Transcutaneous Bilirubin Measurements Can Be Used to Measure Bilirubin Levels during Phototherapy

Abstract

Objective To determine whether transcutaneous bilirubin measurements (TcB) before and during phototherapy taken from covered skin during phototherapy correlate with total serum bilirubin (TSB) levels. Study Design In this prospective observational study, healthy term newborns who required TSB measurements were included. TcB measurements were taken from the forehead before starting and during phototherapy using the BiliChek device. Before starting phototherapy, part of the forehead was covered. Blood for TSB measurement was collected within 5 minutes of TcB measurements. Correlations and mean differences between TcB and TSB before and during phototherapy were calculated. Result Paired TSB and TcB measurements before and during phototherapy in 151 newborns were performed. The mean gestational age was 38.8 weeks and birth weight was 3.1 kg; 53% were male. Before starting phototherapy, TSB and TcB were 183.8 ± 41.6 and 190.5 ± 43 μmol/l, respectively. During phototherapy, TSB and TcB were 191.8 ± 39.4 and 187.8 ± 45.3 μmol/l, respectively. Linear regression analysis showed a significant correlation between TcB and TSB before starting phototherapy and during phototherapy (r: 0.85; p < 0.001 and r: 80.0; p < 0.001), respectively. Before starting phototherapy, the mean difference between TSB and TcB was 6.2 ± 23.2 μmol/l, with a 95% CI of −39.3 to 51.7 μmol. During phototherapy, the mean difference was −2.8 ± 23.5 μmol/l, with a 95% CI of −48.9 to 43.3 μmol/l. Conclusion TcB measurements from covered skin in jaundiced term infants during phototherapy correlate with TSB and can be used to monitor bilirubin levels during phototherapy.

Accuracy of transcutaneous bilirubin on covered skin in preterm and term newborns receiving phototherapy using a JM-105 bilirubinometer

“…They observed that TCB had a slight tendency to overestimate TSB when bilirubin levels were high and that TCB started to underestimate TSB after 96 h of treatment, but in general the correlation shown was good and similar to our findings. Other authors obtained similar results using the same device [5,6,8]. However, in a study published in 2017 by Murli performed in 100 newborns, they found a bad correlation between the TSB and TCB before, during and after the treatment [10].…”

“…For this reason, some published studies have evaluated whether the measurement of TCB in covered skin (PTCB) could maintain the correlation with TSB. These studies show contradictory results and some of them include a limited number of patients, especially as regards preterm infants [3,5,6]. Most of them shared the same model of bilirubinometer, together with a concrete patch, both different to our study's.…”

“…This is also the series with the largest number of TCB determinations recorded on covered skin and the second in terms of the number of preterm infants included. Considering that the majority of studies using a skin cover have been performed with the Bilicheck® device [5][6][7][8][9][10][11][12][13], our series is the most representative in number of cases of any gestational age and preterm age using the JM-105 device [14]. The use of TCB as a screening method for neonatal hyperbilirubinemia is included in clinical practice guidelines.…”

“…On the usefulness of covering the skin from exposure to phototherapy, in 1983, Hegyi et al showed that only the TCB measured in uncovered skin changes during phototherapy, while measurements on covered skin continue to predict the TSB with sufficient reliability [20]. Other subsequent studies carried out with the Bilicheck® bilirubinometer corroborated this statement [5][6][7][8]22]. Zecca et al [7] used a photo-opaque patch of 2.5 cm in diameter designed for treatment during phototherapy (BiliEclipse, Respironics®) located on newborn´s forehead.…”

Relação entre o tempo de clampeamento do cordão umbilical e incidência de Icterícia Neonatal e níveis de hematócrito em recém-nascidos a termo saudáveis / Relationship between umbilical cord clamping time and incidence of Neonatal Jaundice and hematocrit levels in healthy term newborns

“…Ressalta-se também dificuldades com a equipe de saúde para padronizar a cronometragem do tempo de clampeamento, precisando excluir aquelas que não seguiram o método padronizado. Em relação aos níveis de bilirrubina plasmática, optamos por utilizar o método de bilirrubinometria transcutânea (Bilicheck®), tendo em vista que estudos mostram que este método pode ser utilizado de forma confiável para correlacionar com níveis séricos de bilirrubina (19) .…”