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

Abstract

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

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

“…Previously, only four studies evaluated this site in neonates. Unlike our study, all four studies were conducted on preterm infants [11,[17][18][19]. Although the correlation coefficient of the interscapular site (r = 0.86 and r = 0.85) was higher in two studies using JM-103 than that of our study, the correlation coefficient of the interscapular site (r = 0.846) calculated for only late preterm infants in the present study was similar to these studies [11,17].…”

“…Accordingly, the light transmitted by the transcutaneous bilirubinometer can easily access bilirubin and be reflected; thereby, levels are measured correctly [14]. Weber et al [18] reported that the most sensitive and specific area for TcB measurement was the interscapular site in infants born at 23 to 28 6/7 weeks of gestation and the sternum in infants born at 29 to 34 6/7 weeks of gestation. Similar to our study, Agrawal et al [11] measured TcB levels at the forehead, sternum, and interscapular site in preterm infants with a gestational age of ≤ 34 weeks, and the strongest correlation was at the interscapular site.…”

“…Only a few studies have evaluated the reliability of TcB measurement in the gluteal region [3,4,18,21]. Hulzebos et al [3] showed that TcB levels measured on the covered hipbone had a strong correlation and good agreement with TSB levels in preterm infants before, during, and after phototherapy (r = 0.81, 0.81, and 0.84, respectively).…”

Transcutaneous Bilirubin Measurement as a Predictor of Significant Neonatal Hyperbilirubinemia in Low Birth Weight Neonates

“…Interscapular was preferred site in neonates born at 23 to 34 weeks, sternal TCB was more sensitive and specific in babies born at 29 to 35 weeks. 18 In the present study, the average of the forehead and sternal value was a better predictor of neonatal hyperbilirubinemia. The area under the ROC curve for TCB measurements, TCB-AV, TCB -S and TCB-FH were 0.894, 0.887 and 0.878 respectively.…”

“…12,15 Studies have compared various sites for TCB measurement in late preterm infants and the results are contradicting. 11,[16][17][18] Agrawal G et al studied the diagnostic accuracy of TCB at three different sites (Forehead, sternum, and interscapular area) in early preterm infants opined that the interscapular region as a reliable area to measure TCB in infants 34 weeks. 11 They reported a correlation coefficient of 0.82, 0.84 and 0.86 for the forehead, sternum,…”