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Docosahexaenoic acid (DHA) is an essential component for brain development during fetal and early postnatal life. Hyperbilirubinemia is characterized by abnormally high levels of bilirubin in the bloodstream, frequently leading to jaundice in newborns. In severe instances, this condition can progress to neurological damage or kernicterus, a form of brain damage. Initial cell-based experiments conducted by our research team revealed that DHA significantly enhances the survival rate of nerve cells treated with bilirubin and diminishes the oxidative stress indicated by reduced peroxide activity caused by unconjugated bilirubin (UCB). Further investigations through animal studies demonstrated that DHA effectively mitigates bilirubin-induced brain injury in neonatal rats. However, the potential of DHA to decrease the incidence of bilirubin-induced brain damage in clinical settings has not been previously explored or reported. Infants with neonatal hyperbilirubinemia (n = 30 per group) participated in a double-blind, randomized, placebo-controlled parallel study. They received either 100 mg/d DHA or placebo syrup immediately when they were diagnosed. The study found that the bilirubin level at 48 hours of treatment, serum neuron-specific enolase (NSE) levels, mean phototherapy duration, and abnormal rate of cranial magnetic resonance imaging (MRI) were lower in the DHA group than those in the control group (P <.05). These results suggested that DHA is effective as an adjuvant treatment for hyperbilirubinemia in children. It can reduce the incidence of neonatal hyperbilirubinemia brain injury and plays a certain protective role. Clinical study on protective effect of DHA on neonatal bilirubin injury is registered at Chinese Clinical Trial Registry as ChiCTR2300070250. [ABSTRACT FROM AUTHOR]

Objective: To test the accuracy of transcutaneous bilirubinometry (TcB) in neonates 12 h after discontinuing phototherapy. Study design: In a prospective study of 91 neonates at ≥35 weeks of gestation, paired measurements of total serum bilirubin (TSB) and TcB were obtained 12 h after discontinuation of phototherapy. TcB measurements were obtained on the uncovered skin of the sternum and the covered skin of the lower abdomen. Bland–Altman plots were used to evaluate agreement between TSB and TcB. Results: TcB was found to systematically underestimate TSB on both covered and uncovered skin. The smallest but statistically significant difference between TSB and TcB was found on the covered lower abdomen (–1.03, p <.0001) compared with the uncovered skin of the sternum (–1.44, p <.0001). The correlation between TSB and TcB was excellent on both covered (r = 0.86, p <.001) and uncovered skin (r = 0.90, p <.001). Bland and Altman plots showed poor agreement between TcB and TSB. Conclusions: This study demonstrated excellent correlation between TcB and TSB 12 h after phototherapy but poor TcB–TSB agreement. TcB cannot be reliably used in neonates exposed to phototherapy. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to develop models for predicting total serum bilirubin by correcting errors of transcutaneous bilirubin using machine learning based on neonatal biomarkers that could affect spectrophotometric measurements of tissue bilirubin. Methods: This retrospective study included infants born at our hospital (≥36 weeks old, ≥2,000 g) between January 2020 and December 2022. Infants without a phototherapy history were included. Robust linear regression, gradient boosting tree, and neural networks were used for machine learning models. A neural network, inspired by the structure of the human brain, was designed comprising three layers: input, intermediate, and output. Results: Totally, 683 infants were included. The mean (minimum-maximum) gestational age, birth weight, participant age, total serum bilirubin, and transcutaneous bilirubin were 39.0 (36.0–42.0) weeks, 3,004 (2,004–4,484) g, 2.8 (1–6) days of age, 8.50 (2.67–18.12) mg/dL, and 7.8 (1.1–18.1) mg/dL, respectively. The neural network model had a root mean square error of 1.03 mg/dL and a mean absolute error of 0.80 mg/dL in cross-validation data. These values were 0.37 mg/dL and 0.28 mg/dL, smaller compared to transcutaneous bilirubin, respectively. The 95% limit of agreement between the neural network estimation and total serum bilirubin was −2.01 to 2.01 mg/dL. Unnecessary blood draws could be reduced by up to 78%. Conclusion: Using machine learning with transcutaneous bilirubin, total serum bilirubin estimation error was reduced by 25%. This integration could increase accuracy, lessen infant discomfort, and simplify procedures, offering a smart alternative to blood draws by accurately estimating phototherapy thresholds. Plain Language Summary: Neonatal jaundice is a common condition that might occur in the first week of life. Severe high bilirubin levels can lead to long-term problems like cerebral palsy, hearing impairment, and developmental delay. Therefore, newborns are usually evaluated for jaundice every day during their first week. To accurately assess jaundice, we need to measure the total bilirubin in the blood. However, daily blood draws for bilirubin measurements can be uncomfortable and may cause anemia in newborns. Thus, transcutaneous bilirubinometry is devised. It is a device that measures bilirubin through the skin and is commonly used because it is non-invasive. However, transcutaneous bilirubinometry has some accuracy issues. In this study, we successfully improved the accuracy of bilirubin measurement by combining machine learning with transcutaneous bilirubinometry. Being used alone, the transcutaneous bilirubinometer had an error of 1.08 mg/dL. However, combining transcutaneous bilirubinometry with machine learning, the error decreased to 0.80 mg/dL, which is a 25% of improvement. Using this approach, unnecessary blood draws could be reduced by up to 78%. If we incorporate this algorithm into transcutaneous bilirubinometry, this novel method has the potential to improve prediction accuracy and reduce the burden on babies. [ABSTRACT FROM AUTHOR]

Jaundice in the first week of life is found in 60% of term neonates and 80% of preterm neonates. Measurement of bilirubin levels is important in differentiation between physiological to pathological hyperbilirubinemia in neonates, also for determining the treatment of neonatal jaundice. So far, the determination of bilirubin levels is done by examining venous blood serum, but it has side effects. Transcutaneous bilirubin measurement is a non-invasive methods for measure bilirubin level in newborn. To determine the correlation between transcutaneous bilirubin levels and total serum bilirubin levels in neonatal jaundice. This research uses an observational analytical approach with a cross sectional design. Data were collected from patients treated in the period January - March 2023. Research subjects were neonates who experienced neonatal jaundice and underwent examination of total serum bilirubin levels and transcutaneous bilirubin levels with a maximum time interval of 30 minutes between the two examinations. All research subjects had never received phototherapy. Thirty neonates were included. The mean total serum bilirubin level was 14.46 ± 3.63 mg/dL and the mean transcutaneous bilirubin level was 12.50 ± 3.55 mg/dL on the forehead and 13.10 ± 3.25 mg/dL on the sternum. The correlation coefficient between total serum bilirubin and transcutaneous bilirubin was 0.85 on the forehead and 0.88 on the sternum, p<0.000. Transcutaneous bilirubin has a good correlation compared to total serum bilirubin as a screening tool for estimating total serum bilirubin levels in neonatal jaundice. TcB measurement at the sternum has better accuracy than the forehead. [ABSTRACT FROM AUTHOR]

The purpose of the study was to investigate correlation and concordance between total serum bilirubin (TSB) and transcutaneous bilirubin measured at covered (TcBC) and uncovered (TcBU) skin during and after discontinuation of phototherapy. A cross-sectional study included ≥ 34 weeks gestation infants requiring phototherapy for neonatal hyperbilirubinemia. In-house, photo-opaque patches were placed on infants' sternums before phototherapy initiation. Simultaneous blood sampling for TSB, TcBC, and TcBU measurements were performed. Among 103 infants included in the final analysis, 70% were full-term. Covering skin during phototherapy resulted in strong TcBC-TSB correlation (r = 0.91, 95% CI 0.87–0.94, P < 0.001) compared to TcBU (r = 0.53, 95% CI 0.37–0.65, P < 0.001), persisting post-phototherapy (r = 0.88, 95% CI 0.82–0.91, P < 0.001). Bland–Altman analysis showed a higher mean difference and wider 95% limits of agreement for TcBU-TSB during phototherapy (-6.3 mg/dL and -11.1 to -1.6) vs TcBC-TSB (0.9 mg/dL and -1.2 to 2.9). Passing-Bablok regression analysis confirmed good agreement between TcBC and TSB. Conclusions: The application of in-house, photo-opaque patches enhanced the correlation and agreement between TcBC and TSB during and after discontinuation of phototherapy. This may prove particularly useful in resource-limited settings where commercial devices are unavailable. What is Known: • Transcutaneous bilirubin measurement has been widely used as a screening method for neonatal hyperbilirubinemia. • The accuracy of transcutaneous bilirubin measurements during and after phototherapy in infants with hyperbilirubinemia has been debated. What is New: • Our study demonstrated that utilizing carefully designed photo-opaque patches enhanced the accuracy of transcutaneous bilirubin measurement during and after phototherapy. • Effective in-house alternatives are crucial in resource-limited settings where commercial opaque patches are not always accessible or affordable. [ABSTRACT FROM AUTHOR]

Background: Early hospital discharge (<72 hours following birth) of healthy-term and near-term infants is favored to promote family care but may have increased hyperbilirubinemia-related hospital readmissions. In this study, we compared the 2009 and 2022 American Academy of Pediatrics (AAP) discharge guidelines in the United Arab Emirates (UAE) for the impact on hyperbilirubinemia-related readmissions. Materials and methods: This was a retrospective cohort single-center study conducted in the UAE. We reviewed records from the period January 2021 to November 2021; the infants included those with a gestational age (GA) ≥35 weeks and a birth weight (BW) ≥2,500 gms and GA ≥36 weeks/BW ≥ 2,000 gms. Infants were classified into risk zones based on pre-discharge transcutaneous bilirubin (TcB) or total serum bilirubin (TSB) levels (AAP 2009 hyperbilirubinemia nomograms). We compared the 2009 and 2022 AAP discharge thresholds for the needs for follow-up and readmissions for hyperbilirubinemia. Results: We studied 895 newborns; 672 (75%) were born at term with a mean (± standard deviation) GA of 38 ± 1.3 weeks. Most (75.3%) were classified as appropriate for GA and 637 (71%) attended the 1st follow-up as recommended. Based on the 2009 AAP guidelines, 13 (2.9%) out of 447 (70%) were low risk; 12 (6.6%) out of 183 (29%) were low-intermediate risk; and 3 out of 7 (42.9%) were high-intermediate risk. A total of 49 (5.5%) infants were readmitted to the hospital for phototherapy. Unlike in the United States, the 2022 guidelines would have recommended follow-up visits within 2 days in a larger number [579 (64.7%)] than the 2009 recommendations [308 (34.4%)] in UAE; the overall need for phototherapy would also have been higher. However, the frequency of severe hyperbilirubinemia requiring phototherapy would have remained similar. Our population did not have more specific risk factors such as scalp bleeds, ABO isoimmunization, or glucose-6-phosphate dehydrogenase deficiency for developing severe neonatal hyperbilirubinemia. We did have a high number of missed follow-up appointments. Conclusion: In our region, the adoption of the 2022 AAP early hospital discharge guidelines may have increased the number of follow-up visits within 2 days after discharge from the hospital and the overall need of phototherapy. These guidelines need to be specifically evaluated in different ethnic groups in various parts of the world. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the accuracy and reliability of transcutaneous bilirubin (TcB) measurement in screening for neonatal jaundice. By comparing TcB values with serum bilirubin levels (TSB), the research assesses the effectiveness of non-invasive TcB devices as a screening tool. Data were collected from a sample of neonates undergoing jaundice screening, and the correlation between TcB and TSB was analyzed. Results indicate that TcB measurement provides a reliable and accurate method for initial jaundice screening, reducing the need for invasive blood tests while maintaining diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Measurement of transcutaneous bilirubin (TcB) is a non-invasive, widely used technique to estimate serum bilirubin (SB). However, its reliability in multiethnic populations during and after phototherapy is still controversial even in covered skin. The aim of this study was to determine the reliability of TcB in covered (cTcB) and exposed (eTcB) skin during and after phototherapy in a multiethnic population of term and preterm neonates according to Neomar's neonatal skin color scale. Prospective, observational study comparing SB and TcB. We determined SB when clinically indicated and, at the same time, measured cTcB under a photo-opaque patch and eTcB next to it with a jaundice meter (Dräger JM-105TM). All dyads TcB-SB were compared, both globally and according to skin color. We obtained data from 200 newborns (color1: 44, color2: 111, color3: 41, color4: 4) and compared 296 dyads TcB/SB. Correlation between cTcB and SB is strong during (0.74–0.83) and after (0.79–0.88) phototherapy, both globally and by color group. The SB-cTcB bias depends on gestational age during phototherapy and on skin color following phototherapy. The correlation between eTcB and SB during phototherapy is not strong (0.54), but becomes so 12 h after discontinuing phototherapy (0.78). Conclusions: Our study supports the reliability of cTcB to assess SB during and after phototherapy, with differences among skin tones after the treatment. The use of cTcB and Neomar's scale during and mainly after phototherapy may help reduce the number of blood samples required. What is Known: • Controversies exist on the reliability of jaundice meters during and after phototherapy in covered skin. Only a few studies have analyzed their accuracy in multiethnic populations, but none has used a validated neonatal skin color scale. What is New: • We verified correlation between serum and transcutaneous bilirubin in covered skin in a multiethnic population depending on skin color based on our own validated neonatal skin color scale during and after phototherapy. [ABSTRACT FROM AUTHOR]

Background Presently, transcutaneous determination of bilirubin has become a valuable method for the early detection of neonatal hyperbilirubinemia. This study aims to determine the correlation of transcutaneous bilirubin with serum bilirubin levels and assess the factors affecting transcutaneous bilirubin measurement in term and late preterm neonates. Materials and Methods The study included 100 newborns born at a gestational age of 35 to 41 weeks, with a birth weight of 2100 to 3500 g. Simultaneous measurement of bilirubin by traditional (invasive) and transcutaneous (non-invasive) methods was carried out within 15 minutes of admission in the neonatal intensive care unit. Parallel transcutaneous measurements were taken in the forehead and sternum. Statistical analysis was done to determine the correlation of transcutaneous (forehead and sternal) bilirubin with serum bilirubin levels and assess the factors affecting transcutaneous bilirubin measurement. Results In the range of serum bilirubin concentrations till 15 mg/ dl, a close correlation was observed between serum bilirubin (TSB) estimated by direct spectrophotometric method and transcutaneous bilirubin (TcB) estimated by “Bilitest 2000”. TcB estimation on the sternum was better correlated than that on the forehead (r-value: 0.962 vs. 0.935). TcB had a good correlation with TSB across the range of 12.5 - 20.5 mg/dl. Neonatal hypothermia significantly decreased TcB estimation (p =0.021, F=4.227). Respiratory distress, convulsion, sclerema and shock in neonates did not affect TcB estimation. Conclusion TcB has a good correlation with TSB in term and late preterm neonates. Thus TcB readings can be u [ABSTRACT FROM AUTHOR]

BackgroundTranscutaneous bilirubin (TcB) measurements during and after phototherapy for hyperbilirubinemia must be performed on unexposed skin. There are commercially made skin patches for this purpose, but they are relatively unavailable in low-resource settings. We devised a simple cotton patch and tested its use for TcB during phototherapy.MethodsMeasurements were taken in healthy neonates born at a gestational age of ≥35 weeks who were undergoing phototherapy for hyperbilirubinemia in western India before, 12 h after the start, and 12 h after the end of phototherapy. Total serum bilirubin (TSB) was measured using the diazo method in a clinical laboratory. TcB measurements were performed using a Dräger Jaundice Meter JM-105 placed over the sternum on two skin areas that were protected during and after treatment by a commercial (Philips BilEclipse) or self-made patch comprised of cotton gauze and wool.ResultsIn total, 47 neonates were included in our study. Before phototherapy, TSB and TcB values had a strong correlation (Pearson, r = 0.88), with a mean difference of −1.35 mg/dl. Correlations with TSB were good and equivalent for TcB values measured on skin covered by the commercial and self-made patches during (0.78 and 0.70, respectively) and after (0.57 and 0.58, respectively) phototherapy. TcB values measured on skin covered by the two patches correlated well both during and after phototherapy, with r = 0.82 and 0.90, respectively, and mean (95% confidence interval) differences of −1.21 and −0.32 mg/dl, respectively.ConclusionsReliable TcB measurements taken during and after phototherapy can be achieved on skin covered with a simple and affordable cotton skin patch.

Introduction: Prolonged jaundice is very common and can affect about 2-40% of all neonates. The condition warrants close monitoring to avoid missing serious pathology but not to over investigate a normal neonate. Transcutaneous bilirubin (TcB) measurement has been recommended by the AAP. However, there is no published data on the usage of Drager Jaundice Meter JM-105 as a screening modality for prolonged jaundice in term and late preterm neonates in Malaysia. We aimed to evaluate the accuracy of transcutaneous bilirubinometer in monitoring neonates with prolonged jaundice. Materials and methods: A prospective cross-sectional study was conducted in a university hospital in east coast Malaysia, involving 50 neonates with prolonged jaundice. Drager JM-105 device was used to measure TcB while the TSB sample was obtained simultaneously. Fifty pair measurements of TcB and TSB were compared. Results: The mean TSB was 201.96µmol/L (SD 80.98) where the mean TcB was 184.28 µmol/L (SD 73.37). This study demonstrated the mean difference of 17.68 µmol/L in total bilirubin measured by total serum bilirubin (TSB) and transcutaneous bilirubin (TcB) measured by Drager JM-105. This study also showed excellent correlation between TSB values and TcB with correlation coefficient r = 0.963 and r2 = 0.927 (p<0.05). Conclusion: This study showed excellent correlation between TSB values and TcB values. [ABSTRACT FROM AUTHOR]

Background: The cost of transcutaneous bilirubin (TcB) assessments in neonates restricts its availability outside of high-resource environments. There are typically only a few instruments, even in hospitals. Accurate bilirubinometers are becoming increasingly important for outpatient care and home monitoring, since many families these days are sent home before the period that neonatal hyperbilirubinemia peaks. We designed a novel, straightforward Tc bilirubinometer specifically for this purpose, and in this work, we assess the degree of agreement between TcB and TsB before, during, and after phototherapy treatment. Methods: In the newborn unit of the paediatric department at MGMGH and KAPV GMC in Trichy, a prospective cohort research was conducted. Included were newborns with ABO and Rh incompatibility who needed phototherapy after developing clinical jaundice within 10 days of birth. However, those who required an exchange transfusion or post-exchange, had bruises, birth marks, subcutaneous hematomas, or were suffering from conjugated hyperbilirubinemia were prohibited from taking part in the trial. This study involved 400 newborns in all. Results: The majority of newborns had gestational ages more than 35 weeks. For all gestational ages of newborns, there is a strong correlation between baseline transcutaneous bilirubinometer values and total serum bilirubin. Good agreement was found in the agreement study between TcB and TSB, with limits of agreement ranging from 0.6 to 4.1. Compared to the unpatched area, there was good agreement between the patched area TcB and TSB during the whole-time interval following the start of phototherapy. The results of the analysis of Rebound TcB and TSB were also same. Conclusion: A secure instrument for determining bilirubin levels in neonates--term and preterm--is the MBJ-20 Tc bilirubinometer. Since there is minimal possibility of overestimation when utilising TcB from a covered forehead before to, during, and following phototherapy, TcB can be used to monitor neonatal jaundice. Validating TcB's high value or bilirubin in exchange level with serum bilirubin is essential. [ABSTRACT FROM AUTHOR]

Background. Neonatal jaundice is a commonly occurring problem in both full term and preterm neonates. It is one of the major causes for neonatal mortality and morbidity. Objective. To assess the correlation among transcutaneous bilirubinometer readings and Total serum bilirubin levels at different sites in early and late preterm neonates before and at the end of phototherapy. Method. An observational study was conducted in preterm neonates diagnosed with jaundice. The Transcutaneous Bilirubin (TCB) instrument, Drager JM105 is used to assess TCB and it was recorded on three sites and average of the three readings was noted. Prior to phototherapy, TCB was noted 30 min before TSB was sent. A photo-opaque patch was placed on the sternum and phototherapy was given. At the end of the phototherapy, TCB on the sternum was noted and then TSB was sent with a time gap of not more than 30 min. Results. In this study, out of 50 neonates 14 were early preterm and 36 were late preterm babies. It was found that there was a positive correlation between TCB and TSB in early preterm babies before phototherapy (p value=0.0019), but there was no correlation between TCB and TSB at the end of phototherapy. In late preterm babies there was no correlation between TCB and TSB both before phototherapy and at the end of phototherapy. Conclusion. In this study it was found that TCB has positive correlation with TSB and can be implemented for the screening of hyperbilirubinemia even in preterm neonates.

Early-term neonates (with a gestational age (GA) of 37 and 0/7 weeks to 38 and 6/7 weeks) face higher morbidities, including respiratory and neurodevelopmental issues, than full-term (39 and 0/7 weeks to 40 and 6/7 weeks) infants. This study explores whether hyperbilirubinemia necessitating phototherapy also differs between these groups. A retrospective study was conducted on neonates born from January 2021–June 2022, excluding those with specific conditions. Evaluated factors included GA, birth weight, bilirubin levels, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and feeding type, with phototherapy given as per AAP guidelines. Of 1085 neonates, 356 met the criteria. When stratifying the neonates based on the need for phototherapy, a higher proportion of early-term neonates required phototherapy compared to full-term (p < 0.05). After factoring in various risks (GA; birth weight; gender; feeding type; G6PD deficiency; transcutaneous bilirubin levels at 24 h and 24–48 h postpartum; maternal diabetes; and the presence of caput succedaneum or cephalohematoma), early-term neonates were more likely to need phototherapy than full-term babies (OR: 2.15, 95% CI: 1.21 to 3.80). The optimal cut-off for transcutaneous bilirubin levels 24–48 h postpartum that were used to predict phototherapy need was 9.85 mg/dl. In conclusion, early-term neonates are at a greater risk for developing jaundice and requiring phototherapy than full-term neonates. Monitoring bilirubin 24–48 h postpartum enhances early prediction and intervention. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the analytical performance of a new transcutaneous bilirubin (TcB) device - BiliCareTM (Gerium Medical, Yavne, Israel). Methods: The neonatal TcB measurements were compared between BiliCareTM and the existing BiliChekTM systems (n = 40). TcB measured by BiliCareTM were also compared with total serum bilirubin (TSB) using a Roche Cobas702 chemistry analyzer (n = 31) and whole blood bilirubin using a Radiometer ABL 835 (n = 11). Reproducibility was assessed by repeating TcB measurements with 2 BiliCareTM devices on a normal neonate, two with borderline jaundice, and one with overt jaundice 10 to 20 times respectively within 30 minutes. Results: Compared with BiliChekTM, BiliCareTM demonstrated an average bias of -35.9 µmol/L (-20.6%) (BiliCareTM = 0.6724 BiliChekTM +20.984, r = 0.8414). BiliCareTM had a better agreement with Cobas702 (BiliCareTM = 0.8356 Cobas702 +31.884, r = 0.8576, average bias 8.0 µmol/L (5.3%)). Similarly, BiliCareTM had a -12.7 µmol/L (- 7.2%) average bias compared with ABL835 (BiliCareTM = 0.6166 ABL835 +54.464, r = 0.8287). At TcB 94.5, 155.2, 182.7, and 269.3 µmol/l levels, BiliCareTM had demonstrated imprecision as 8.9%, 9.8%, 5.4%, and 6.9% respectively. Conclusions: The new BiliCareTM correlates with total serum bilirubin as measured on laboratory chemistry analyzer Cobas702 and is acceptable for neonatal transcutaneous bilirubin testing. [ABSTRACT FROM AUTHOR]

Abstract Background Universal screening for neonatal hyperbilirubinemia risk assessment is recommended by the American Academy of Pediatrics to reduce related morbidity. In Bangladesh and in many low- and middle-income countries, there is no screening for neonatal hyperbilirubinemia. Furthermore, neonatal hyperbilirubinemia may not be recognized as a medically significant condition by caregivers and community members. We aimed to evaluate the acceptability and operational feasibility of community health worker (CHW)-led, home-based, non-invasive neonatal hyperbilirubinemia screening using a transcutaneous bilimeter in Shakhipur, a rural subdistrict in Bangladesh. Methods We employed a two-step process. In the formative phase, we conducted eight focus group discussions with parents and grandparents of infants and eight key informant interviews with public and private healthcare providers and managers to explore their current knowledge, perceptions, practices, and challenges regarding identification and management of neonatal hyperbilirubinemia. Next, we piloted a prenatal sensitization intervention and home-based screening by CHWs using transcutaneous bilimeters and evaluated the acceptability and operational feasibility of this approach through focus group discussions and key informant interviews with parents, grandparents and CHWs. Results Formative findings identified misconceptions regarding neonatal hyperbilirubinemia causes and health risks among caregivers in rural Bangladesh. CHWs were comfortable with adoption, maintenance and use of the device in routine home visits. Transcutaneous bilimeter-based screening was also widely accepted by caregivers and family members due to its noninvasive technique and immediate display of findings at home. Prenatal sensitization of caregivers and family members helped to create a supportive environment in the family and empowered mothers as primary caregivers. Conclusion Adopting household neonatal hyperbilirubinemia screening in the postnatal period by CHWs using a transcutaneous bilimeter is an acceptable approach by both CHWs and families and may increase rates of screening to prevent morbidity and mortality.

Background: Transcutaneous bilirubin (TcB) measurement is useful, but dissociation with total serum bilirubin (TSB) is a clinical problem in measurement. We verified the accuracy of the latest version of the JM-105 jaundice meter. Methods: The TcB, TSB, and hematocrit (Hct) measurements obtained in the first 4 days of life in 2788 term neonates were analyzed. Results: When divided into 2-mg/dL classes, the difference between the TcB and TSB measurements did not change as TcB increased, but both overestimation and underestimation of TcB increased as TcB increased. At TcB greater than 11 mg/dL, inaccurate measurements with dissociation greater than 2 mg/dL exceeded 10% of the TcB measurements. The Hct value was associated with overestimation and underestimation. Conclusion: To evaluate neonatal jaundice accurately, it is desirable to measure TSB by blood sampling before discharge from obstetrics or in the case of worsening jaundice on day 4 or 5 of life.

Objective The study aimed to evaluate the validity of transcutaneous bilirubin (TcB) measurements at three sites in premature infants born at 23 0/7 to 34 6/7 weeks' gestational age (GA) compared with total serum bilirubin (TSB) measurements. Study Design A prospective study was conducted at Banner – University Medical Center Phoenix, where informed consent was obtained from the infant's parent or legally authorized representative. Cohort A was comprised of infants 23 0/7 to 28 6/7 weeks' GA and Cohort B contained subjects 29 0/7 to 34 6/7 weeks' GA. Baseline TSB measurements were collected at approximately 24 hours of life, as the standard of care and the TcB measurements were obtained from the sternum, interscapular, and buttock areas at approximately ± 30 minutes from collection of the TSB. Statistical analysis of measurements including sensitivity, specificity, positive, and negative predictive values, and the area under the receiver operator characteristic curve (AUROC) were performed. Results A total of 166 infants were included in the study population. Cohort A consisted of 41 subjects and Cohort B contained 125 subjects. The results showed that baseline TcB measurements from the interscapular area were the most sensitive and specific with TSB levels >5.0 mg/dL in Cohort A. Baseline TcB measurements from the sternum demonstrated greatest sensitivity and specificity when the TSB level was >8.0 mg/dL in Cohort B. In general, each of the three sites in both cohorts demonstrated excellent AUROCs and negative predictive values. Conclusion The use of a TcB meter in preterm infants can be a reliable noninvasive screening tool for hyperbilirubinemia, and it may be beneficial in decreasing painful stimuli and iatrogenic blood loss when used as an adjunct to TSB monitoring. Key Points Interscapular TcB is sensitive/specific in 23 to 29 weeks' GA. Sternal TcB is sensitive/specific in 29 to 35 weeks' GA. TcB readings are reliable in preterm infants. TcB is reliable when serum bilirubin is >5.0 mg/dL. [ABSTRACT FROM AUTHOR]

Background: Universal screening for neonatal hyperbilirubinemia risk assessment is recommended by the American Academy of Pediatrics to reduce related morbidity. In Bangladesh and in many low- and middle-income countries, there is no screening for neonatal hyperbilirubinemia. Furthermore, neonatal hyperbilirubinemia may not be recognized as a medically significant condition by caregivers and community members. We aimed to evaluate the acceptability and operational feasibility of community health worker (CHW)-led, home-based, non-invasive neonatal hyperbilirubinemia screening using a transcutaneous bilimeter in Shakhipur, a rural subdistrict in Bangladesh. Methods: We employed a two-step process. In the formative phase, we conducted eight focus group discussions with parents and grandparents of infants and eight key informant interviews with public and private healthcare providers and managers to explore their current knowledge, perceptions, practices, and challenges regarding identification and management of neonatal hyperbilirubinemia. Next, we piloted a prenatal sensitization intervention and home-based screening by CHWs using transcutaneous bilimeters and evaluated the acceptability and operational feasibility of this approach through focus group discussions and key informant interviews with parents, grandparents and CHWs. Results: Formative findings identified misconceptions regarding neonatal hyperbilirubinemia causes and health risks among caregivers in rural Bangladesh. CHWs were comfortable with adoption, maintenance and use of the device in routine home visits. Transcutaneous bilimeter-based screening was also widely accepted by caregivers and family members due to its noninvasive technique and immediate display of findings at home. Prenatal sensitization of caregivers and family members helped to create a supportive environment in the family and empowered mothers as primary caregivers. Conclusion: Adopting household neonatal hyperbilirubinemia screening in the postnatal period by CHWs using a transcutaneous bilimeter is an acceptable approach by both CHWs and families and may increase rates of screening to prevent morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: The measurement of total serum bilirubin is a stressful diagnostic method; therefore, it is necessary to measure bilirubin levels using non-invasive ways. The present study aimed to assess the relationship between bilirubin levels measured using three methods of transcutaneous, serum, and Kramer’s scale in term neonates with jaundice. Methods: This descriptive-analytical study was conducted on 180 full-term neonates admitted to Imam Ali Hospital in Alborz province, Iran. Bilirubin level was measured by three methods of serum, transcutaneous (using MBJ20, B&M Technology Co., China), and Kramer’s scale (based on the appearance) before phototherapy. Thereafter, the relationship between serum bilirubin levels using transcutaneous and Kramer’s scale was determined by the Pearson and Spearman correlation coefficients. Results: The correlation coefficient between serum bilirubin and transcutaneous bilirubin (TCB) was obtained at 0.915 before phototherapy. Furthermore, the correlation coefficients between serum bilirubin and TCB were calculated at 0.881 and 0.77 in the covered and uncovered areas after phototherapy, respectively. The correlation coefficient between TCB in the covered and uncovered areas was 0.81. The mean difference between serum bilirubin and TCB was 0.42±1.25 before phototherapy. Moreover, the mean difference values between serum bilirubin and TCB were reported as 1.36±1.37 and 83.1±63.4 in the covered and uncovered areas after phototherapy, respectively. Conclusion: As evidenced by the obtained results, there was a significant correlation between TCB and serum bilirubin before the initiation of phototherapy. Therefore, it is recommended to use TCB instead of repeated blood sampling to follow and monitor neonates.

Aim:Transcutaneous bilirubin (TCB) measurement methods cause false results during and after phototherapy (PT), so bilirubin levels are followed by total serum bilirubin (TSB) measurement, which causes taking blood samples and increases the risk of infection. We compared the TCB measurements made with Bilicare™ and TSB measurements by preventing PT exposure of a part of the skin in newborns receiving PT and evaluating the reliability of the measurements made with Bilicare™ after PT.Methods:This study was conducted between 01 February-30 June 2020 as a single-center cross-sectional study. The study included newborns aged 35 weeks and up who were admitted to a neonatal intensive care unit for PT. TSB measurements were reviewed by the hospital automation system. Bilicare™ bilirubin meter was used for TCB measurements. Simultaneous TSB and TCB measurements were made before PT. The skin area to be measured was covered with a radio-opaque patch. After PT, simultaneous TSB, exposed skin area TCB, and patched skin area TCB were measured. Simultaneous TSB and TCB measurements were repeated 24 h after the end of PT. The relationship between these data was evaluated statistically.Results:This study was conducted with 171 late preterm and term newborns with a gestational age of ≥35 weeks. 79 (46.1%) were female and 92 (53.9%) were male newborns. The mean gestational age was 38.3±1.15 weeks. When maternal and newborn blood groups were evaluated, 107 (62.5%) had no blood incompatibility, 53 (30.9%) had ABO incompatibility incompatibility, 9 (5.2%) had Rh incompatibility, 1 (0.6%) had subgroup incompatibility, and 1 (0.6%) had ABO incompatibility and Rh incompatibility. The correlation coefficient (r) of TSB and TCB measurements made before PT was 0.97 and a strong correlation was found. A correlation coefficient (r) of 0.98 and a strong correlation between closed skin area TCB measurement and TSB measurement immediately after PT were detected. The correlation coefficient (r) was 0.96 and a strong correlation was found between the TCB and TSB measurements performed 24 h after the PT was terminated.Conclusion:This study shows that TCB measurements made from unexposed areas can be safely measured in patients with PT.

Transcutaneous bilirubin (TcB) measurement is useful, but dissociation with total serum bilirubin (TSB) is a clinical problem in measurement. We verified the accuracy of the latest version of the JM-105 jaundice meter. The TcB, TSB, and hematocrit (Hct) measurements obtained in the first 4 days of life in 2788 term neonates were analyzed. When divided into 2-mg/dL classes, the difference between the TcB and TSB measurements did not change as TcB increased, but both overestimation and underestimation of TcB increased as TcB increased. At TcB greater than 11 mg/dL, inaccurate measurements with dissociation greater than 2 mg/dL exceeded 10% of the TcB measurements. The Hct value was associated with overestimation and underestimation. To evaluate neonatal jaundice accurately, it is desirable to measure TSB by blood sampling before discharge from obstetrics or in the case of worsening jaundice on day 4 or 5 of life. [ABSTRACT FROM AUTHOR]

Objective: To assess the utility of jaundice surveillance and routine 24 hour bilirubin screening in identifying neonates who qualify for phototherapy (PT) at ≤24 hours after birth., Study Design: In this retrospective, single-center observational study, records of neonates ≥35 0/7  weeks gestation born to O+, antibody negative mothers (n = 6098) were screened to identify who received PT at ≤24 hours after birth. The hour specific TSB at which neonates qualified for PT, blood type, direct antiglobulin test (DAT), and whether treatment was triggered by jaundice detection at <24 hours or the 24-hour bilirubin screen were determined., Results: 59 neonates (1.0%) qualified for PT ≤ 24 hours after birth; 10 (17%) were identified by jaundice detection at <24 hours, whereas 49 (83%) were identified on 24-hour bilirubin screening. Forty-eight of the 59 (81%) were ABO incompatible and DAT+; 11 were DAT negative, one of whom had glucose-6-phosphate dehydrogenase deficiency. Among the ≤24 hour PT group, 17 had a PT qualifying TSB within 3 mg/dL of exchange transfusion (ET); 14 of whom were only identified first on 24-hour bilirubin screening. Six exceeded ET thresholds, 4 of whom were identified on 24-hour bilirubin screening., Conclusions: Neonates who qualified for PT at ≤24 hours were identified mostly by 24-hour bilirubin screening, a fraction of whom had a TSB that approached or exceeded ET thresholds. Our findings support routine birth hospitalization bilirubin screening and suggest screening no later than 24 hours after birth may be beneficial., Competing Interests: Declaration of Competing Interest Dr. Watchko disclosed a financial relationship with McGraw-Hill. The other authors have no conflict of interest relevant to this article to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Abstract Background Neonatal jaundice may cause severe neurological damage if poorly evaluated and diagnosed when high bilirubin occurs. The study explored how to effectively integrate high-dimensional genetic features into predicting neonatal jaundice. Methods This study recruited 984 neonates from the Suzhou Municipal Central Hospital in China, and applied an ensemble learning approach to enhance the prediction of high-dimensional genetic features and clinical risk factors (CRF) for physiological neonatal jaundice of full-term newborns within 1-week after birth. Further, sigmoid recalibration was applied for validating the reliability of our methods. Results The maximum accuracy of prediction reached 79.5% Area Under Curve (AUC) by CRF and could be marginally improved by 3.5% by including genetic variant (GV). Feature importance illustrated that 36 GVs contributed 55.5% in predicting neonatal jaundice in terms of gain from splits. Further analysis revealed that the main contribution of GV was to reduce the false-positive rate, i.e., to increase the specificity in the prediction. Conclusions Our study shed light on the theoretical and practical value of GV in the prediction of neonatal jaundice.

Early-term neonates (with a gestational age (GA) of 37 and 0/7 weeks to 38 and 6/7 weeks) face higher morbidities, including respiratory and neurodevelopmental issues, than full-term (39 and 0/7 weeks to 40 and 6/7 weeks) infants. This study explores whether hyperbilirubinemia necessitating phototherapy also differs between these groups. A retrospective study was conducted on neonates born from January 2021–June 2022, excluding those with specific conditions. Evaluated factors included GA, birth weight, bilirubin levels, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and feeding type, with phototherapy given as per AAP guidelines. Of 1085 neonates, 356 met the criteria. When stratifying the neonates based on the need for phototherapy, a higher proportion of early-term neonates required phototherapy compared to full-term (p < 0.05). After factoring in various risks (GA; birth weight; gender; feeding type; G6PD deficiency; transcutaneous bilirubin levels at 24 h and 24–48 h postpartum; maternal diabetes; and the presence of caput succedaneum or cephalohematoma), early-term neonates were more likely to need phototherapy than full-term babies (OR: 2.15, 95% CI: 1.21 to 3.80). The optimal cut-off for transcutaneous bilirubin levels 24–48 h postpartum that were used to predict phototherapy need was 9.85 mg/dl. In conclusion, early-term neonates are at a greater risk for developing jaundice and requiring phototherapy than full-term neonates. Monitoring bilirubin 24–48 h postpartum enhances early prediction and intervention.

To compare transcutaneous bilirubin (TcB) to total serum bilirubin (TSB) in jaundiced neonates by using a JM-103 bilirubinometer. We conducted a retrospective study in jaundiced infants ≥35 weeks' gestation. Infants' and maternal information, TcB measurements, and TSB levels were collected. The correlation and consistency between TcB and TSB were analyzed by Pearson's correlation analysis and the Bland–Altman plot. Multivariate regression analysis was used to identify characteristics associated with the difference between TcB and TSB, underestimation by TcB and overestimation by TcB. A total of 787 paired samples were collected. There was a strong correlation between TcB and TSB with a Pearson correlation coefficient of 0.708 (p <.001). In preterm infants, outpatients and infants with high TSB levels, the TcB measurements were less precise. The TcB–TSB difference was significantly associated with gender, maternal hypertension disease, ABO hemolytic disease, and outpatient setting (p <.05). Only the outpatient setting had statistical significance in the underestimation of TSB ≥2 mg/dL. Generally, TcB by a JM-103 bilirubinometer had a good correlation and consistency with the TSB values. However, small for gestational age, postnatal age of hour, ABO hemolytic disease, and outpatient setting may lead to inconsistencies between the TcB and TSB. [ABSTRACT FROM AUTHOR]

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BackgroundHyperbilirubinemia remains a common morbidity among infants. Additional research on bilirubin kinetics and associated risk factors will contribute to providing a more targeted management approach for the Filipino infant.ObjectiveTo develop a Filipino bilirubin nomogram by studying bilirubin patterns during the first 5 days of life.MethodologyThis prospective study recruited 1,412 stable, full-term infants (≥37 weeks age of gestation) born at the Philippine General Hospital (PGH). Using the Dräger-Minolta JM-103 jaundice meter, transcutaneous bilirubin (TcB) levels were determined at the 3rd, 6th, 12th, 24th, 36th, 48th, 72nd, 96th, and 120th hour of life (HOL). A bilirubin nomogram was created using the averages of 3 TcB forehead and sternal measurements at each time epoch. Simultaneous measurement of TcB and total serum bilirubin (TsB) on a subset of 106 infants was done to determine correlation.ResultsCorrelation coefficients were high between TsB and forehead TcB (r2 = 0.88), and between TsB and sternal TcB (r2 = 0.91). The Filipino bilirubin nomogram reflected a steep rise until the 48th hour, followed by plateauing of values. Inadequate nursing and bilirubin levels at 12th and 48th HOL were risk factors for developing significant hyperbilirubinemia at 72nd HOL.ConclusionTcB is a reliable, non-invasive bilirubin screening tool. Among healthy, full-term, Filipino infants, their nomogram features a sudden increase in bilirubin values during the first 48 h, followed by a plateau. To aid in identification of infants at risk for significant hyperbilirubinemia, healthcare providers can assess breastfeeding adequacy and perform bilirubin screening at the 24th−48th HOL. Registration No. (RGAO-2016-0686).

BackgroundNeonatal hyperbilirubinemia is a significant health problem in Myanmar. We introduced transcutaneous bilirubin (TcB) measurements in 2017 and developed an hour-specific TcB nomogram for early detection and treatment of hyperbilirubinemia in Myanmar neonates. This study aimed to evaluate whether our screening method for hyperbilirubinemia decreased the requirement of blood exchange therapy (ET).MethodsThis retrospective cohort study was conducted at the Central Women’s Hospital, Yangon. Two groups were included as follows: group 1 (control group; comprising infants born in 2016 and screened on the basis of Kramer’s rule), and group 2 (intervention group; comprising infants born in 2019 and screened by TcB measurement using a nomogram). The number of ETs was analyzed based on causes of hyperbilirubinemia and number of days after birth.ResultsGroups 1 and 2 comprised 12,968 and 10,090 infants, respectively. Forty-six and two infants in Groups 1 and 2, respectively, required an ET. The odds ratio for ET was 18.0 (Group 1 to Group 2; 95% confidence interval [CI]: 4.8–67.1; p = 0.000). Serum bilirubin values at the time ET was administered were significantly higher in Group 1 than those in Group 2 (median: 23.0 and 16.8, respectively).ConclusionThe management of hyperbilirubinemia using our screening method (TcB Nomogram) can effectively reduce the need for ET in neonates in Myanmar.

Objective: To create a nomogram based on transcutaneous bilirubin values (TCB) in first week of life for term and late preterm (>34 weeks) neonates.Methods and Design: Prospective longitudinal study.Setting: Four tertiary-care teaching hospitals (one each in eastern and southern India, two in northern India) between February 2019 and March 2020.Participants: A total of 2492 term and late preterm (>34 weeks) neonates.Intervention: Bilirubin was measured by transcutaneous bilirubinometer (Drager JM-105, Germany) in all neonates in pre-specified times of the day, 12 hourly every day since birth till discharge between 48 and 72 h, and data were recorded in epochs of 6 hourly intervals. Post-discharge, all neonates were called for review in next 48 h.Outcome Measures: Primary-TCB in first week of life. Secondary-factors having significant association with significant hyperbilirubinaemia requiring phototherapy.Results: Total of 2492 neonates (males 1303 and female 1189), with a total of 14 162 TCB recordings were analysed and mean hourly bilirubin (TCB) at hourly intervals till 120 h and then daily bilirubin values on Days 6 and 7 were tabulated. We have constructed hour-specific bilirubin nomogram with percentiles as per gestational age in term and near-term Indian neonates till 120 h of life. Amongst the known risk factors, delayed cord clamping, primipara and breastfeeding jaundice had significant association for hyperbilirubinaemia needing phototherapy.Conclusions: We have created gestation-specific nomogram of TCB levels in 6 hourly intervals for the first 120 postnatal hours, obtained from a large predominantly breast fed healthy, term and near-term Indian neonates. [ABSTRACT FROM AUTHOR]

Background: The accuracy and reliability of noninvasive methods of neonatal jaundice assessment are not completely obvious, including which area of the body is more suitable to estimate actual bilirubin with transcutaneous bilirubinometry (TCB). Methods: This cross-sectional study compares the accuracy of three noninvasive methods for neonatal jaundice estimation included visual estimation, TCB on the forehead, and TCB on the sternum. The mean and standard deviation describe quantitative variables. In addition to analytical analysis, we used the linear regression test to evaluate the association of different variables with the accuracy of TCB as well as paired t test for comparing the TCB results on the sternum with the forehead before and after phototherapy. For all statistical tests, a P value less than 0.05 was considered as significant. Results: We enrolled 100 neonates with a mean age ( ± SD, standard deviation) of 6.5 ± 1.9 days (range 2--11 days) in our study. The mean gestational age (GA) of the participants was 38.94 weeks ± 1.00 w SD, and their mean ( ± SD) weight was 3302 g ( ± 315.60). The mean (mg/dL) ± SD for bilirubin level by clinical estimation of jaundice, TCB on the forehead and TCB on the sternum were 17.35 ± 2.88, 17.23 ± 1.63, and 17.77 ± 1.58, respectively. Also, comparing mean differences before and after phototherapy showed that TCB on the sternum is a good predictor for neonatal jaundice before phototherapy (0.539 vs. 0.348). Conclusion: TCB on the sternum is more predictive than the forehead, especially before phototherapy, to assess the need for treatment in outpatient settings. [ABSTRACT FROM AUTHOR]

BACKGROUND: Jaundice is the quite common benign condition in neonates, but due to its potential toxicity, neonates must be monitored. This study was aimed to evaluate the effect of serum albumin level on the transcutaneous bilirubin (TcB) measurements in term neonates with unconjugated hyperbilirubinemia. METHODS: Serum albumin and total serum bilirubin (TSB) of 252 jaundiced term neonates were estimated and simultaneously TcB was measured over sternum and the effect of serum albumin on TcB measurements was evaluated. RESULTS: The correlation between TSB and TcB was linear and significant for the entire cohort. When this correlation was studied separately in the groups with different albumin levels, maximum correlation (r = 0.888, R2 linear = 0.789, p < 0.001) was observed in group 1 with hypo-albuminemia followed by in group 2 with normal albumin levels (r = 0.854, R2 linear = 0.729, p < 0.001) and group 3 with higher albumin levels (r = 0.809, R2 linear = 0.689, p < 0.001). Bland-Altman plot analysis of whole study population demonstrate good agreement between TSB and TcB [95% CI = –0.038 to 0.493 mg/dL, 17/252 = 6.75% outside the limits of agreement, Mean difference = 0.227]. This analysis in different groups also show good agreement between TSB and TcB. CONCLUSIONS: The correlation between the TSB and TcB may affected by serum albumin level. Therefore, transcutaneous bilirubinometry is not able to replace invasive TSB measurement. However, in the absence of TSB it could be an alternative to measure the level of bilirubin in term neonates. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the utility of a Transcutaneous Bilirubin nomogram in high risk neonates and to evaluate the validity of Transcutaneous Bilirubin and Total serum bilirubin in both low and high-risk neonates. Study Design: Cross-sectional study. Place and Duration of Study: Postnatal Ward, Aga Khan University Hospital, Karachi, from May to Oct 2019. Methodology: The participants will include all neonates born and admitted in the well baby nursery with jaundice. All neonates with gestational age of

Objective: The aim of this study was to determine the effect of breastfeeding and intensive breast milk nutritional support program (IBNSP) on hospitalization rates for hyperbilirubinemia in normal term newborns.Methods: This study's sample consisted of 68 newborn infants (experimental group: 34; control group: 34) born at a university hospital from October 2020 to April 2021. Five steps of breastfeeding and IBNSP were administered to the experimental group for the first 48 h after birth. This program starts at the postpartum first hour and continues until the 48th hour. It includes face-to-face training, practical support on breastfeeding, and one-to-one demonstration and practice methods. The control group received the standard care recommended by the World Health Organization. Both groups' bilirubin levels were measured 24 and 72 h after birth. Participants in both groups were hospitalized for risky (according to bilirubin values) situations. The groups' bilirubin levels and hospitalization rates for hyperbilirubinemia were compared.Results: There was no statistically significant difference between the experimental (5.19 ± 1.27) and the control (5.83 ± 1.52) groups' bilirubin levels at 24 h after birth, (t = -1.881, p = 0.064); however, the control group infants (12.03 ± 3.67 mg/dl) had higher bilirubin levels than the infants in the experimental group 72 h after birth (9.55 ± 2.82 mg/dl) (t = -3.122, p = 0.003). The experimental group's hospitalization rate for hyperbilirubinemia (n: 1, 2.9%) was lower than the control group's rate (n: 8, 23.5%), and this difference was statistically significant (X2 = 6.275, p = 0.014).Conclusions: Breastfeeding and IBNSP effectively prevent hospitalization for hyperbilirubinemia and reduce newborns' bilirubin levels. [ABSTRACT FROM AUTHOR]

Background: The measurement of total serum bilirubin is a stressful diagnostic method; therefore, it is necessary to measure bilirubin levels using non-invasive ways. The present study aimed to assess the relationship between bilirubin levels measured using three methods of transcutaneous, serum, and Kramer’s scale in term neonates with jaundice. Methods: This descriptive-analytical study was conducted on 180 full-term neonates admitted to Imam Ali Hospital in Alborz province, Iran. Bilirubin level was measured by three methods of serum, transcutaneous (using MBJ20, B&M Technology Co., China), and Kramer’s scale (based on the appearance) before phototherapy. Thereafter, the relationship between serum bilirubin levels using transcutaneous and Kramer’s scale was determined by the Pearson and Spearman correlation coefficients. Results: The correlation coefficient between serum bilirubin and transcutaneous bilirubin (TCB) was obtained at 0.915 before phototherapy. Furthermore, the correlation coefficients between serum bilirubin and TCB were calculated at 0.881 and 0.77 in the covered and uncovered areas after phototherapy, respectively. The correlation coefficient between TCB in the covered and uncovered areas was 0.81. The mean difference between serum bilirubin and TCB was 0.42±1.25 before phototherapy. Moreover, the mean difference values between serum bilirubin and TCB were reported as 1.36±1.37 and 83.1±63.4 in the covered and uncovered areas after phototherapy, respectively. Conclusion: As evidenced by the obtained results, there was a significant correlation between TCB and serum bilirubin before the initiation of phototherapy. Therefore, it is recommended to use TCB instead of repeated blood sampling to follow and monitor neonates. [ABSTRACT FROM AUTHOR]

Objective: To compare the diagnostic accuracy of various transcutaneous bilirubin (TcB) nomograms for predischarge screening. Methods: The paired total serum bilirubin (TSB) and TcB measurements collected in neonates ≥35 weeks and ≥2000 g birth weight were analyzed. BiliCare™ bilirubinometer was used for TcB measurement. We chose the following nomograms for the study: Bhutani nomogram, Maisel's nomogram, Agarwal nomogram, Thakkar nomogram, American Academy of Pediatrics (AAP) nomogram within 3 mg/dl of phototherapy cutoff, AAP nomogram >70% of phototherapy cutoff and if TcB value is above 13 mg/dl. The diagnostic accuracy of these nomograms for TcB was compared with TSB plotted in the Bhutani nomogram. Results: TcB showed a positive correlation with TSB (Pearson correlation coefficient = 0.783). Bhutani nomogram, Maisel's nomogram and AAP (using within 3 mg/dL cutoff) nomogram showed good sensitivity and low false-negative rate while avoiding blood draws in most neonates. Conclusion: Bhutani nomogram, Maisel's nomogram, and AAP (using within 3 mg/dL of phototherapy cutoff) nomograms have comparable diagnostic accuracy for predischarge bilirubin screening in neonates. [ABSTRACT FROM AUTHOR]

Aim: Transcutaneous bilirubin (TCB) measurement methods cause false results during and after phototherapy (PT), so bilirubin levels are followed by total serum bilirubin (TSB) measurement, which causes taking blood samples and increases the risk of infection. We compared the TCB measurements made with Bilicare™ and TSB measurements by preventing PT exposure of a part of the skin in newborns receiving PT and evaluating the reliability of the measurements made with Bilicare™ after PT. Methods: This study was conducted between 01 February-30 June 2020 as a single-center cross-sectional study. The study included newborns aged 35 weeks and up who were admitted to a neonatal intensive care unit for PT. TSB measurements were reviewed by the hospital automation system. Bilicare™ bilirubin meter was used for TCB measurements. Simultaneous TSB and TCB measurements were made before PT. The skin area to be measured was covered with a radio-opaque patch. After PT, simultaneous TSB, exposed skin area TCB, and patched skin area TCB were measured. Simultaneous TSB and TCB measurements were repeated 24 h after the end of PT. The relationship between these data was evaluated statistically. Results: This study was conducted with 171 late preterm and term newborns with a gestational age of ≥35 weeks. 79 (46.1%) were female and 92 (53.9%) were male newborns. The mean gestational age was 38.3±1.15 weeks. When maternal and newborn blood groups were evaluated, 107 (62.5%) had no blood incompatibility, 53 (30.9%) had ABO incompatibility incompatibility, 9 (5.2%) had Rh incompatibility, 1 (0.6%) had subgroup incompatibility, and 1 (0.6%) had ABO incompatibility and Rh incompatibility. The correlation coefficient (r) of TSB and TCB measurements made before PT was 0.97 and a strong correlation was found. A correlation coefficient (r) of 0.98 and a strong correlation between closed skin area TCB measurement and TSB measurement immediately after PT were detected. The correlation coefficient (r) was 0.96 and a strong correlation was found between the TCB and TSB measurements performed 24 h after the PT was terminated. Conclusion: This study shows that TCB measurements made from unexposed areas can be safely measured in patients with PT. [ABSTRACT FROM AUTHOR]

Objective  The present study was aimed at developing a circumferential phototherapy unit using 3M reflective materials in the double-sided phototherapy unit and investigating its efficacy in treating neonatal hyperbilirubinemia. Study Design  Forty-two infants with neonatal hyperbilirubinemia were selected from our hospital; they were randomly divided into control (n  = 21) and experimental groups (n  = 21). The experimental group was treated with the circumferential phototherapy unit, while the control group was treated with an ordinary phototherapy unit. Results  No significant differences were noted between the two groups in the levels of transcutaneous bilirubin before phototherapy (p  > 0.05). After 12 hours of phototherapy, the value of transcutaneous bilirubin decreased significantly in the experimental group compared with that of the control group (p  < 0.05). Additionally, the two groups did not exhibit any significant difference in the side effects (p  > 0.05). Conclusion  Our results indicated that the circumferential phototherapy unit was more effective than the ordinary phototherapy unit in treating neonatal hyperbilirubinemia. Key Points A circumferential phototherapy unit was developed using 3M reflective materials. The circumferential phototherapy unit was more effective than the ordinary. The two groups did not exhibit any significant difference in the side effects. [ABSTRACT FROM AUTHOR]

Abstract Background To confirm the accuracy of transcutaneous bilirubin (TcB) in the neonatal intensive care unit both with and without phototherapy, and compare forehead and sternum as the TcB assessment site. Methods We simultaneously assessed the total serum bilirubin (TSB) and TcB at the forehead and sternum, using a JM-103 bilirubinometer. We analyzed the correlation between the TSB and TcB assessed at the forehead and sternum, with measurements classified as ‘without phototherapy’ (before phototherapy and > 24 hours after phototherapy discontinuation) and ‘with phototherapy’ (after 24 hours of phototherapy). Results There were 1,084 paired forehead and sternum TcB measurements, with the corresponding TSB measurement, from 384 infants. Their mean gestational age of 35.4 ± 3.2 weeks (62% were preterm) and a mean birth weight of 2434 ± 768 grams, and TSB was 6.61 ± 3.56 mg/dL. Without phototherapy, TcB values at the forehead and sternum were correlated well to the TSB value (r = 0.925 and 0.915, respectively). With phototherapy, TcB values at the forehead and sternum were significantly correlated with the TSB value, but TcB at the forehead (r = 0.751) was a better match to the TSB than was TcB at the sternum (r = 0.668). Additionally, Bland-Altman plots showed a greater degree of underestimation of the TSB by TcB at the sternum with phototherapy. Conclusions TcB was more accurate in infants not receiving phototherapy. During phototherapy, it is better to assess TcB at the forehead rather than at the sternum.

Background. Alkaline phosphatase is an enzyme that catalyzes the hydrolysis of esters in an alkaline environment. Four isoenzymes have been identified in the human body: placental alkaline phosphatase (PLALP isoenzyme), intestinal alkaline phosphatase (IAP), hepatic/bone/renal alkaline phosphatase (L/B/K ALP) and germ cell alkaline phosphatase (GCALP). The uses of ALP in neonatology have been intensively studied, and associations have been demonstrated between elevated alkaline phosphatase levels and hypocalcemia and hypophosphatemia in premature infants, the onset of early osteopenia and the occurrence of necrotizing enterocolitis. Objective. The current study aimed to demonstrate the correlation between elevated alkaline phosphatase levels in blood from the umbilical cord and elevated transcutaneous bilirubin levels that indicated phototherapy. Material and methods. The study included 250 term newborns within 01-06.2018 and 31 had indication for phototherapy, and 219 without indication for phototherapy, in a tertiary maternity hospital in Bucharest, Romania. Alkaline phosphatase was determined in the umbilical cord serum. Results. The values of the alkaline phosphatase were from 145 to 417 U/l for the newborns without phototherapy and the treated group was beetween 320 and 602 U/l. The values of the alkaline phosphatase were not influenced by the birth weight, Apgar score, and gender. Conclusions. Alkaline phosphatase may represent a predictive marker for the need for phototherapy in term neonates, but further extended studies are required on larger groups of patients.

Background: Neonatal hyperbilirubinemia is a common problem in neonates with an incidence of about 60% in term babies and 80% in preterm babies. It is the commonest cause of admission to the hospitals in the newborn period. We should assess all babies for jaundice at every opportunity. Methods include visual assessment, transcutaneous bilirubinometer (TcB) or total serum bilirubin (TSB). Objective: This is a descriptive study aimed to evaluating the protocol of management of unconjugated hyperbilirubinemia in neonatal intensive care unit at Qena University Hospital. Patients and method(s): This descriptive study included neonates admitted to neonatology unit at Qena university hospital from (April to October 2019), Total number of admitted neonates in our NICU through this period were 1274, from which 517 neonates had jaundice as a primary cause of admission or developed during the course of NICU stay. Result(s): In this period the total number of NICU admission was 1274 cases, out of 517 jaundiced neonates, 100 (19.3%) were diagnosed to have unconjugated jaundice on admission without any associated other diseases and 417 (80.7%) of them were admitted due to other causes and developed jaundice during the course of the disease. The other 417 neonates were admitted to our NICU due to RD in 409 (79.1%) cases, 4 (0.8%) cases due to sepsis, two (0.4%) cases due to CHD and two (0.4%) cases due to surgical causes. The unconjugated neonatal jaundice represented (7.8%) (100 cases out of 1274 neonates admitted during the period of the study). Physiological jaundice represented 89.4% while pathological jaundice represented 10.6% of causes of neonatal jaundice. Regarding treatment of studied neonates 12% of cases need only follow up with no need for Phototherapy, 62.8% of cases needed single or double Phototherapy, 12.4% needed extensive Phototherapy (triple phototherapy), 12.8% of cases needed capsule Phototherapy and no cases needed neither exchange transfusion nor drug therapy. Only 0.4% of jaundiced neonates developed prolonged hyperbilirubinemia, while no complications were detected in 99.6% of cases. We started treatment based on measuring bilirubin by TSB in 62.3% of jaundiced neonates and 37.7% by TCB. The mean values of TSB in jaundiced neonates (11.46 ± 4.92) were significantly higher than the TCB (10.31 ± 4.61), P =0.0005. There was significant positive correlation between mean TSB and mean TCB (R= 0.946, P < 0.001). There was no significant difference regarding mean TSB between different gestational age groups p= 0.242). Conclusions: Hyperbilirubinemia is one of the most common causes of hospital admission in our nursery. Among the causes of hyperbilirubinemia, physiologic jaundice was the most common. Intensive phototherapy is effective in lowering TSB in unconjugated jaundice at / or near levels of exchange transfusion, and this may be helpful in decreasing needs for and risks of exchange transfusions. TcB measurements may underestimate the TSB values, so it should be considered only as a screen and samples should be sent to the laboratory for confirmation especially at high risk groups and high levels of TCB.

Objective To investigate the accuracy of transcutaneous bilirubin（TCB）monitoring results at different parts in premature infants,and to provide evidence-based reference for the monitoring of jaundice in premature infants.Methods The databases of PubMed,Cochrane Library,Embase,China national knowledge infrastructure（CNKI）,Chinese BioMedical Literature Database（CBM）,VIP and Wanfang databases were searched to collect literatures on the correlation between the TCB and the Total Serum Bilirubin（TSB）of different parts of premature infants from inception to September 30,2020.The quality of the included literatures were evaluated by two evaluators according to the Quality Assessment of Diagnostic Accuracy Studies（QUADAS-2）scale,and then Pearson correlation coefficient was transformed into Fisher′Z and meta-analysis was performed.Results A total of 18 literatures were included,including 1,806 samples.The results of TCB monitoring in the forehead,sternum,abdomen and scapula of premature infants were well correlated with TSB at the same time（r=0.814,0.824,0.735,0.862;95%CI:0.77-0.85,0.76-0.87,0.61-0.83,0.85-0.87）.Conclusion There was a good correlation between the measured TCB values of different parts in premature infants and the TSB values at the same time.The accuracy of the monitoring results of different parts of TCB was as follows:scapula,sternum,forehead and abdomen.It is suggested that the scapular skin should be the first choice for preterm TCB monitoring. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the reliability of the Dräger Jaundice Meter JM-105 for the screening of neonatal jaundice in Malay neonates. Methods: A cross-sectional study was conducted in a university hospital involving 130 jaundiced neonates requiring serum bilirubin determination from day 2 to day 7 of life. Results: The mean total serum bilirubin (TSB) was 232 µmol/L, whereas the mean transcutaneous bilirubin (TcB) measured at the forehead and sternum were 222 µmol/L and 223 µmol/L, respectively. Further, TcB underestimates TSB with a mean difference of 10.10 µmol/L at the forehead and 9.27 µmol/L at the sternum. A positive linear relationship was observed between TSB with TcB forehead (r = 0.82) and TcB sternum (r = 0.80). A good discriminations ability was observed for both the TcB forehead (receiver operating characteristics [ROC] curve = 89.8%) and sternum (ROC curve = 89.7%) at a TSB level of 205 µmol/L. The sensitivity ranges from 84.4% to 85.3%, while the specificity ranges from 77.4% to 76.4%. Conclusion: Our study demonstrates a strong linear relationship and good diagnostic accuracy of TcB values compared to TSB values. To conclude, TcB measured at the forehead or sternum is a good alternative as a non-invasive screening tool for non-severe hyperbilirubinemia in Malay neonates. [ABSTRACT FROM AUTHOR]

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Background: Neonatal jaundice may cause severe neurological damage if poorly evaluated and diagnosed when high bilirubin occurs. The study explored how to effectively integrate high-dimensional genetic features into predicting neonatal jaundice.Methods: This study recruited 984 neonates from the Suzhou Municipal Central Hospital in China, and applied an ensemble learning approach to enhance the prediction of high-dimensional genetic features and clinical risk factors (CRF) for physiological neonatal jaundice of full-term newborns within 1-week after birth. Further, sigmoid recalibration was applied for validating the reliability of our methods.Results: The maximum accuracy of prediction reached 79.5% Area Under Curve (AUC) by CRF and could be marginally improved by 3.5% by including genetic variant (GV). Feature importance illustrated that 36 GVs contributed 55.5% in predicting neonatal jaundice in terms of gain from splits. Further analysis revealed that the main contribution of GV was to reduce the false-positive rate, i.e., to increase the specificity in the prediction.Conclusions: Our study shed light on the theoretical and practical value of GV in the prediction of neonatal jaundice. [ABSTRACT FROM AUTHOR]

Background: Recently, the Bilistick®, a point-of-care instrument to measure bilirubin levels, has been developed. It is fast and cheaper than transcutaneous bilirubin (TCB)-measuring devices, but data on diagnostic properties are scarce. Objective: This study aimed to compare the performance of the Bilistick® (BM-BS 1.0 – FW version 2.0.1) and the JM-105 bilirubinometer for measuring bilirubin. Method: This is a prospective study in infants born after ≥32 weeks' gestation, and/or a birth weight of ≥1,500 g, and a postnatal age ≤14 days in Surabaya, Indonesia. Bilirubin was measured with the Bilistick® System (BM-BS 1.0 – FW version 2.0.1), transcutaneously (TCB) with the JM-105 bilirubinometer, and in serum (TSB) with a routine laboratory technique. Mean differences and 95% limits of agreement (LOA) and correlations were calculated. Result: We enrolled 149 neonates and 126 had paired measurements of Bilistick® bilirubin, TCB, and TSB. Bilistick® failed in 16 (10.7%) infants. Mean Bilistick® bilirubin-TSB difference was −11 µmol/L (95% LOA: −101 to 79 µmol/L) and r = 0.738 (p < 0.001). Mean TCB-TSB difference was 26 μmol/L (95% LOA: −33 to 88) and r = 0.785 (p < 0.001). The sensitivity, specificity, PPV, and NPV for Bilistick® bilirubin for a TSB above treatment thresholds were 0.74, 0.84, 0.67, and 0.88, respectively, and for TCB 0.92, 0.64, 0.54, and 0.95, respectively. Conclusion: The Bilistick® System (BM-BS 1.0 – FW version 2.0.1) underestimates TSB, whereas TCB overestimates TSB in jaundiced Indonesian infants. Further improvement of Bilistick®'s diagnostic accuracy with less false-negative readings is essential to increase its use. [ABSTRACT FROM AUTHOR]

Background: Neonatal jaundice is the most common cause of newborns' hospitalization. This study aimed to examine various maternal, childbirth, and neonatal factors affecting the neonatal skin bilirubin level and severe jaundice. Methods: This cross-sectional study was conducted on 1066 healthy neonates with a gestational age of 35 weeks or over and birth weight of ≥2000 g at teaching hospitals of Alzahra and Taleghani in Tabriz, Iran, during 2016-2017. The participants were selected using convenience sampling. Data were collected using a three-part researcher-made questionnaire assessing maternal, childbirth, and neonatal characteristics based on the medical histories of mothers and newborns as well as interviews with mothers. Neonatal jaundice was measured utilizing the Kj-8000 device on days 3-6 after birth by measuring the skin bilirubin level. Moreover, the need to phototherapy (severe jaundice) was determined based on the American Academy of Pediatrics guideline. The generalized linear model and multivariate logistic regression were employed for data analysis. Results: Out of the followed-up neonates, 94 (9.96%) cases developed severe jaundice and 850 (90.04%) newborns did not show any symptoms of this complication. The results of the adjusted generalized linear model showed that infant’s bilirubin level correlated significantly with a history of jaundice in previous children, infant’s age at first meconium excretion, frequency of feeding, gestational age, mother’s blood type, and a number of maternal ultrasound during pregnancy. Moreover, the results of adjusted logistic regression revealed an association between severe jaundice and variables, such as the place of residence, history of jaundice in previous children, feeding the infant with water or sugar water during breastfeeding intervals, frequency of feeding the infant, gestational age, mother’s blood type, time of discharge from the hospital, and number of pregnancies. Conclusion: Some factors related to neonatal jaundice were identified to raise the awareness of healthcare personnel for the early identification and treatment of neonatal jaundice in order to prevent its complications.

Error simulation models have been used to understand the relationship between analytical performance and clinical outcomes. We developed an error simulation model to understand the effects of method bias and precision on misclassification rate for neonatal hyperbilirubinemia using an age-adjusted risk assessment tool. For each of 176 measured total bilirubin (TSBM) values, 10,000 simulated total bilirubin (TBS) values were generated at each combination of bias and precision conditions for coefficient of variation (CV) between 1 and 15%, and for biases between −51.3 μmol/L and 51.3 μmol/L (−3 and 3 mg/dL) fixed bias. TBS values were analyzed to determine if they were in the same risk zone as the TSBM value. We then calculated sensitivity and specificity for prediction of ≥75th percentile for postnatal age values as a function of assay bias and precision, and determined the rate of critical errors (≥95th percentile for age TSBM with <75th percentile TBS). A sensitivity >95% for predicting ≥75th percentile bilirubin values was observed when there is a positive fixed bias of greater than 17.1 μmol/L (1.0 mg/dL) and CV is maintained ≤10%. A specificity >70% for predicting <75th percentile bilirubin values was observed when positive systematic bias was 17.1 μmol/L (1 mg/dL) or less at CV ≤ 10%. Critical errors did not occur with a frequency >0.2% until negative bias was −17.1 μmol/L (−1 mg/dL) or lower. A positive systematic bias of 17.1 μmol/L (1 mg/dL) may be optimal for balancing sensitivity and specificity for predicting ≥75th percentile TSB values. Negative systematic bias should be avoided to allow detection of high risk infants and avoid critical classification errors. [ABSTRACT FROM AUTHOR]

Objectives: Quality assurance (QA) plays an integral role in Point of Care Testing (POCT) programs. Quality control (QC) is an important QA program component to ensure high quality results and enhanced patient care. The measurement of transcutaneous bilirubin (TcB) in the POCT setting is an essential part of newborn care in Alberta, Canada. However, there is currently no available commercial QC material for TcB meters. An in-house developed QC material has been in use within a single TcB POCT program within Alberta. The objective of this study was to determine the performance of this QC material by other POCT staff and clinical end-users to assess whether its use could be expanded. Design and methods: Two levels of QC material were measured by POCT staff and clinical end-users across 12 different sites using the Dräger Jaundice Meter JM-103® and JM-105® meters. Results: The performance of the QC material was acceptable when tested by POCT staff, was stable and reliable over time, and had an acceptable CV (≤8%). However, the data does not support use of the QC material by clinical end-users. Conclusions: The use of the QC material could be expanded into other TcB settings for use by POCT staff. Additional training and experience with the QC material by end-users is needed to facilitate QC use in the clinical setting.