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Transcutaneous bilirubin levels in extremely preterm infants less than 30 weeks gestation



The primary objective of this study was to determine the relationship between transcutaneous bilirubin (TcB) levels and total serum bilirubin (TSB) levels in extremely preterm infants.

Study design

We conducted a prospective multicenter study of extremely preterm infants less than 30 weeks gestation in California. Difference between paired TcB and TSB values were compared based on gestational age, birth weight, maternal race/ethnicity, chronological age as well as during and after phototherapy.


TSB values ranged from 0 to 12.6 mg/dl and the TcB values ranged from 0 to 14.2 mg/dl. TSB was predicted with a high degree of accuracy at TSB = 2.37 + 0.54 (TcB) with r = 0.786. There was good correlation across gestational age, birth weight, race/ethnic, chronological age subgroups as well as during and after phototherapy.


Our study supports the use of TcB as a screening tool for monitoring jaundice in extremely preterm infants.

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Fig. 1: Correlation Graph.
Fig. 2: Bland-Altman plot.
Fig. 3: Box plot of gestational age subgroups.
Fig. 4: Box plot on and off phototherapy.

Data availability

Complete de-identified study data that underlie the results reported in the manuscript will be available upon request. Data requests should be directed to the corresponding author.


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The authors thank Dr. Jeffrey Maisels for his expert input and guidance. The authors thank Joanne Kuller, Clinical nurse specialist, UCSF Benioff Children’s Oakland & Marcie Portillo, Neonatal Research Institute, Sharp Mary Birch Women & Children’s Hospital for their assistance with the data collection process at their respective centers. We also would like to thank Dr. Robert Kahle, Past President, California Association of Neonatologists (CAN) and CAN Research Committee members for their support with this study.


The authors received no funding to conduct this study.

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Authors and Affiliations



MNS, RR and DRB conceptualized and designed the study. MNS designed the study protocol, data collection documents and coordinated the study. AK, PJ, MFV, MC, VP, HT, RCT, VA and MN collected study data. MB analyzed study data and created tables and figures for the study. MNS wrote the initial version of the manuscript and MB, RR, AK, PJ, VA, RCT, HT, VP, MV, DRB, MC & MN critically reviewed and revised the manuscript.

Corresponding author

Correspondence to Meera. N. Sankar.

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The authors declare no competing interests.

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Sankar, M.N., Ramanathan, R., Joe, P. et al. Transcutaneous bilirubin levels in extremely preterm infants less than 30 weeks gestation. J Perinatol 43, 220–225 (2023).

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