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Purpose: Although neonatal jaundice is a ubiquitous and predominantly benign phenomenon, the risk of neurotoxicity exists in a number of infants with unconjugated hyperbilirubinemia. Plotting bilirubin values on nomograms enables clinicians to employ an anticipatory and individualized approach with the goal of avoiding excessive hyperbilirubinemia and preventing acute bilirubin encephalopathy and its progression to kernicterus. We aimed to construct nomograms for White term infants based on transcutaneous bilirubin (TcB) measurements using a JM-105 device., Methods: TcB measurements were taken in infants at ages ranging from 0 to 96 postnatal hours. We then constructed hour-specific TcB nomograms from forehead and sternum measurements in infants who did not require subsequent phototherapy., Results: We included 2,981 TcB measurements taken on the forehead and 2,977 measurements taken on the sternum in 301 White term newborn infants. We assessed the predictive abilities of the nomograms at six postnatal time intervals using receiver operating characteristic curves. The areas under the curves indicated reasonable prediction of hyperbilirubinemia requiring phototherapy, except for the forehead measurement taken within the first 12 h of life. Sensitivity tended to rise as postnatal age increased., Conclusion: The nomograms illustrate dermal bilirubin dynamics in White term neonates during the first 4 days of life. They may be useful tools to predict individualized risk of hyperbilirubinemia requiring treatment, and to plan optimal follow-up of infants at risk of bilirubin neurotoxicity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Casnocha Lucanova, Zibolenova, Matasova, Matasova and Zibolen.)

Objective: To compare the course of the transcutaneous bilirubin (TcB) values of early-term newborns with those of term newborns in the first month of life and to investigate whether early-term newborns have an increased risk of significant hyperbilirubinemia requiring treatment., Design: A prospective, controlled cohort analysis., Setting: A tertiary level mother-child birth and health care center., Participants: Four hundred early-term (37 0/7 to 38 6/7 weeks) and 320 term (39 0/7 to 41 6/7 weeks) newborns born during a 27-month period., Methods: A total of six TcB measurements in a longitudinal manner were made in early-term and term newborns: the first two at 6 and 48 hours after birth and the next four on routine examination days (Days 4, 7, 15, and 30). Demographic characteristics, values of daily TcB measurements, number of newborns with significant hyperbilirubinemia, and risk of jaundice requiring treatment were compared between the two groups., Results: All six TcB values were significantly greater in the early-term group than in the term group (p < .001 for each). Early-term newborns had a statistically significant increased risk of jaundice requiring treatment compared to term newborns (risk ratio = 1.91; 95% confidence interval [1.23-2.96]; p = .0046). Results of the repeated-measures analysis of variance and post hoc adjusted multiple comparison analysis showed that TcB levels increased to and peaked at 96 hours after birth and then gradually decreased to baseline (first measurement) levels at 30 days after birth in each group., Conclusions: Early-term newborns should not be treated as full-term newborns because they have significantly higher TcB levels. These newborns should be closely monitored for pathologic jaundice because they have increased risk for significant hyperbilirubinemia requiring phototherapy., Competing Interests: Conflict of Interest The authors report no conflict of interest or relevant financial relationships., (Copyright © 2021 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Background: The aim was to assess the predictability of transcutaneous bilirubinometry in late preterm and term neonates at risk for pathological hyperbilirubinemia, and to identify the neonatal population in which transcutaneous bilirubin most accurately predicts serum bilirubin level (SB, mg/dl)., Methods: The correlations between transcutaneous bilirubin (TCB, mg/dl) and SB in different neonatal population subsets; and between ΔTSB (TCB-SB) and relevant neonatal variables and clinical groups were analyzed., Results: TCB correlated with SB (r = 0.82, p < 0.05) in the cohort (n = 350) and in population subsets (r = 0.81-0.9, p < 0.001). Black infants with gestational age (GA) >35 weeks and chronological age (CA) >3 days recorded strongest correlation (r = 0.9, p < 0.001) followed by Blacks, and non-Black infants with CA >3 days and GA >35 weeks. ΔTSB was positive in Blacks, and in infants with CA <3 days, or with no phototherapy. ΔTSB was negative in non-Blacks, in infants with positive direct Coombs test (DC+) or those receiving phototherapy. Black race [beta (SE) = 1.3(0.33), p < 0.001] had positive, while CA [beta (SE) =-1.74 (0.36), p < 0.001], DC + status [beta (SE) =-0.72 (0.25), p = 0.004] and receipt of phototherapy [beta (SE) =-0.84 (0.21), p < 0.001] each had negative correlation with ΔTSB. ΔTSB for Blacks was >Whites, Hispanics and Asians., Conclusion: SB is best predicted by TCB in Black infants with CA over 3 days and GA over 35 weeks. Variability in SB estimation by TCB is race, CA and immune mediated hemolysis specific.

Background: Neonatal hyperbilirubinemia is a common condition that frequently requires treatment with phototherapy and less commonly by exchange transfusion, especially in preterm infants. It is important to identify and monitor infants at risk of severe unconjugated hyperbilirubinemia early in the postnatal period to instigate appropriate management plans., Aims: To evaluate transcutaneous bilirubinometry (TCB) as a screening tool at 24 and 48 h of age to predict the need for phototherapy during hospital stay in preterm infants., Study Design: A single centre prospective cohort study in a level III perinatal centre., Subjects: Preterm infants (23 +0 to 36 +6 weeks of gestation) were eligible for enrolment., Outcome Measures: Primary outcome was to assess the predictive value of TCB at 24 and 48 h of age for the need of phototherapy during hospital stay., Results: A total of 338 preterm infants were enrolled. The majority of infants (98.1%) born below 32 weeks of gestation required phototherapy. For infants born at >31 + 6 weeks of gestation, TCB at 24 h of age ≥81 μmol/l had sensitivity 83%, specificity 56%, positive predictive value (PPV) 54.7% and negative predictive value (NPV) 84%. TCB at 48 h of age ≥145 μmol/l had sensitivity 65%, specificity 62%, PPV 24% and NPV 90%., Conclusion: TCB performed poorly at 24 and 48 h of age as a predictor of phototherapy during hospital stay in preterm infants. The negative predictive value of the test at 48 h of age might be helpful for infants born after 31 + 6 weeks of gestation., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background : Severe neonatal jaundice (SNJ) and the associated long-term health sequelae are a significant problem in low-income countries (LIC) where measurement of total serum bilirubin (TSB) is often unavailable. Transcutaneous bilirubinometry (TcB) provides the opportunity for non-invasive, point-of-care monitoring. Few studies have evaluated its agreement with TSB levels during phototherapy in LIC. Aim : To determine agreement between TcB and TSB during phototherapy in a Haitian newborn population and to establish whether TcB can be safely used to guide treatment during phototherapy when TSB is unavailable. Methods : A single-centre prospective study (February to May 2017) in Cap Haïtien, northern Haiti was undertaken. Newborns <7 days of age with clinically detected jaundice were eligible for inclusion. A TcB device (JM-103) was used to screen for newborn jaundice along with a parallel TSB. A strip of black tape was placed across the sternum during phototherapy and uncovered for subsequent TcB measurements. Decisions about phototherapy treatment were based upon UK National Institute of Clinical Excellence (NICE) threshold criteria. Paired TSB and TcB measurements were compared using Bland-Altman methods. Results : The final analysis included 70 parallel TSB/TcB measurements from 35 infants within the first 5 days of life. Nineteen (54.3%) were male and 12 (34.3%) were <35 weeks. Thirty-two (91.4%) were receiving phototherapy. There was good agreement between TSB and TcB. Compared with TSB, TcB tended to over-estimate bilirubin (mean difference 11.1 µmol/L, 95% CI -10.2-32.5 µmol/L). However, at higher bilirubin levels (>250 µmol/L), TcB tended to under-estimate bilirubin compared with TSB and the difference increased. Conclusion : In an LIC setting in which serum bilirubin testing is not commonly available, TcB demonstrates good agreement with TSB and can be safely used to guide jaundice treatment during phototherapy but can lead to over-treatment at lower bilirubin levels and are more inaccurate at higher levels. For TcB levels >250 µmol, confirmation with serum bilirubin should be performed, if available, to avoid under-estimation. Abbreviations : LIC: low income countries; LMIC: low and middle income countries; TcB: transcutaneous bilirubinometry; TSB: transcutaneous serum biliubin.

Background: Measurement of transcutaneous bilirubin (TcB) is a quick, reliable and painless method to guide management of hyperbilirubinemia. Studies in term and late preterm infants have found that TcB measurements from covered areas (TcB-C) during phototherapy (PHT) co-relate well with serum bilirubin levels. Limited data exists in extremely low birth weight (ELBW) infants., Methods: In this prospective observational study, an opaque patch was placed on the back of an ELBW infant prior to initiation of PHT. TcB-C and TcB-E (TcB from exposed area) levels were measured at birth and at 24-h intervals for 5 days. Total serum bilirubin (TSB) levels were also measured within 30 min of obtaining TcB levels. A Wilcoxon signed rank test was used for data analysis. A mixed effect model was used to adjust for repeated measurements over time. The p value < 0.05 was considered significant., Results: A total of 19 infants were enrolled in the study, with a mean gestational age of 26 ± 2 weeks and mean weight 827 ± 127 g. The difference between TcB-C and TSB was 2.68 ± 2.41 mg/dl (mean ± SD, p <  0.001). In contrast, the difference between TcB-E and TSB was - 0.51 ± 1.74 mg/dl (p = 0.02). TcB-C consistently overestimates TSB, while TcB-E consistently underestimates TSB., Conclusions: During PHT exposure, TcB-C does not correlate with TSB values in ELBW infants. TcB-C levels cannot be used as a surrogate for TSB measurement in ELBW infants.

Background: Transcutaneous bilirubinometry (TcB) is routinely used to monitor jaundice in term and near-term infants. However, before 35 weeks gestation, the technique has not been widely adopted., Aim: The aim of this study is to study the correlation between TcB and total serum bilirubin (TsB) before, during, and after phototherapy in preterm infants born before 35 weeks' gestation., Methods: Jaundice was monitored in infants born before 35 weeks' gestation by simultaneous measurements of TsB and TcB assessed by a Drager Jaundice Meter JM-103 (Draeger Medical, Inc., Telford, PA)., Results: About 588 pairs of measurements were recorded in 86 premature infants of 26-34 weeks, weighing 618-2400 grams. The overall correlation coefficient between TcB and TsB was 0.8 (p = .001). Subset analysis revealed lower correlation in infants born before 30 weeks. TcB was consistently estimated around 1 mg% lower than TsB. Neither the cause of the jaundice nor major neonatal morbidities significantly influenced the TcB-TsB correlation., Conclusions: TcB is a reliable measure of jaundice before 35 weeks' gestation with a mean under-estimation of ≈1 mg%. TcB use may reduce unnecessary invasive blood tests.

Objectives: To assess the agreement of transcutaneous bilirubin (TcB) measurement with the Bilicare™ System in comparison to TcB measured with JM-103™ and total serum bilirubin (TSB)., Methods: Caucasian infants with gestational age ≥35 weeks with non-hemolytic jaundice received TcB measurement with both Bilicare™ and JM-103™ devices. TSB was also obtained in infants at risk of phototherapy., Results: We studied 458 infants measuring TcB with Bilicare™ and JM-103™, correlating the results and with TSB. The mean difference ± 2SD between Bilicare™ and JM-103™ TcB was 2.02 ± 4.46 mg/dL and decreased from 2.88 ± 3.17 to 1.20 ± 4.55, and to -0.95 ± 4.58 mg/dL at mild, moderate and high TcB values, respectively., Conclusions: Bilicare™ and JM-103™ TcB measurements are well correlated, but Bilicare™ over-estimates TcB for mild and moderate values and under-estimates it for high values compared to JM-103™. This could increase the prescription of TSB measurements for less serious cases and decrease them in the most worrisome.

BACKGROUND: The aim was to assess the predictability of transcutaneous bilirubinometry in late preterm and term neonates at risk for pathological hyperbilirubinemia, and to identify the neonatal population in which transcutaneous bilirubin most accurately predicts serum bilirubin level (SB, mg/dl). METHODS: The correlations between transcutaneous bilirubin (TCB, mg/dl) and SB in different neonatal population subsets; and between ΔTSB (TCB-SB) and relevant neonatal variables and clinical groups were analyzed. RESULTS: TCB correlated with SB (r = 0.82, p < 0.05) in the cohort (n = 350) and in population subsets (r = 0.81–0.9, p < 0.001). Black infants with gestational age (GA) >35 weeks and chronological age (CA) >3 days recorded strongest correlation (r = 0.9, p < 0.001) followed by Blacks, and non-Black infants with CA >3 days and GA >35 weeks. ΔTSB was positive in Blacks, and in infants with CA <3 days, or with no phototherapy. ΔTSB was negative in non-Blacks, in infants with positive direct Coombs test (DC+) or those receiving phototherapy. Black race [beta (SE) = 1.3(0.33), p < 0.001] had positive, while CA [beta (SE) =−1.74 (0.36), p < 0.001], DC + status [beta (SE) =−0.72 (0.25), p = 0.004] and receipt of phototherapy [beta (SE) =−0.84 (0.21), p < 0.001] each had negative correlation with ΔTSB. ΔTSB for Blacks was >Whites, Hispanics and Asians. CONCLUSION: SB is best predicted by TCB in Black infants with CA over 3 days and GA over 35 weeks. Variability in SB estimation by TCB is race, CA and immune mediated hemolysis specific. [ABSTRACT FROM AUTHOR]

Objective: The goal of the study was to provide missing data on the accuracy of enhanced transcutaneous bilirubinometry in a monoracial population of term neonates, considering three different measurement sites. Material and Methods: Transcutaneous bilirubin was measured using the JM-105 device on the forehead, chest, and abdomen. Blood sampling for total serum bilirubin concentration has been performed within 10 minutes of transcutaneous measurements. Paired transcutaneous bilirubin and total serum bilirubin measurements were statistically analyzed. Results: The study group consisted of 102 healthy term Slovak infants. The correlation between total serum bilirubin and transcutaneous bilirubin was significant (coefficient of determination R2: 0.9045 forehead, 0.8808 sternum, 0.8467 abdomen). Transcutaneous measurements underestimated serum bilirubin levels significantly when total serum bilirubin values were higher than 15 mg/dL, irrespective of the site of transcutaneous measurements. The lowest mean difference between total serum bilirubin and transcutaneous bilirubin was identified on the sternum (median: -1.1 mg/ dL). The area under the curve was >0.97 and >0.93 for detecting total serum bilirubin levels >10 mg/ dL and >13 mg/dL, respectively, for all measurement sites. Transcutaneous measurements on the forehead and sternum provided very high sensitivity, with the best performance at the forehead. Conclusion: Transcutaneous bilirubinometry using an enhanced device is an accurate, sensitive, and convenient screening method in term Caucasian neonates. Transcutaneous bilirubin measurements on the forehead, sternum, and abdomen are reliable, with the best performance on the forehead. It is necessary to confirm higher transcutaneous bilirubin values with a total serum bilirubin measurement. [ABSTRACT FROM AUTHOR]

Abstract Diffuse reflectance spectroscopy is a non-destructive method to obtain biochemical and physiological information by investigating the optical properties of skin. Transcutaneous bilirubin (TcB) measurement utilizes reflectance spectroscopy to determine the jaundice level in newborns. Although TcB measurement has some advantages over total serum bilirubin (TSB) measurement such as being non-invasive, noninfectious, painless, and instantaneous, the existing TcB devices cannot yet replace TSB devices due to the inaccuracy of measurements. In this paper, we propose the use of reflectance spectroscopy in conjunction with regression tools such as multiple polynomial regression (MPR), artificial neural network (ANN), and support vector regression (SVR) to predict the jaundice level. The proposed methods were tested on TcB measurement data obtained from 314 babies. TcB measurements were collected by two devices: a commercially available product, Draeger JM-103, and a prototype device on which we can implement the proposed algorithms. The results are encouraging towards increasing the clinical usage of transcutaneous bilirubinometers as all the three methods accurately predict the jaundice level with a correlation value between 0.932 and 0.943. The proposed use of ANN improves the non-invasive transcutaneous approach, with results converging to more accurate invasive serum bilirubin measurements by blood sampling. [ABSTRACT FROM AUTHOR]

Phototherapy remains mainstay of treating neonatal hyperbilirubinemia across gestational age spectrum. Neonates under phototherapy (PTx) require frequent estimation of serum bilirubin (TSB) to monitor disease progression. Transcutaneous bilirubinometer (TcB) is widely used for estimation of TSB with limited data for neonates receiving PTx. The aim of study was to assess the diagnostic accuracy of TcB as compared to TSB in preterm and term infants receiving phototherapy. Methods: This prospective study analyzed 385 paired TcB-TSB samples from 234 hemodynamically stable preterm (89) and term (145) neonates receiving in-hospital PTx. Indigenous photo-opaque patch was applied to sternum before starting PTx. TcB was measured from patched area of skin using Dräger JM-103 device at 12 and 24 hours during phototherapy within 5 minutes of blood collection for TSB. Linear regression and Bland-Altman plots were used to compare TcB with TSB. Results: The mean (SD) gestational age and birth weight were 35.8 (2.43) weeks and 2250 (560) grams. Difference of mean of TcB and TSB was ranging between 0.7-1 mg/dl with TcB underestimating TSB. At 12 hours and 24 hours of PTx, the correlation coefficient were (r = 0.84 and 0.81, p<0.01) among preterm and (r = 0.76 and 0.79, p<0.01) among term infants. Bland-Altman plot showed significant agreement between TcB from patched site and TSB in both preterm and term neonates. Conclusion: TcB demonstrated significant accuracy in predicting TSB in both term and preterm neonates receiving PTx with slight underestimation of TSB. The study showed marginally higher correlation for preterm infants. [ABSTRACT FROM AUTHOR]

Serum bilirubin can be estimated using a technique that is real-time, noninvasive, painless, fast, and relatively inexpensive technique which is transcutaneous bilirubinometry (TcB). There is a paucity of published research data in Nigeria on TcB, and the aim of this study was to determine the correlation of TcB with total serum bilirubin (TSB) and in a group of term Nigerian neonates at Lagos State University Teaching Hospital (LASUTH) using the Konica Minolta JM-103. Materials and Methods: One hundred and fifty neonates were consecutively recruited at LASUTH, and detailed sociodemographic and clinical information was recorded with an interviewer-administered questionnaire. TcB readings were taken on the forehead, sternum, and abdomen of the calm neonate in a supine position, and blood samples for TSB estimation were drawn from a peripheral vein within 10 min of TcB measurement. Results: Eighty-nine (59.3%) neonates were male; 129 (86%) neonates were of 37–39 weeks' gestational age while 56 (37.3%) presented in the clinic after 48 h of life. Over 83% of the neonates had TcB values that were higher than TSB values, and the percentage of neonates with TSB values > 12 mg/dl was 45.2% compared with 56.8% obtained by TcB. The correlation of TcB with TSB using the Pearson's correlation was positive (r = 0.924). The mean error of TcB compared with the TSB level was independent of gender, gestational age, age at presentation, or birth weight. The measured bias by the Bland and Altman method was 0.97 mg/dl (95% confidence interval: 0.74–1.21) while imprecision was ± 2.96 mg/dl. The best correlation at the forehead was r = 0.928. Conclusion: Excellent correlation of TcB with TSB was obtained from this study, and it is envisaged that further researches will be carried out in dark skinned neonates and that the use of the JM-103 will be widely adopted as a screening tool in Nigeria. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the accuracy of transcutaneous bilirubin measurement in a large population of newborn infants, before and during the phototherapy. Patients and Methods: Asingle Bilicheck instrument was used for transcutaneous measurements. A photo-opaque patch was positioned over the measurement site prior to starting phototherapy. Transcutaneous bilirubinometry was conducted on an unpatched area of the forehead skin and on the nearby site covered by the photo-opaque patch. Readings were obtained from patched and unpatched areas and simultaneous total serum bilirubin concentrations were compared. Results: We studied 134 term and 36 preterm newborns. Pre-phototherapy measurements showed a strong correlation (r: 0.929, P < 0.001, Limit of agreement: -1.8 to 3.1) between Bilicheck and serum bilirubin readings. Post-phototherapy correlation between Bilicheck and serum bilirubin readings was (r: 0.921, P < 0.001, LOA: -1.8 to 2.8) among term and (r: 0.887, P = 0.001, LOA: -1.4 to 2.7) among preterm neonates in patched areas. These correlations were (r: 0.666, P < 0.001, LOA: -1.7 to 7.3) among term and (r: 0.756, P < 0.001, LOA: -0.5 to 5.3) preterm neonates post-phototherapy in unpatched areas. Conclusion: BiliCheck can be safely used for the evaluation of bilirubin levels in preterm and term newborn infants under phototherapy. BiliCheck is slightly less reliable among preterm newborns. [ABSTRACT FROM AUTHOR]

In order to screen for neonatal significant hyperbilirubinemia,a propective cross sectional study was carried out on 343 full-term neonates taken to investigator in Kerman between October 1995 and july 1996.there was a linear correlation between serum bilirubin and transcutaneous bilirubinometri (r=0.85,standard error=0.004).sensitivity and specificity of this method were 95% and 84% respectively.ragarding the low price and the ease of the usage on one hand and interlaboratory variations in bilirubin measurements on the other hand, transcutaneous bilirubinometry by icterometer is considered to be an accurate method for screening of significant hyperbilirubinemia in Iranian neonates.

OBJECTIVES: Our goal was to assess the impact of programmatic and coordinated use of transcutaneous bilirubinometry (TcB) on the incidence of severe neonatal hyperbilirubinemia and measures of laboratory, hospital, and nursing resource utilization. METHODS: We compared the neonatal hyperbilirubinemia-related outcomes of 14 796 prospectively enrolled healthy infants ≥35 weeks gestation offered routine TcB measurements in both hospital and community settings by using locally validated nomograms relative to a historical cohort of 14 112 infants assessed by visual inspection alone. RESULTS: There was a 54.9% reduction (odds ratio [OR]: 2.219 [95% confidence interval (CI): 1.543-3.193]; P < .0001) in the incidence of severe total serum bilirubin values (≥342 µmol/L; ≥20 mg/dL) after implementation of routine TcB measurements. TcB implementation was associated with reductions in the overall incidence of total serum bilirubin draws (134.4 vs 103.6 draws per 1000 live births, OR. 1.332 [95% CI: 1.226-1.4461; P < .0001) and overall phototherapy rate (5.27% vs 4.30%, OR: 1.241 [95% CI: 1.122-1.374]; P< .0001), a reduced age at readmission for phototherapy (104.3 ± 52.1 vs 88.9 ± 70.5 hours, P < .005), and duration of phototherapy readmission (24.8 ± 13.6 vs 23.2 ± 9.8 hours, P < .05). There were earlier (P < .01) and more frequent contacts with public health nurses (1.33 vs 1.66, P < .01) after introduction of the TcB program. CONCLUSIONS: Integration of routine hospital and community TcB screening within a comprehensive public health nurse newborn follow-up program is associated with significant improvements in resource utilization and patient safety. [ABSTRACT FROM AUTHOR]

Background: Taking blood for bilirubin measurement is a common cause of blood sampling in premature infants. Transcutaneous bilirubinometry is a method of bilirubin measurement and its value in term newborns is well established. In some studies, transcutaneous bilirubinometry has been accepted for premature babies who did not receive phototherapy. However its value in assessment of bilirubin in preterm babies undergoing phototherapy is not well known. The aim of present study was evaluation the accuracy of transcutaneous bilirubinometry in preterm neonates during phototherapy. Methods: We enrolled preterm newborns admitted to the neonatal unit of Shahid Beheshti hospital, Isfahan University of Medical Sciences with gestational age of 26-36 weeks and age of 2-22 days who needed blood sampling for determination of plasma bilirubin level. We measured bilirubin using BiliCheck from glabella and sternum within 30 minutes of blood sampling. Findings: We assessed 72 preterm infants with mean birth weight of 1381.7 gram and mean gestational age of 30.03 weeks. There were significant correlation between transcutaneous bilirubinometry of glabella and serum bilirubin levels (P < 0.05; r = 0.83). There were also correlation between transcutaneous bilirubinometry of sternal region and serum bilirubin levels but this was weaker than glabella (P < 0.05; r = 0.55). Conclusion: Measurement of bilirubin with transcutaneous bilirubinometry from covered area of glabella in preterm infants undergoing phototherapy could be a useful predictor of serum bilirubin level. With this method, we could reduce blood sampling in preterm neonates. So, the need for blood transfusion, the pain from taking blood and its side effects will be reduced. [ABSTRACT FROM AUTHOR]

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Aim: To evaluate the performance of the Konica Minolta/Air-Shields® JM-103 jaundice meter on the basis of infant skin tone during the early neonatal period. Methods: Infants were prospectively categorized into light, medium and dark skin tone groups relative to two reference colours. Transcutaneous bilirubin readings were taken at predetermined intervals through the early neonatal period on a convenience sample of 938 healthy infants ≥37 weeks gestation. Serum bilirubin measurements were drawn routinely with metabolic studies and repeated in the presence of an elevated transcutaneous reading or clinically significant jaundice. Results: Multivariate linear regression analysis showed a significant impact on serum and transcutaneous bilirubin agreement by skin tone. Highest precision and lowest bias were observed for medium skin toned infants. Greater disagreement between serum and transcutaneous measurements was noted at serum bilirubin concentrations >200 μmol/L. Insufficient numbers of dark skin toned infants were enroled to evaluate fully the performance of the jaundice meter for this group. Conclusion: The JM-103 jaundice meter displayed good correlation with serum bilirubin concentrations in light and medium skin tone infants, although it showed a tendency to under-read in the lighter skin tone group and to over-read in the darker skin tone group. The device shows excellent performance characteristics for use as a screening device. [ABSTRACT FROM AUTHOR]

Objectives: We determined usefulness of transcutaneous bilirubinometry to decrease the need for blood sampling to assay serum total bilirubin (STB) in the management of jaundiced healthy Indian neonates. Methods: Newborns, ≥35 weeks’ gestation, with clinical evidence of jaundice were enrolled in an institutional approved randomized clinical trial. The severity of hyperbilirubinaemia was determined by two non-invasive methods: i) protocol-based visual assessment of bilirubin (VaB) and ii) transcutaneous bilirubin (TcB) determination (BiliCheck®). By a random allocation, either method was used to decide the need for blood sampling, which was defined to be present if assessed STB by allocated method exceeded 80% of hour-specific threshold values for phototherapy (2004 AAP Guidelines). Results: A total of 617 neonates were randomized to either TcB (n = 314) or VaB (n = 303) groups with comparable gestation, birth weight and postnatal age. Need for blood sampling to assay STB was 34% lower (95% CI: 10% to 51%) in the TcB group compared with VaB group (17.5% vs 26.4% assessments; risk difference: −8.9%, 95% CI: −2.4% to −15.4%; p = 0.008). Conclusion: Routine use of transcutaneous bilirubinometry compared with systematic visual assessment of bilirubin significantly reduced the need for blood sampling to assay STB in jaundiced term and late-preterm neonates. (ClinicalTrials.gov number, NCT00653874) [ABSTRACT FROM AUTHOR]

Abstract: Background: The few existing studies evaluating the reliability of transcutaneous bilirubin monitoring during phototherapy gave controversial results. Aims: To evaluate the accuracy of transcutaneous bilirubin measurement in a large population of newborn infants, during phototherapy. Study design and methods: Total serum bilirubin and transcutaneous bilirubin on patched and unpatched skin areas were simultaneously measured in newborn infants undergoing phototherapy. Transcutaneous measurements were performed with a multiwavelength transcutaneous bilirubinometer (Respironics BiliCheck™). The Passing-Bablok regression and the Bland-Altman plot were used to estimate the relationship between serum and transcutaneous bilirubin. Results: We studied 364 newborn infants with a mean (SD) gestational age of 34.6 (3) weeks and a mean birth weight of 2371 (805) grams. Total serum bilirubin, patched transcutaneous bilirubin and unpatched transcutaneous bilirubin were similar before phototherapy. After 52 (33) hours of phototherapy, the difference between serum bilirubin and patched transcutaneous bilirubin was 0.2 (3.1) mg/dL (not significant) while the difference between serum bilirubin and unpatched transcutaneous bilirubin was 3.2 (3.0) mg/dL (p <0.001). Statistical analysis showed a good agreement between serum bilirubin and patched transcutaneous bilirubin, while unpatched transcutaneous bilirubin underestimates serum levels. The difference between patched and unpatched values was significantly lower in preterm than in term infants (2.8 mg/dL vs. 3.6 mg/dL; p <0.001). Conclusion: BiliCheck can be safely used for the evaluation of bilirubin levels in newborn infants under phototherapy. Its reliability on patched skin of the forehead is high enough to consistently reduce blood draws and to ascertain when to discontinue phototherapy. Because of the individual variance, any clinical decision has to be taken on the basis of the transcutaneous bilirubin trend more than on a single value. [Copyright &y& Elsevier]

This prospective study was conducted to evaluate the accuracy of transcutaneous bilirubinometry in preterm newborns less than 32 weeks of gestation. Serum bilirubin values measured by direct spectrophotometry were considered as standard, the range was 2.2-12.5 mg/dL. 32 jaundiced infants of less than 32 weeks of gestation without phototherapy, including 10 ELBW neonates, were enrolled. Close correlation (R=0.933) existed between total serum bilirubin and transcutaneous bilirubin values measured over sternum. [ABSTRACT FROM AUTHOR]

Objective: Comparison of visual screening with transcutaneous bilirubinometry (TcB) in identifying neonates with plasma total bilirubin (PTB) ≥75th percentile. Design: In 100 paired readings PTB was 34 ± 24 μmol/L higher than the TcB counterpart. A TcB reading of 154 μmol/L was therefore regarded as equivalent to a PTB of 188 μmol/L, corresponding to the 75th percentile at 48 h. Predischarge, all newborns were evaluated for jaundice, first by visual inspection and then transcutaneously. PTB was ordered as indicated by visual assessment or if the TcB reading was ≥154 μmol/L. Results: Of 346 newborns tested, 25 (7.2%) had a PTB concentration ≥75th percentile. Forty-nine had PTB determinations based on TcB compared with 83 by visual assessment. However, a similar number of affected newborns was identified by each method (21/25 (84%) by visual screening vs. 18/25 (72%) by TcB). PTB concentrations of those who had been chosen by TcB were higher than those selected visually (202 ± 24 μmol/L vs. 186 ± 31 μmol/L). Conclusions: A practical method for predischarge detection of neonates with plasma total bilirubin concentration ≥ 75th percentile, implementing transcutaneous bilirubinometry, is described. The transcutaneous technique required fewer blood tests than visual assessment for similar yield. [ABSTRACT FROM AUTHOR]

Aim: Hour-specific nomogram evaluation of serum or skin bilirubin is a suitable approach for managing neonatal hyperbilirubinemia and it is recommended by American Academy of Paediatrics. We aimed to provide data about skin bilirubin levels during the natural course of hyperbilirubinemia in European healthy neonates. Methods: We enrolled 2198 healthy newborn infants (gestational age [GA]≥ 35 weeks), from 24 to 96 h of life and performed transcutaneous bilirubin (TcB) measurement, in order to draw the nomogram for 10th, 25th, 50th, 75th and 95th percentiles of skin bilirubin, both for term and near term babies. All measurements were performed with a multiwavelength transcutaneous bilirubinometer (Respironics BiliCheck™), within 2 h of the designed time and data were analysed with linear and local smoother regression. Results: We described the peculiar pattern of skin bilirubin increasing rate over different time periods. Bilirubin linearly increases rapidly in the first 48 h and less rapidly from 48 to 72 h, while the increment is insignificant from 72 to 96 h. Conclusion: We provide the first data on skin bilirubin trend in a large predominantly breastfed and healthy European newborn population during the natural course of nonpathologic hyperbilirubinemia. Nomogram and increment rate of skin bilirubin are useful to identify neonates requiring closer evaluation and to plan an adequate follow-up. [ABSTRACT FROM AUTHOR]

Objectives: To determine the sensitivity and specificity of different levels of bilirubin measured by the transcutaneous bilirubinometer Bilicheck on forehead and sternum for predicting severe hyperbilirubinaemia of total serum bilirubin (TSB) ≥ 300 µmol/L in Malay, Chinese and Indian infants. Design: A prospective observational study. Setting: A tertiary care University hospital. Methods: A total of 345 healthy jaundiced term infants were recruited prior to commencement of phototherapy or exchange transfusion. Transcutaneous bilirubin (TcB) level was measured with the Bilicheck from infants’ foreheads (TcBh) and sternums (TcBs) within 30 min of serum bilirubin measurement by the diazo method in the hospital laboratory. Results: The median serum TSB level of these infants was 233.0 µmol/L (range: 108.0–589.0). Ninety-five (27.5%) infants had TSB ≥ 300 µmol/L. There was good correlation between log10TSB and TcB measured from the forehead ( r = 0.80, P < 0.0001) and the sternum ( r = 0.86, P < 0.0001). At TcBh cut-off of 250 µmol/L, the Bilicheck detected TSB ≥ 300 µmol/L with a sensitivity of 100% and a specificity of 39.2%, the area under the receiver operative characteristic curve being 0.89 (95% confidence interval 0.85, 0.92). At TcBs cut-off of 200 µmol/L, the Bilicheck detected TSB ≥ 300 µmol/L with a sensitivity of 100% and a specificity of 33.6%, the area under receiver operative characteristic curve being 0.93 (95% confidence interval 0.90, 0.96). Conclusion: The Bilicheck is not a substitute for measuring serum bilirubin. However, using predetermined TcB cut-off values with reasonable sensitivity and specificity, it is a useful screening tool to identify infants with TSB ≥ 300 µmol/L requiring blood sampling, hospital admission and treatment. [ABSTRACT FROM AUTHOR]

Unlabelled: The aim of this study was to compare predictions of hyperbilirubinaemia by eye, performed by trained physicians and nurses, with predictions obtained using two commercial bilirubinometers. Jaundice was assessed in 92 white and 48 non-white healthy full-term neonates using three non-invasive methods and by total serum bilirubin as the reference method. Clinical assessment of cephalocaudal progression of jaundice was carried out independently by a physician and by nurses. Simultaneously, the Minolta Airshields JM-102 was applied on the sternum, the BiliCheck on both the forehead and the sternum, and finally, serum bilirubin concentrations were determined. The Minolta JM-102 showed the best performance with r2 = 0.90, an intraclass correlation coefficient (ICC) of 0.93, and a 95% confidence interval (CI) of +/- 4 units (approx. 56 micromol/l). The BiliCheck performed slightly better on the forehead than over the sternum with r2=0.90, an ICC of 0.88, and a CI of +/- 62 microtmol/l. Assessment of jaundice by eye was least accurate with r2 = 0.74, an ICC of 0.67, and a CI of +/- 1.5 zones (corresponding to 75 Lmol/l). Skin pigmentation and ambient light both adversely affected noninvasive bilirubin estimation.Conclusion: All three non-invasive methods are well suited for estimation of serum bilirubin but show large confidence intervals. In healthy term newborns, hyperbilirubinaemia (>250 Lmol/l) can be safely ruled out by eye if jaundice does not reach the abdomen or the extremities (Kramer zones 1 and 2), with < 22 units ( < 230 micromol/l) for the Minolta JM-102, or with a cut-off of 190 microlmol/l for the Bili-Check. If these respective thresholds are exceeded, serum bilirubin concentrations should be measured. [ABSTRACT FROM AUTHOR]

Aim: 1) To compare the clinical assessment of craniocaudal progression of jaundice and two transcutaneous bilirubinometers with serum bilirubin values in preterm neonates; 2) to identify factors affecting the difference between non-invasive bilirubin estimation and serum bilirubin. Methods: Serum bilirubin was clinically estimated in healthy preterm newborn infants (34 to 36.9 gestational weeks) independently by a primary investigator and by nurses, and subsequently compared with separate measures of two transcutaneous bilirubinometers. Results: A total of 107 measurements were performed on 69 infants. Minolta JM-102 showed the best performance, with ROC area under the curve of 0.96, followed by Bili Check ™ over the sternum (0.89) and over the forehead (0.88), clinical assessment by nurses (0.73) and by a physician (0.70). Serum bilirubin >190 μmol/l can be detected with 95% sensitivity with Minolta JM-102 ≥19 units, with Bili Check ™ ≥145 μmol/l over the sternum and ≥165 μmol/l over the forehead and with jaundice progression to the trunk or further (Kramer zone ≥2). Gestational age affects all non-invasive methods in the estimation of serum bilirubin, whereas skin colour affects both Bili Check ™ and clinical assessment. Ambient light affects only clinical assessment. Conclusion: Minolta JM-102 showed the best performance, closely followed by Bili Check ™, with clinical assessment performing far worse than either transcutaneous method. None of the three methods are recommended as complete substitutes for serum bilirubin values in jaundiced preterm infants. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the potential advantages of use of the Bilicheck® in the very preterm population, with special emphasis on the effect of possible adverse skin conditions on the accuracy of the measurements. In addition we estimated the potential for safe reduction of the number of blood samples taken for serum bilirubin determinations by introduction of the Bilicheck® into the neonatal intensive-care unit (NICU). Methods: Total serum bilirubin (TSB) and transcutaneous bilirubin (TcB) were determined in very preterm newborns (gestational age < 30 weeks). To assess the agreement between TSB and TcB values, Bland-Altman plots were analyzed. Accuracy and (intra-device) imprecision were determined by statistical analysis. A screening model was developed to estimate the potential for safe reduction of the number of blood samples taken for TSB determination. Results: Correlations between TcB and TSB values varied between 0.86 and 0.88 and all were statistically significant. Bland-Altman plots and statistical analysis showed that the agreement between TcB and TSB measurements was largest for the group with good skin conditions, as expected. The Bilicheck® device had an acceptable level of intra-device imprecision (2.29 ± 13.51 μmol/l). Applying the screening model to our entire study population, 35 of the 93 TSB measurements (38%) could have been saved. Conclusions: The Bilicheck® is a screening device with the potential to reliably indicate hyperbilirubinemia in very preterm infants. Caution is required when skin measurements are performed in the presence of peripheral edema and/or a poor peripheral circulation. Its application in the NICU environment has the potential to reduce the number of blood samples by 40%. [ABSTRACT FROM AUTHOR]

Aim: To evaluate whether transcutaneous bilirubinometry (TcB) would be a reliable and efficient screening technique for hyperbilirubinaemia in very low birthweight (VLBW, < or =1500 g) infants in an intensive care unit setting.Methods: TcB measurements (Minolta Airshield Jaundice Meter JM-102, Osaka, Japan) were obtained immediately before or within 10 min following routine blood sampling for plasma bilirubin concentration measurements in 124 VLBW infants not receiving phototherapy. The relationship between the two techniques was analysed by linear regression analysis. A plasma bilirubin > or =150 micromol/l was defined as hyperbilirubinaemia. The sensitivity and specificity of possible TcB cut-off readings to detect hyperbilirubinaemia was evaluated.Results: There was a significant correlation between the measurements of both techniques (p < 0.0001, r = 0.68). In the present study, a TcB cut-off reading of 14 would have reduced the need for plasma bilirubin measurements by 26% without missing true hyperbilirubinaemia.Conclusion: The data suggest that TcB will improve VLBW infant care in an intensive care unit setting by reducing the need for invasive bilirubin concentration measurements. [ABSTRACT FROM AUTHOR]

Aim: To investigate the correlation between transcutaneous bilirubinometry (TcB) and total serum bilirubin (TsB) in jaundiced infants before and after, but not during phototherapy.Methods: This study prospectively investigated the correlation between TcB and TsB in term and near term infants before and after phototherapy.Results: Overall 673 pairs of measurements (TcB and TsB) were performed on 371 infants of ≥35 weeks gestation and with birth weight above 2000 g. Of these 337 sets were from 200 infants who had not been treated with phototherapy (Group 1) and 336 measurements from 171 infants taken between 1 h and 5 d after phototherapy (Group 2). The correlation coefficient between TcB and TsB in the whole cohort was r = 0.72. The correlation was low during the first 8 h after phototherapy (r = 0.56), but thereafter the correlation returned to the range of 0.65-0.8. Using the Sobel test, no significant difference was found between the correlation coefficients at the different time periods, with the possible exception of the difference between 1 and 8 h and 9 and 16 h which was of borderline significance with a p value of 0.06.Conclusion: This study demonstrates good correlation between TcB and TsB by 8 h after phototherapy. This adds validity to community-based screening programs employing TcB measurements plotted on TsB nomograms. Such programs may contribute to prevention of tragic cases of bilirubin-induced neurologic damage. [ABSTRACT FROM AUTHOR]

Objective: The cephalocaudal progression in neonatal jaundice is a well-known phenomenon. Since transcutaneous bilirubin measurements (TcB) are increasingly applied, for which different body site can be used, we aimed to quantify the cephalocaudal progression of neonatal jaundice through TcB and to assess the influence of gestational age, postnatal age and the degree of hyperbilirubinemia on this cephalocaudal progression.Study Design: In jaundiced neonates ≥32 weeks of gestational age, TcB was measured on 5 sites: forehead, sternum, hipbone, proximal tibia and foot, during the first two weeks of life.Results: 58 neonates were included. Mean ratios of TcB on the 5 sites compared to the forehead were: sternum 1,03 (SD 0,14), hipbone 0,80 (SD 0,16), proximal tibia 0,63 (SD 0,14) and foot 0,44 (SD 0,15). Gestational age, postnatal age nor the degree of hyperbilirubinemia were associated with the cephalocaudal progression (ANOVA p > 0,05).Conclusion: The cephalocaudal progression of neonatal jaundice is evident, with caudal levels of TcB being less than half of cephalic measurements. This implicates that TcB measurements caudal from the sternum are less reliable, and should be avoided. The degree of cephalocaudal progression is not associated with gestational or postnatal age, nor with height of bilirubin levels. [ABSTRACT FROM AUTHOR]