Hyperbilirubinemia and Transcutaneous Bilirubin Estimation – An Update (original) (raw)
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Transcutaneous bilirubin level to predict hyperbilirubinemia in preterm neonates
F1000Research
Background: Hyperbilirubinemia is common in neonates, with higher prevalence among preterm neonates, which can lead to severe hyperbilirubinemia. Assessment of total serum bilirubin (TSB) and use of a transcutaneous bilirubinometer (TcB) are existing methods to identify and predict hyperbilirubinemia. This study aimed to determine TcB cut-off values during the first day for preterm neonates to predict hyperbilirubinemia at 48 and 72 hours. Methods: A total of 90 neonates born ≤35 weeks were included in the study. They were divided into two groups (Group I: 1000-1500 grams; Group II: 1501-2000 grams). The bilirubin level was measured on the sternum using TcB at the ages of 12, 24, and 72 h. TSB measurements were taken on the third day or if TcB level reached ± 1.24 mg/dL phototherapy threshold and if TcB showed abnormal results (Group I: 5.76-8.24 mg/dL; Group II: 8.76-11.24 mg/dL). Hyperbilirubinemia was defined as TSB ≥7 mg/dL for group I and >10 mg/dL for group II. Results: In ...
Caspian Journal of Pediatrics (CJP), 2015
Background: The readmission rate for neonatal jaundice has been increased in recent years. This has been attributed to shorter length of postpartum hospital stays without comprehensive follow-up. The purpose of this study was to determine the diagnostic value of pre-discharge transcutaneous bilirubin (TcB) levels for prediction of subsequent hyperbilirubinemia in healthy term neonates. Methods: Between October and December 2013, a total of 99 healthy term neonates born at the Babol Clinic Hospital of healthy mother were enrolled in a prospective cross sectional study. The TcB levels were measured in all enrolled neonates between 12 and 24 hours of age just before discharge. All newborns were followed-up for jaundice to 10th day. Newborns with clinical jaundice were recalled and their serum bilirubin levels were measured. Appropriate treatment was performed based on the Amirkola Children's Hospital Protocol. TcB levels were compared between the non-treatment and treatment groups. Results: The mean age of the TcB measuring was 17.5±2.6 hours. A total of 18.1% neonates (18 of 99) were developed severe hyperbilirubinemia (need for treatment). The mean of cutaneous bilirubin level in the non-treatment and treatment groups was 5.2±1.6mg/dl and 6.3±0.9 mg/dl, respectively. The cutaneous bilirubin level at cut-off 6 mg/dl was associated with 80.0% sensitivity and 63.0% specificity. The negative predictive value was 94.6%. Conclusion: Single TcB measurements at the first 24 hours predict hyperbilirubinemia with a reasonably high degree of accuracy.
Comparison of Transcutaneous and Total Serum Bilirubin in Newborns of 34 or More Weeks of Gestation
Asian Journal of Clinical Pediatrics and Neonatology, 2018
Background: Measuring the bilirubin concentration with accuracy is essential for diagnosis and proper management of neonatal hyperbilirubinemia. Serum bilirubin (TSB) is considered as the gold standard, but it takes some time.It is painful for the baby and expensive and stressful for the parents. Transcutaneous bilirubin (TcB) can be measured without pain and is very fast. Aim of the study: To assess if TcB measurement can be an effective alternate screening test for diagnosing neonatal hyperbilirubinemia. Subjects and Methods: A total of 97 newborns with clinical jaundice were enrolled. Before the initiation of phototherapy, venous blood for TSB measurement was drawn. Within 30 minutes Drager's bilirubinometer JM-103 measured TcB on the infants' sternum. Simple linear regression analysis determined the relation between TcB and TSB values. The strength of the relationship and agreement between these two methods was calculated by Pearson's correlation coefficient "r" and Bland-Altmann plot respectively. Results: The TcB correlated well with TSB(r=0.95, 95% confidence interval= 0.93 to 0.97). The mean deviation and variability (±2SD) of TcB from TSB were 0.8 and ±2.5mg/dl respectively. There was a good agreement between TcB and TSB. Conclusion: Our study showed that TcB checking can be applied as a valuable screening tool in neonates with clinically suspected jaundice.
Middle East Journal of Rehabilitation and Health, 2016
Background: An elevated level of bilirubin in the blood is the most common and benign problem among newborns; it is also the most important factor in the evaluation of neonatal jaundice in newborns. If severe indirect hyperbilirubinemia is left untreated, it can be neurotoxic; therefore, doctors cannot overstate the need for the early detection of hyperbilirubinemia. Objectives: We investigated the relationship between the skin and plasma methods of the quality of the BiliChek process as a means of diagnosing hyperbilirubinemia Patients and Methods: This study was performed at Amiralmomenin hospital in Semnan, Iran and examined 64 healthy infants who had gestational ages of 37 weeks and greater and jaundice as their sole cause for hospitalization. Infants hospitalized due to other diseases, such as sepsis, were excluded from the study. First, a blood sample was taken to determine the infants' serum total bilirubin. Then, the amount of bilirubin was determined with BiliChek placed on three locations: the infants' foreheads, chests, and left thighs. Results: SD ± mean values of the skin method on each forehead, chest, and thigh were respectively (3.5 ± 13.8, 12.8 ± 3.5 and 9.7 ± 2.6 mg per deciliter); using the plasma method, bilirubin SD ± mean was 14.4 ± 4.0, so that the skin method in all three areas was lower than the plasma method. Variables such as the type of delivery, birth rank, blood type, birth weight, and maternal age are independent of hyperbilirubinemia level, and there is no significant relationship between them. There is only a significant relationship between bilirubin levels and a baby's age, as there is a significant relationship to birth (P = 0.000). Cut off point for the use of BiliChek in the forehead has been set at 3.13 milligrams per deciliter, and the sensitivity and specificity levels are 83.87% and 92.59%, respectively. As for the chest, it was 3.13 mg dL, with sensitivity and specificity levels of 83.87% and 96.30%, respectively. For the thigh, it was 9.7 mg per dL, with sensitivity and specificity levels of 83.87% and 96.30% respectively. There is no significant difference between the three areas mentioned in the skin method for predicting hyperbilirubinemia. Conclusions: In our study, we determined that BiliChek can be used in the diagnosis of hyperbilirubinemia, but this use is limited and applies only to the cutoff point and for values higher than the cutoff point. BiliChek is used as a means of screening for infants that need blood sampling.
Clinical Biochemistry, 2009
- To determine the relationship between transcutaneous bilirubin measurements (TcB), performed using BiliCheck or Minolta Air-Shields JM-103, and total serum bilirubin levels (TSB) and 2) to evaluate the predictive accuracy of TcB measurements for risk using the nomogram recommended by the Canadian Pediatric Society (CPS). A total of 154 healthy term neonates from the newborn nursery at McMaster Children's Hospital meeting the inclusion criteria were enrolled. TcB measurements were performed within 30 min of obtaining the TSB measurement. Both devices showed a good correlation with the laboratory method (BiliCheck-Vitros, R2=0.86; Minolta Air-Shields JM-103-Vitros, R2=0.85), but underestimated the serum bilirubin. Applying the risk classification using the 40th, 75th, and 95th percentile of the Bhutani nomogram a 6%, 0%, and 1% false negative rate was found for BiliCheck and 62%, 74% and 81% for the Minolta Air-Shields JM-103 device. After correcting for the differences using either the bias or the 95% CI the false negative rate was reduced to zero in all cases. TcB measurements cannot be directly applied to a TSB nomogram but must be adjusted for any observed biases in order to avoid misclassifying newborns at risk for hyperbilirubinemia.
A CORRELATION STUDY BETWEEN TRANSCUTANEOUS BILIRUBIN AND TOTAL SERUM BILIRUBIN LEVELS AMONG NEONATES
Asian Journal of Pharmaceutical and Clinical Research Journal, 2022
Objective: The availability of modern bilirubin meters that measure bilirubin concentration in dermal and subcutaneous tissues has made it possible to obtain serial, non-invasive (i.e., painless) TcB (transcutaneous bilirubin) measurements. However, concerns have been raised regarding the appropriateness of comparing these TcB values to serum bilirubin values. This study aims to find a correlation between transcutaneous bilirubin and total serum bilirubin. Methods: Prospective analytic study carried out in NICU of Govt. RDBP Jaipuria Hospital. Newborn babies up to the 10th postnatal day of life with visually found jaundice had been enrolled in the study. TcB was measured over mid-sternum with Dräger JM 105™ device. Simultaneous total serum bilirubin (TSB) measurements had been done. Pearson’s correlation coefficient and Bland–Altman analysis had been done. ROC curves of mean TcB at different TSB level had been constructed. Results: In the study, 120 babies had been included. A significant correlation was founded between TcB and TSB measured values. Pearson’s correlation coefficient was 0.892 (p<0.001). The average error in evaluating hyperbilirubinemia with TcB compared to TSB was 0.101, with limits of agreement between −3.73 and +3.55. The AUOC at three TSB levels (>10 mg/dl, >12 mg/dl, and >15 mg/dl) was 0.860, 0.892, and 0.849. Conclusion: In our study, TcB measurements correlated well with TSB measurements and validated its use as a screening tool for the evaluation of jaundice in newborns.
Indian journal of applied research, 2018
Background: Bilirubin induced neurological dysfunction is one of the major causes of morbidity in preterm neonates secondary to uncontrolled hyperbilirubinemia. While jaundice per se is not preventable none the less early detection of threatening bilirubin levels permit initiation of phototherapy and prevents kernicterus. Objectives To determine the first day total bilirubin value, at 24 hours of life; which will predict with reasonable accuracy, preterm neonates likely to develop subsequent significant hyperbilirubinemia requiring treatment. To establish the cut-off values and comparison of the obtained value for prediction of significant neonatal hyperbilirubinemia in preterm neonates. Material and methods The study was conducted on a group of 90 preterm neonates, with no comorbidities,over a period of one year. The main outcome measured was hyperbilirubinemia requiring intervention. Serum bilirubin level was sent at 24 hours of age. These babies were followed up clinically for...
Hyperbilirubinemia and Transcutaneous Bilirubinometry
Clinical Chemistry, 2009
BACKGROUND: Neonatal jaundice or hyperbilirubinemia is a common occurrence in newborns. Although most cases of neonatal jaundice have a benign course, severe hyperbilirubinemia can lead to kernicterus, which is preventable if the hyperbilirubinemia is identified early and treated appropriately.
Journal of Evolution of Medical and Dental Sciences, 2019
BACKGROUND Jaundice is yellowish discolouration of the skin, the mucous membranes or the eyes. It is caused by high levels of the chemical bilirubin in blood, a by-product of destruction of old red blood cells. A newborn baby's liver is not fully matured, so jaundice is common during a baby's first few days of life 1 Since bilirubin is potentially toxic to the central nervous system, early detection and appropriate management of neonatal jaundice (NNJ) is of paramount importance 2. Hence early detection of neonatal jaundice is an important issue. The present study was conducted to find out the critical value of serum bilirubin in the cord blood and at 24 hrs. in predicting the subsequent development of hyperbilirubinemia in healthy newborn babies. METHODS Cord blood sample and blood sample at 24 hours were collected from all 200 babies. After 24 hours and up to 5 th post-natal day, blood samples for serum bilirubin estimation were taken from those babies who were clinically suspected to be having jaundice. RESULTS Total serum bilirubin > 2.3 mg/dl has sensitivity of 75.3% (95% CL 65.2% to 83.6%), specificity of 81.3% (95% CL 72.6% to 88.2%), positive predictive value of 77.8 (67.8 to 85.9), negative predictive value of 79.1% (70.3% to 86.3). The diagnostic ability of TSB at 24 hrs. to predict the need for phototherapy shows that TSB > 5.3 mg/dl, has sensitivity of 87% (95% CL 78.5% to 93.2%), specificity of 67.3% (95% CL 57.5% to 76%), positive predictive value of 69.8 (60.6 to 78.0), negative predictive value of 85.7 (87.5 to 85.4). CONCLUSIONS The time to reach maximum total serum bilirubin level after birth is 3 rd postnatal day in our study. So, the baby in need of phototherapy has to be identified earlier to 3 rd postnatal day. A total serum bilirubin level prior to 3 rd day which can predict the later need of photo-therapy in a given baby will have clinical utility. The optimum cut off value of total serum bilirubin in cord blood which can predict the need for phototherapy is > 2.3 mg/dl and value of total serum bilirubin at 24 hrs which can predict the need for phototherapy is > 5.3 mg/dl. So, these at-risk babies should be observed carefully for the need of phototherapy.
Journal of Universal College of Medical Sciences, 2014
INTRODUCTION: Hyperbilirubinemia is a common problem in the neonates. It can progress to develop kernicterus unless intervention is initiated. Severity of jaundice and decision for management are usually based on total serum bilirubin (TsB) estimation which technique and results closely correlates with total serum bilirubin levels. OBJECTIVES: To compare the accuracy of visual assessment of jaundice by single trained observer based on Kramer's index with total serum bilirubin levels in healthy term neonates. To compare accuracy of non invasive bilirubin assessment with serum bilirubin levels, to compare trans-cutaneous bilirubin assessment on different sites (forehead and sternum) and to develop a cutoff point oftrans-cutaneous bilirubin level for serum bilirubin assessment. METHODS: This prospective study was conducted in the Neonatal unit of the department of Paediatrics at Kasturba Hospital ,Manipal. Study period was from October 2007 to June 2008. Clinical assessment of jaun...