Comparison of Diagnostic Accuracy of Different Sites for Transcutaneous Bilirubin Measurement in Early Preterm Infants

Overview

Journal Indian J Pediatr

Specialty Pediatrics

Date 2018 Jul 20

PMID 30022429

Citations 4

Authors

Garima Agrawal

Kapil Garg

Sadasivan Sitaraman

Anurag Sarna

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate correlation of transcutaneous bilirubin (TcB) measured at different body sites with serum total bilirubin (TSB) in early preterm infants.

Methods: This hospital based prospective comparative study was carried out in the Department of Pediatrics, SMS Medical College, Jaipur between April 2015 to March 2016. Early preterm infants with gestational age ≤ 34 weeks in whom clinical jaundice was significant mandating TSB measurement were included in the study. Study subjects who met the inclusion criteria were chosen consecutively. Neonates in whom phototherapy was already initiated and those with poor perfusion (capillary refill time > 3 s) were excluded from the study. All the measurements were carried out within first postnatal week. Transcutaneous bilirubin was measured from three sites: forehead, sternum and interscapular region and within 15 min of TcB measurement, blood samples were taken and serum bilirubin level was calculated.

Results: Correlation coefficients of transcutaneous bilirubin measured from forehead, sternum and interscapular sites were 0.82, 0.84 and 0.86 respectively. TcB measured from all the three sites correlated significantly with serum bilirubin (p < 0.001), but the correlation was best at interscapular site. Sensitivity, specificity and false negative rates were calculated with respect to starting phototherapy. Interscapular site had the highest sensitivity and lowest false negative rate (87.6 and 12.4% respectively) as compared to forehead (79.2 and 20.8% respectively) and sternum (87.1 and 12.9% respectively).

Conclusions: Transcutaneous bilirubin measurement is an acceptable method for identification of hyperbilirubinemia requiring treatment in early preterm newborns. The authors recommend interscapular region as a reliable site in infants of gestational age ≤34 wk for measuring transcutaneous bilirubin.

Citing Articles

Transcutaneous bilirubinometry versus total serum bilirubin measurement for newborns.

Okwundu C, Olowoyeye A, Uthman O, Smith J, Wiysonge C, Bhutani V Cochrane Database Syst Rev. 2023; 5:CD012660.

PMID: 37158489 PMC: 10167941. DOI: 10.1002/14651858.CD012660.pub2.

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

Ho S, Lin Y, Chen C Diagnostics (Basel). 2021; 11(9).

PMID: 34574069 PMC: 8466921. DOI: 10.3390/diagnostics11091729.

The forehead is a better site than the sternum to check transcutaneous bilirubin during phototherapy in sick infants.

Jeon J, Lim G, Oh K, Lee N, Park H, Chung M BMC Pediatr. 2020; 20(1):548.

PMID: 33278875 PMC: 7718678. DOI: 10.1186/s12887-020-02450-w.

Transcutaneous Bilirubin for Screening of Significant Jaundice in Very Preterm Neonates.

Chawla D Indian J Pediatr. 2018; 86(1):4.

PMID: 30370482 DOI: 10.1007/s12098-018-2810-1.

References

Cashore W . Bilirubin and jaundice in the micropremie. Clin Perinatol. 2000; 27(1):171-9, vii. DOI: 10.1016/s0095-5108(05)70012-9. View

Knupfer M, Pulzer F, Braun L, Heilmann A, Robel-Tillig E, Vogtmann C . Transcutaneous bilirubinometry in preterm infants. Acta Paediatr. 2001; 90(8):899-903. View

Ip S, Chung M, Kulig J, OBrien R, Sege R, Glicken S . An evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics. 2004; 114(1):e130-53. DOI: 10.1542/peds.114.1.e130. View

Karolyi L, Pohlandt F, Muche R, Franz A, Mihatsch W . Transcutaneous bilirubinometry in very low birthweight infants. Acta Paediatr. 2004; 93(7):941-4. DOI: 10.1111/j.1651-2227.2004.tb02693.x. View

Szabo P, Wolf M, Bucher H, Haensse D, Fauchere J, Arlettaz R . Assessment of jaundice in preterm neonates: comparison between clinical assessment, two transcutaneous bilirubinometers and serum bilirubin values. Acta Paediatr. 2004; 93(11):1491-5. DOI: 10.1080/08035250410018328. View

Willems W, van den Berg L, de Wit H, Molendijk A . Transcutaneous bilirubinometry with the Bilicheck in very premature newborns. J Matern Fetal Neonatal Med. 2004; 16(4):209-14. DOI: 10.1080/14767050400013818. View

De Luca D, Zecca E, de Turris P, Barbato G, Marras M, Romagnoli C . Using BiliCheck for preterm neonates in a sub-intensive unit: diagnostic usefulness and suitability. Early Hum Dev. 2006; 83(5):313-7. DOI: 10.1016/j.earlhumdev.2006.06.006. View

Boo N, Ishak S . Prediction of severe hyperbilirubinaemia using the Bilicheck transcutaneous bilirubinometer. J Paediatr Child Health. 2007; 43(4):297-302. DOI: 10.1111/j.1440-1754.2007.01062.x. View

Elias L, Guinsburg R, Peres C, Balda R, Dos Santos A . Disagreement between parents and health professionals regarding pain intensity in critically ill neonates. J Pediatr (Rio J). 2008; 84(1):35-40. DOI: 10.2223/JPED.1748. View

10.

Stillova L, Matasova K, Zibolen M, Stilla J, Kolarovszka H . Transcutaneous bilirubinometry in preterm neonates. Indian Pediatr. 2009; 46(5):405-8. View

11.

Schmidt E, Wheeler C, Jackson G, Engle W . Evaluation of transcutaneous bilirubinometry in preterm neonates. J Perinatol. 2009; 29(8):564-9. DOI: 10.1038/jp.2009.38. View

12.

Badiee Z, Mohammadizadeh M, Shamee M . Diagnostic usefulness of transcutaneous bilirubinometry in very preterm newborns. Int J Prev Med. 2012; 3(4):262-5. PMC: 3354395. View

13.

Sajjadian N, Shajari H, Saalehi Z, Esphahani F, Alizadeh Taheri P . Transcutaneous bilirubin measurement in preterm neonates. Acta Med Iran. 2013; 50(11):765-70. View

14.

Yaser A, Tooke L, Rhoda N . Interscapular site for transcutaneous bilirubin measurement in preterm infants: a better and safer screening site. J Perinatol. 2014; 34(3):209-12. DOI: 10.1038/jp.2013.167. View

15.

Kurokawa D, Nakamura H, Yokota T, Iwatani S, Morisawa T, Katayama Y . Screening for Hyperbilirubinemia in Japanese Very Low Birthweight Infants Using Transcutaneous Bilirubinometry. J Pediatr. 2015; 168:77-81.e1. DOI: 10.1016/j.jpeds.2015.08.038. View

16.

Tan K, Mylvaganam A . Transcutaneous bilirubinometry in preterm very low birthweight infants. Acta Paediatr Scand. 1988; 77(6):796-801. DOI: 10.1111/j.1651-2227.1988.tb10758.x. View

17.

Poissonnet C, Burdi A, Garn S . The chronology of adipose tissue appearance and distribution in the human fetus. Early Hum Dev. 1984; 10(1-2):1-11. DOI: 10.1016/0378-3782(84)90106-3. View

18.

Bhutani V, Johnson L, Sivieri E . Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics. 1999; 103(1):6-14. DOI: 10.1542/peds.103.1.6. View