Transcutaneous Bilirubin After Phototherapy in Term and Preterm Infants

Abstract

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.

Accuracy of transcutaneous bilirubin measurement in newborns after phototherapy

“…[4][5][6][7][8] Tan and Dong 9 referred a study group consisting exclusively of Asian infants. Grabenhenrich et al 10 included only 39 term infants, and Povaluk et al 11 from Brazil only 15 term neonates after phototherapy. The findings are inconsistent.…”

Comparison of transcutaneous and serum bilirubin before, under, and after phototherapy in term and late‐preterm infants

“…Juster‐Reicher et al found a good correlation between TcB and TSB at 8 hours after phototherapy in infants with ≥35 weeks of gestational age and birth weight of ≥2000 g . Other investigators found a moderate correlation between TcB and TSB before and after phototherapy, but a lesser correlation during phototherapy; moreover, some studies found that TcB was not reliable for monitoring neonatal hyperbilirubinemia during or after phototherapy . In this study, we demonstrated the correlation between TcB and TSB before, under (mean duration under phototherapy was 3.7 and 4.4 days in term and late‐preterm infants, respectively), and after discontinuing phototherapy in a population of jaundiced term and late‐preterm infants, which revealed acceptably a highly positive linear correlation.…”

Hiperbilirubinemia pada neonatus >35 minggu di Indonesia; pemeriksaan dan tatalaksana terkini

“…[18][19] Bilirubinometer transkutan merupakan metode yang akurat dan tidak invasif sehingga dapat menjadi alternatif pemeriksaan bilirubin neonatus. 20 Kelemahan [21][22] Beberapa penelitian melaporkan hasil pemeriksaan bilirubin yang tidak akurat dan konsisten apabila bilirubin total lebih besar dari 15mg/dl. 14,23,24 Dengan demikian, secara umum TcB cukup menjanjikan karena meminimalisir pengambilan darah, dapat digunakan sebagai pemeriksaan universal, dan tetap akurat dengan kadar bilirubin di bawah 15mg/dl.…”