Abstract
Objective:
To determine the agreement between transcutaneous bilirubin (TcB) measured from shielded skin and serum total bilirubin (STB) in infants (34 to 41 weeks of gestation) with hyperbilirubinemia receiving phototherapy (PT).
Study Design:
In this prospective cohort study, we shielded a small area of skin on sternum using a commercial photo-opaque patch (BilEclipseTM, Philips Respironics, Murrysville, PA, USA). The TcB from the shielded skin (TcBs) and STB were measured at four time points—before initiation, 12 and 24 h during and once after (12 h) cessation of PT. TcB was measured using multiwavelength transcutaneous bilirubinometer (BiliChek, Philips Children’s Medical Ventures, Monroeville, PA, USA). The STB was measured in triplicate by spectrophotometry (Apel BR 5100, APEL, Japan). Bland and Altman plots were drawn to determine agreement between the TcBs and STB.
Results:
The gestation and birth weight of enrolled neonates were 37.0 (1.0) weeks and 2750 (458) g, respectively. The age at initiation and duration of PT were 75 (27 to 312) and 25.3 (4.4) h, respectively. Bland and Altman plot showed poor agreement between TcBs and STB at all time points. The gradient (median, range) between TcBs and STB at 0, 12, 24 h and 12 h after cessation of PT were −0.2 (−4.9 to 3.5), 1.4 (−4.7 to 4.0), 1.5 (−3.8 to 9.4) and 2 (−2.9 to 5.8) mg dl−1. The proportions of TcBs values outside ±1.5 mg dl−1 of STB ranged from 47 to 64% at four time points.
Conclusion:
TcBs does not appear to be reliable for estimating serum bilirubin in late preterm and term neonates receiving PT.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Woodgate P, Jardine LA . Neonatal jaundice: phototherapy. BMJ Clin Evid 2015; 2015: pii: 0319.
Sarici SU, Serdar MA, Korkmaz A, Erdem G, Oran O, Tekinalp G et al. Incidence, course, and prediction of hyperbilirubinemia in near-term and term newborns. Pediatrics 2004; 113: 775–801.
Dai J, Parry DM, Krahn J . Transcutaneous bilirubinometry: its role in the assessment of neonatal jaundice. Clin Biochem 1997; 30: 1–9.
Lilien LD, Harris VJ, Ramamurthy RS, Pildes RS . Neonatal osteomyelitis of the calca-neus: complication of heel puncture. J Pediatr 1976; 88: 478–480.
Bosschaart N, Kok JH, Newsum AM, Ouweneel DM, Mentink R, van Leeuwen TG et al. Limitations and opportunities of transcutaneous bilirubin measurements. Pediatrics 2012; 129: 689–695.
Rubaltelli FF, Gourley GR, Loskamp N, Modi N, Roth-Kleiner M, Sender A et al. Transcutaneous bilirubin measurement: a multicenter evaluation of a new device. Pediatrics 2001; 107: 1264–1271.
Ebbesen F, Rasmussen LM, Wimberley PD . A new transcutaneous bilirubinometer, BiliCheck, used in the neonatal intensive care unit and the maternity ward. Acta Paediatr 2002; 91: 203–211.
Lodha R, Deorari AK, Jatana V, Paul VK . Non-invasive estimation of total serum bilirubin by multi-wavelength spectral reflectance in neonates. Indian Pediatr 2000; 37: 771–775.
Samanta S, Tan M, Kissack C, Nayak S, Chittick R, Yoxall CW . The value of Bilicheck as a screening tool for neonatal jaundice in term and near-term babies. Acta Paediatr 2004; 93: 1486–1490.
Dai J, Krahn J, Parry DM . Clinical impact of transcutaneous bilirubinometry as adjunctive screen for hyperbilirubinemia. Clin Biochem 1996; 29: 581–586.
Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF . Hyperbilirubinemia in the newborn infant> or =35 weeks’ gestation: an update with clarifications. Pediatrics 2009; 124: 1193–1198.
Keren R, Bhutani VK, Luan X, Nihtianova S, Cnaan A, Shwatrz JS . Identifying newborns at risk of significant hyperbilirubinemia: a comparison of two recommended approaches. Arch Dis Child 2005; 90: 415–421.
Bhutani VK, Gourley GR, Adler S, Kreamer B, Dalin C, Johnson LH . Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia. Pediatrics 2000; 106: E17.
Nagar G, Vandermeer B, Campbell S, Kumar M . Reliability of transcutaneous bilirubin devices in preterm infants: a systematic review. Pediatrics 2013; 132: 871–881.
Mishra S, Chawla D, Agarwal R, Deorari AK, Paul VK, Bhutani VK . Transcutaneous bilirubinometry reduces the need for blood sampling in neonates with visible jaundice. Acta Paediatr 2009; 98: 1916–1919.
Brown AH, Kim NH, Valencia G, Nuchpuchdee P, Boyle G. Factors affecting the transcutaneous measurement of bilirubin: influence of race, gestational age, phototherapy and albumin binding capacity. In: Rubaltelli FF (ed). Neonatal Jaundice. Plenum: New York, NY, USA, 1984, pp 95–104..
Knudsen AA, Ebbesen F . Transcutaneous bilirubinometry in neonatal intensive care units. Arch Dis Child Fetal Neonatal Ed 1996; 75: F53–F56.
Barrington KJ, Sankaran K Canadian Paediatric Society, Fetus and Newborn Committee.. Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants. Paediatr Child Health 2007; 12 (Suppl B): 1B–12B.
American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114: 297–316.
Hegyi T, Hiatt IM, Gertner IM, Zanni R, Tolentino T . Transcutaneous bilirubinometry: dermal bilirubin kinetics during phototherapy. Pediatr Res 1983; 17: 888–891.
Tan KL, Dong F . Transcutaneous bilirubinometry during and after phototherapy. Acta Paediatr 2003; 92: 327–331.
Ozkan H, Oren H, Duman N, Duman M . Dermal bilirubin kinetics during phototherapy in term neonates. Acta Paediatr 2003; 93: 577–581.
Nanjundaswamy S, Petrova A, Mehta R, Hegyi T . Transcutaneous bilirubinometry in preterm infants receiving phototherapy. Am J Perinatol 2005; 22: 127–131.
Fonseca R, Kyralessa R, Malloy M, Richardson J, Jain SK . Covered skin transcutaneous bilirubin estimation is comparable with serum bilirubin during and after phototherapy. J Perinatol 2012; 32: 129–131.
Zecca E, Barone G, De Luca D, Marra R, Tiberi E, Romagnoli C . Skin bilirubin measurement during phototherapy in preterm and term newborn infants. Early Hum Dev 2009; 85: 537–540.
Kumar A, Faridi MM, Singh N, Ahmed SH . Transcutaneous bilirubinometry in the management of bilirubinemia in term neonates. Indian J Med Res 1994; 99: 227–250.
Fok TF, Lau SP, Hui CW, Fung KP, Wan CW . Transcutaneous bilirubinometer: its use in Chinese term infants and the effect of haematocrit and phototherapy on the TcB index. Aust Paediatr J 1986; 22: 107–109.
Ballard JL, Khoury JC, Wedig K, Eilers-Walsman BL, Lipp R . New Ballard Score, expanded to include extremely premature infants. J Pediatr 1991; 119: 417–423.
Halamek LP, Stevenson DK. Neonatal jaundice. In: Fanroff AA, Martin RJ (eds). Neonatal Perinatal Medicine. Diseases of the Fetus and Infant, 7th edn. Mosby Year Book: St Louis, MO, USA, 2002, pp 1335..
Bland JM, Altman DG . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 8476: 307–310.
Christensen T, Kinn G . Bilirubin bound to cells does not form photoisomers. Acta Paediatr 1993; 82: 22–25.
Neonatal Jaundice - National Collaborating Centre for Women’s and Children’s Health Commissioned by the National Institute for Health and Clinical Excellence, May 2010. Available at http://www.nice.org.uk/nicemedia/live/12986/48678/48678.pdf.
Acknowledgements
We thank Professor Vinod Bhutani (Department of Neonatal and Developmental Medicine, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA, USA) for his inputs in protocol development and manuscript writing. We acknowledge Philips Children’s Medical Ventures for providing calibration tips and photo-opaque patches. Calibration tips and photo-opaque patches were provided free of cost by Philips Children’s Medical Ventures, USA. This agency did not have any role in the protocol development, implementation, data collection, analysis or publication of the study.
Author contributions
LM had the primary responsibility for protocol development, study implementation, data management and writing the manuscript. AT and RA participated in development of the protocol, and supervised implementation of the study and contributed to writing of the manuscript. AS and Ms Dolma participated in implementation of the study and provided inputs in manuscript writing. VKP, AKD, SV and MJS participated in protocol development and data analysis. They provided critical inputs in manuscript writing. RA is the guarantor of the study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Murli, L., Thukral, A., Sankar, M. et al. Reliability of transcutaneous bilirubinometry from shielded skin in neonates receiving phototherapy: a prospective cohort study. J Perinatol 37, 182–187 (2017). https://doi.org/10.1038/jp.2016.189
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jp.2016.189
This article is cited by
-
Transcutaneous bilirubin levels in extremely preterm infants less than 30 weeks gestation
Journal of Perinatology (2023)
-
Efficacy of transcutaneous bilirubinometry as compared to serum bilirubin in preterm newborn during phototherapy
European Journal of Pediatrics (2021)
-
Accuracy of transcutaneous bilirubin on covered skin in preterm and term newborns receiving phototherapy using a JM-105 bilirubinometer
Journal of Perinatology (2020)
-
Transcutaneous bilirubinometer use and practices surrounding jaundice in 150 California newborn intensive care units
Journal of Perinatology (2018)
-
Comparison between Bilistick System and transcutaneous bilirubin in assessing total bilirubin serum concentration in jaundiced newborns
Journal of Perinatology (2017)