Covered skin transcutaneous bilirubin estimation is comparable with serum bilirubin during and after phototherapy

Fonseca, Rafael; Kyralessa, R; Malloy, Michael H.; Richardson, Joan; Jain, Sunil K.

doi:10.1038/jp.2011.66

Cited by 38 publications

(43 citation statements)

References 11 publications

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“…In this population, we showed diagnostic performance of TcB was comparable for hyperbilirubinemia screening and for bilirubin monitoring during phototherapy and in the hours following treatment discontinuation. These results had also been found by others in term or near-term populations [13,14], although this is still debated [12]. …”

Section: Discussionsupporting

confidence: 59%

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Diagnosis Accuracy of Transcutaneous Bilirubinometry in Very Preterm Newborns

Rubio¹,

Epiard

Gebus

et al. 2016

Neonatology

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Background: Transcutaneous bilirubin (TcB) is a validated test for systematic screening of neonatal hyperbilirubinemia and monitoring term and near-term infants under phototherapy. Objectives: To evaluate TcB diagnostic accuracy for very preterm neonates. Methods: Total serum bilirubin (TSB) and TcB measurements were performed prospectively in a multicenter sample of newborns <30 weeks of gestational age (GA). TcB sensitivity, specificity, predictive values, and likelihood ratios for the detection of neonates requiring phototherapy were calculated over the first 15 days of life, with or without phototherapy, with the expectation of achieving a detection rate of hyperbilirubinemia of over 95%. The potential influence of neonatal characteristics on the discordance between TcB and TSB in very preterm newborns was analyzed using multivariate multilevel logistic regression analyses. Results: Altogether, 481 measurements were analyzed in 167 preterm patients. Mean GA was 27.6 ± 1.6 weeks. The rates of newborns requiring phototherapy were 52% in the first 3 days, 16% from the 4th to the 7th day, and 2% during the second week. Diagnostic performance was similar among babies with or without phototherapy. TcB sensitivity decreased over time from 100% (93.9-100.0) to 50% (1.3-98.7). Specificity showed an inverse evolution from 14.8% (7.0-26.2) to 80.7% (72.2-89.2). The best performance was that of negative predictive values which varied from 95.5 to 100.0. False negatives were rare throughout the study (0.8% of measurements). In a multivariate analysis, the only factor significantly influencing discordance between TcB and TSB was postnatal age. We did not find any impact of GA and skin color. Conclusion: Among very preterm babies, TcB measurements might be useful for screening for neonatal jaundice in the first 2 weeks of life. In case of a TcB value below the phototherapy threshold, invasive TSB quantification could be unnecessary, with potential avoidance of blood drawing.

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Section: Discussionsupporting

confidence: 59%

“…However, the performance of TcB during phototherapy and in the hours after discontinuation of phototherapy is still debated, even in term and near-term neonates [12,13,14], and has never been explored in very preterm infants.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis Accuracy of Transcutaneous Bilirubinometry in Very Preterm Newborns

Rubio¹,

Epiard

Gebus

et al. 2016

Neonatology

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“…Unlike the most of the authors 6,11,19 who measured on the patched forehead, we have kept in mind the suggestion by Bhutani et al 20 that clinicians should seek alternative anatomic sites unexposed to high levels of ambient lighting. Because the lower abdomen is covered by a diaper in every infant, this alternative measurement site may prove as convenient in nurseries anywhere.…”

Section: Discussionmentioning

confidence: 98%

Accuracy of transcutaneous bilirubin measurement in newborns after phototherapy

et al. 2016

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“…13 Other studies that investigated the relation of post-phototherapy bilirubin detection methods reported only descriptive group means or measures of association (correlation) but failed to derive applicable estimates from their data. [14][15][16]20 Answering the need for measures applicable in clinical decisionmaking, we calculated safety margins to assure that ,1% of TcB-screened neonates will be falsely labeled negative. Up to 8 hours after finishing phototherapy, we consider TcB measures safe below levels of the individual therapy threshold 27.3 mg/dL.…”

Section: Discussion Tcb Levels After Phototherapymentioning

confidence: 99%

“…12 Two theoretical kinetics for post-phototherapy TcB have been contrasted recently (plateau versus rebound). 13 In short, TcB levels were found significantly lower than TSB 6 hours after cessation of light exposure, 14 but TcB may resume preexposure validity 18 to 24 hours after phototherapy. 15 Because of this delayed equalization of bilirubin between blood and skin tissue, the validity of TcB has been questioned during and after phototherapy.…”

mentioning

confidence: 99%

Transcutaneous Bilirubin After Phototherapy in Term and Preterm Infants

Grabenhenrich¹,

Grabenhenrich

Bührer³

et al. 2014

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Phototherapy decreases bilirubin concentration in skin more rapidly than in blood. During and after phototherapy, transcutaneous bilirubin measurements are considered unreliable and therefore discouraged. WHAT THIS STUDY ADDS:Transcutaneous bilirubin underestimates total serum bilirubin by 2.4 mg/dL (SD, 2.1 mg/dL) during the first 8 hours after phototherapy. This gives a safety margin of ∼7 mg/dL below the treatment threshold to omit confirmatory blood sampling. abstract OBJECTIVES: To compare transcutaneous bilirubin (TcB) readings with total serum bilirubin (TSB) after phototherapy, estimating the range of TcB where confirmation through blood sampling can be avoided. METHODS:Preterm and term neonates receiving in-hospital phototherapy underwent TcB measurements (device JM-103, TcB) alongside routine TSB before and after treatment. We calculated time-dependent safety margins for transcutaneous readings to correctly assign 99% of infants not to receive phototherapy. RESULTS:Between August 2011 and December 2012, 86 newborn infants (47 preterm, 39 term) underwent a total of 189 parallel measurements. Mean difference (TcB 2 TSB) before treatment was 20.6 mg/dL (SD, 1.9 mg/dL). Within the first 8 hours after phototherapy, TcB levels were 22.4 mg/dL (SD, 2.1 mg/dL) below TSB. Thereafter the difference gradually returned to pretreatment values (21.8 mg/dL in 8-16 hours, 21.1 mg/dL in 16-24 hours, and 20.8 mg/dL after 24 hours), while variations remained stable over time (SD, 1.4-1.8 mg/dL). In the first 8 hours after treatment, TcB levels of 27.3 mg/dL below the individual phototherapy threshold allowed safe rejection of confirmatory blood sampling. After 8 hours, that safety margin was reduced to approximately 25.0 mg/dL. CONCLUSIONS: TcB measurements remain a valuable tool after phototherapy when time-dependent underestimation of TcB is being accounted for.

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Covered skin transcutaneous bilirubin estimation is comparable with serum bilirubin during and after phototherapy

Cited by 38 publications

References 11 publications

Diagnosis Accuracy of Transcutaneous Bilirubinometry in Very Preterm Newborns

Diagnosis Accuracy of Transcutaneous Bilirubinometry in Very Preterm Newborns

Accuracy of transcutaneous bilirubin measurement in newborns after phototherapy

Transcutaneous Bilirubin After Phototherapy in Term and Preterm Infants

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