sensitivity and specificity when the TSB level was >8.0 mg/dL in Cohort B. In general, each of the three sites in both cohorts demonstrated excellent AUROCs and negative predictive values. Conclusion The use of a TcB meter in preterm infants can be a reliable noninvasive screening tool for hyperbilirubinemia, and it may be beneficial in decreasing painful stimuli and iatrogenic blood loss when used as an adjunct to TSB monitoring. Key Points

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confidence: 99%

Transcutaneous Bilirubin Monitoring in Preterm Infants of 23 to 34 Weeks' Gestation

Weber

Vadasz-Chates²,

Wade

et al. 2021

Am J Perinatol

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“…However, there is some doubt regarding the use of TcB as a complete replacement for TSB [7], especially in preterm and low birth weight infants [8]. Although some studies have reported that TcB is less accurate in preterm infants than in full-term infants, a greater number of studies have reported that TcB is an accurate and reasonable alternative to TSB in preterm infants [9][10][11]. Furthermore, many recent reports have verified the accuracy and usefulness of TcB in preterm and low birth weight infants [12].…”

Section: Discussionmentioning

confidence: 99%

“…In real clinical practice, we have mostly used the forehead and sternum for TcB assessment. Some reports have used other sites, such as the interscapular space, hipbone, abdomen [10], and patchcovered skin; however, these sites are not commonly used in real clinical practice. Additionally, although TcB assessment at covered skin (r = 0.80) has been shown to be much better than TcB assessment at uncovered skin, the use of a patch is not convenient [2,19].…”

Section: Discussionmentioning

confidence: 99%

The forehead is a better site than the sternum to check transcutaneous bilirubin during phototherapy in sick infants

Jeon

Lim

et al. 2020

BMC Pediatr

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Background To confirm the accuracy of transcutaneous bilirubin (TcB) in the neonatal intensive care unit both with and without phototherapy, and compare forehead and sternum as the TcB assessment site. Methods We simultaneously assessed the total serum bilirubin (TSB) and TcB at the forehead and sternum, using a JM-103 bilirubinometer. We analyzed the correlation between the TSB and TcB assessed at the forehead and sternum, with measurements classified as ‘without phototherapy’ (before phototherapy and > 24 hours after phototherapy discontinuation) and ‘with phototherapy’ (after 24 hours of phototherapy). Results There were 1,084 paired forehead and sternum TcB measurements, with the corresponding TSB measurement, from 384 infants. Their mean gestational age of 35.4 ± 3.2 weeks (62% were preterm) and a mean birth weight of 2434 ± 768 grams, and TSB was 6.61 ± 3.56 mg/dL. Without phototherapy, TcB values at the forehead and sternum were correlated well to the TSB value (r = 0.925 and 0.915, respectively). With phototherapy, TcB values at the forehead and sternum were significantly correlated with the TSB value, but TcB at the forehead (r = 0.751) was a better match to the TSB than was TcB at the sternum (r = 0.668). Additionally, Bland-Altman plots showed a greater degree of underestimation of the TSB by TcB at the sternum with phototherapy. Conclusions TcB was more accurate in infants not receiving phototherapy. During phototherapy, it is better to assess TcB at the forehead rather than at the sternum.

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“…[4] Agrawal et al in a study published in this issue of the journal, evaluate the correlation and diagnostic performance of TcB measured at different body sites with STB in preterm neonates born at less than 35 wks of gestation. [5] TcB measured at interscapular area was found to have best correlation with STB and highest sensitivity for diagnosing the need of phototherapy. However, even for intrascapular area, the 95% CI for agreement between STB and TcB ranged from −4.3 to +5.4 mg/dL.…”

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Transcutaneous Bilirubin for Screening of Significant Jaundice in Very Preterm Neonates

Chawla

2018

Indian J Pediatr

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Comparison of Diagnostic Accuracy of Different Sites for Transcutaneous Bilirubin Measurement in Early Preterm Infants

Abstract: Transcutaneous bilirubin measurement is an acceptable method for identification of hyperbilirubinemia requiring treatment in early preterm newborns. The authors recommend interscapular region as a reliable site in infants of gestational age ≤34 wk for measuring transcutaneous bilirubin.

Cited by 12 publications

References 17 publications

Transcutaneous Bilirubin Monitoring in Preterm Infants of 23 to 34 Weeks' Gestation

Transcutaneous Bilirubin Monitoring in Preterm Infants of 23 to 34 Weeks' Gestation

The forehead is a better site than the sternum to check transcutaneous bilirubin during phototherapy in sick infants

Transcutaneous Bilirubin for Screening of Significant Jaundice in Very Preterm Neonates

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