The Impact of Phototherapy on the Accuracy of Transcutaneous Bilirubin Measurements in Neonates: Optimal Measurement Site and Timing

Abstract

Transcutaneous bilirubinometer devices are widely applied to assess neonatal hyperbilirubinemia. However, the optimal skin site and timing of transcutaneous bilirubin (TCB) measurements for the strongest correlation with total serum bilirubin (TSB) levels after phototherapy are still unclear. We conducted a retrospective observational study evaluating the correlation of TCB and TSB levels in neonates postphototherapy. The TCB measurements on the forehead and mid-sternum at 0 and 30 min postphototherapy were assessed by using a JM-103 bilirubinometer. Paired TCB and TSB measurements were assessed by Pearson correlation and Bland–Altman plots. We analyzed 40 neonates with 96 TSB and 384 TCB measurements. The TSB level correlated moderately with the forehead TCB level at 30 min postphototherapy (r = 0.65) and less strongly with the midsternum TCB level at 0 min postphototherapy (r = 0.52). The forehead at 30 min after cessation of phototherapy was the best time point and location of TCB measurement for the assessment of neonatal jaundice status. The reliability of TCB measurements varied across skin sites and durations after phototherapy. The effectiveness of TCB measurement to assess neonatal hyperbilirubinemia is much better on covered skin areas (foreheads) 30 min postphototherapy. The appropriate application of transcutaneous bilirubinometers could aid in clinical practice and avoid unnecessary management.

Comparison of Transcutaneous and Total Serum Bilirubin Measurements at Five Different Sites in Newborns before and after Phototherapy

“…Several studies reported that TcB measurement's effectiveness in assessing TSB is better and more reliable on covered skin areas during or after phototherapy [3,7,12,[20][21][22]. Although three of these studies [12,20,21] used BiliChek, Hulzebos et al [3], and Ho et al [7] used JM-103. Casnocha Lucanova et al [5] utilized Minolta JM-103.…”

“…The abdomen, interscapular, and gluteal regions are used less frequently for TcB measurements [3,4,10,11]. TcB measurement in areas covered by a diaper or commercialized tool can avoid underestimating the TSB levels in infants undergoing phototherapy [7]. Several studies reported that TcB measurements from covered sites during phototherapy were more reliable than those from exposed areas [3,4,[12][13][14].…”

“…The common locations for TcB measurement are the forehead and sternal area [3,4,[6][7][8]. Measurements in these areas have the best correlation with TSB [9].…”

Demystifying non-invasive approaches for screening jaundice in low resource settings: a review

“…This necessitates an investigation into the challenges confronting the accuracy of TcB during phototherapy and the formulation of strategies to surmount these constraints. Moreover, the exploration of alternative techniques or modifications to existing technology capable of furnishing precise and reliable bilirubin measurements during phototherapy is imperative ( 223 ). A comprehensive understanding of the photo breakdown of bilirubin concerning TcB measurements and the development of techniques to account for this phenomenon would significantly enhance the clinical applicability of TcB devices.…”

Transcutaneous Bilirubin Accuracy Before, During, and After Phototherapy: A Meta-Analysis

“…[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Also, several of the included studies have repeated paired measurements per neonate. 23,[28][29][30]33,35,38,39,44,45,[50][51][52][53][54][55][56][57][58][59][60][61][62][63] In earlier literature, it is postulated that TcB values in the higher ranges (above 256 lmol/L [3 mg/dL]) are not reliable. 7 We were not able because of lack of original data to separately assess the agreement in the higher ranges.…”