Skip to main content
Springer Nature Link
Log in

Efficacy of transcutaneous bilirubinometry as compared to serum bilirubin in preterm newborn during phototherapy

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Transcutaneous measurement of bilirubin is being used for neonatal jaundice. Its utility during phototherapy in preterm babies is not established. The objective of our study was to assess the efficacy of transcutaneous bilirubin (TcB) measurement in comparison to total serum bilirubin in preterm newborns at admission and during phototherapy at the covered skin area (glabella). It was a prospective observational study and conducted at the neonatal intensive care unit of a tertiary care hospital from January 2017 to January 2019. One hundred eligible preterm neonates were enrolled. Babies who were very sick, with poor peripheral circulation, edematous, having conjugated hyperbilirubinemia, with major congenital malformations, already received phototherapy or exchange transfusion were excluded. Paired total serum bilirubin and transcutaneous bilirubin were measured at admission and 6 h and 24 h during phototherapy. TcB was measured from the area (glabella) covered by an eye protector during phototherapy. The sample for TsB was taken within 10 min of TcB measurement. The mean differences between TsB and TcB values at admission and 6 h and 24 h of phototherapy were − 0.005 (0.353) mg/dl, − 0.350 (0.611) mg/dl, and − 0.592 (0.353) mg/dl, respectively. At admission or before starting of phototherapy, the difference (TsB-TcB) was statistically not significant (p = .125), while the difference in these values was statistically significant at 6 h and 24 h of phototherapy.

Conclusion: TcB measurements from the covered skin area in jaundiced preterm infants during phototherapy were not correlated with TsB and cannot be used as an alternate of serum bilirubin testing.

What is known

• HPLC bilirubin measurement is a gold standard test for bilirubin measurement but impractical for day to day use. Serum total bilirubin is used for clinical testing..

• There is evidence for use of transcutaneous bilirubinometry for assessment of bilirubin in term newborn.

What is new

• TcB measurements from a covered skin area in jaundiced preterm newborns under phototherapy were not correlated significantly at 6 h and 24 h of phototherapy, but correlated before phototherapy.

• TcB cannot be used as an alternate of serum bilirubin testing in preterm infants during phototherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and material

NA

Code availability

NA

Abbreviations

CI:

Confidence interval

r :

Correlation coefficient

LED:

Light-emitting diode

SD:

Standard deviation

TcB:

Transcutaneous bilirubin

TsB:

Total serum bilirubin

References

  1. Woodgate P, Jardine LA (2011) Neonatal jaundice. BMJ Clin Evid 2011:0319

    PubMed  PubMed Central  Google Scholar 

  2. Mishra S, Chawla D, Agarwal R, Deorari AK, Paul VK (2010) Transcutaneous bilirubin levels in healthy term and late preterm Indian neonates: original article. Indian J Pediatr 77(1):45–50. https://doi.org/10.1007/s12098-010-0007-3

    Article  PubMed  Google Scholar 

  3. Reyes CA, Stednitz DR, Hahn C, Mutchie KD, McCullough SR, Kronberg K (2008) Evaluation of the BiliChek being used on hyperbilirubinemic newborns undergoing home phototherapy. Arch Pathol Lab Med 132(4):684–689. https://doi.org/10.5858/2008-132-684-EOTBBU

    Article  PubMed  Google Scholar 

  4. Zecca E, Barone G, De Luca D, Marra R, Tiberi E, Romagnoli C (2009) Skin bilirubin measurement during phototherapy in preterm and term newborn infants. Early Human Dev 2009 85(8):537–540. https://doi.org/10.1016/j.earlhumdev.2009.05.010

    Article  CAS  Google Scholar 

  5. Fonseca R, Kyralessa R, Malloy M, Richardson J, Jain SK (2012) Covered skin transcutaneous bilirubin estimation is comparable with serum bilirubin during and after phototherapy. J Perinatol 32(2):129–131. https://doi.org/10.1038/jp.2011.66

    Article  CAS  PubMed  Google Scholar 

  6. Jangaard KA, Curtis H, Goldbloom RB (2006) Estimation of bilirubin using BiliChek, a transcutaneous bilirubin measurement device: effects of gestational age and use of phototherapy. Paediatr Child Health 11:79–83. https://doi.org/10.1093/pch/11.2.79

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ozkan H, Oren H, Duman N, Duman M (2003). Dermal bilirubin kinetics during phototherapy in term neonates. ActaPaediatr; 92 (5): 577–581, DOI: https://doi.org/10.1111/j.1651-2227.2003.tb02510.x

  8. Costa-Posada U, Concheiro-Guisán A, Táboas-Ledo MF et al (2020) Accuracy of transcutaneous bilirubin on covered skin in preterm and term newborns receiving phototherapy using a JM-105 bilirubinometer. J Perinatol 40:226–231. https://doi.org/10.1038/s41372-019-0557-9

    Article  CAS  PubMed  Google Scholar 

  9. Lucanova LC, Matasova K, Zibolen M, Krcho P (2016) Original Article. Accuracy of transcutaneous bilirubin measurement in newborns after phototherapy. J Perinatol 36(10):858–861. https://doi.org/10.1038/jp.2016.91

    Article  CAS  Google Scholar 

  10. Murli L, Thukral A, Sankar MJ et al (2017) Reliability of transcutaneous bilirubinometry from shielded skin in neonates receiving phototherapy: a prospective cohort study. J Perinatol 37(2):182–187. https://doi.org/10.1038/jp.2016.189

    Article  CAS  PubMed  Google Scholar 

  11. Mussavi M, Niknafs P, Bijari B (2013) Determining the correlation and accuracy of three methods of measuring neonatal bilirubin concentration. Original Article. Iran J Pediatr 23(3):333–339

    PubMed  PubMed Central  Google Scholar 

  12. Neonatal Jaundice. Clinical Guideline 2010 Funded to produce guidelines for the NHS by NICE, Published by the Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, Regent’s Park, London NW1 4RG; 1:1-495. https://www.nice.org.uk/guidance/cg98/evidence/full-guideline-245411821. Assessed 22 Dec 2020 

  13. Itoh S, Okada H, Kuboi T, Kusaka T (2017) Phototherapy for neonatal hyperbilirubinemia: review article. Pediatr Int 59:959–966. https://doi.org/10.1111/ped.13332

    Article  CAS  PubMed  Google Scholar 

  14. Nagar G, Vandermeer B, Campbell S, Kumar M (2013) Reliability of transcutaneous bilirubin devices in preterm infants: a systematic review. Pediatrics 132:871–881. https://doi.org/10.1542/peds.2013-1713

    Article  PubMed  Google Scholar 

  15. Nagar G, Vandermeer B, Campbell S, Kumar M (2016) Effect of phototherapy on the reliability of transcutaneous bilirubin devices in term and near-term infants: a systematic review and meta-analysis. Neonatology. 109(3):203–212. https://doi.org/10.1159/000442195

    Article  CAS  PubMed  Google Scholar 

  16. Raimondi F, Lama S, Landolfo F et al (2012) Measuring transcutaneous bilirubin: a comparative analysis of three devices on a multiracial population. BMC Pediatr 12:70

    Article  CAS  Google Scholar 

  17. Sajjadian N, Shajari H, Saalehi Z, Esphahani F, Taheri PA (2012) Transcutaneous bilirubin measurement in preterm neonates. Original Article. Acta Medica Iran 50(11):765–770

    CAS  Google Scholar 

  18. Bhutani V, Vilms R, Hamerman-Johnson L (2010) Universal bilirubin screening for severe neonatal hyperbilirubinemia. J Perinatol 30:S6–S15. https://doi.org/10.1038/jp.2010.98

    Article  PubMed  Google Scholar 

  19. Juster-Reicher A, Flidel-Rimon O, Rozin I, Shinwell ES (2015) Correlation of transcutaneous bilirubinometry (TcB) and total serum bilirubin (TsB) levels after phototherapy. J Matern Fetal Neonatal Med 28(11):1329–1331. https://doi.org/10.3109/14767058.2014.953923

    Article  CAS  PubMed  Google Scholar 

  20. Stillova L, Matasova K, Zibolen M et al (2009) Short Communication. Transcutaneous bilirubinometry in preterm beonates. Indian Pediatr 46:405–408

    CAS  PubMed  Google Scholar 

  21. Alsaedi SA (2018) Transcutaneous bilirubin measurements can be used to measure bilirubin levels during phototherapy. Int J Pediatr 2018:4856390

    Article  Google Scholar 

  22. Cucuy M, Juster-Reicher A, Flidel O, Shinwell E (2018) Correlation between transcutaneous and serum bilirubin in preterm infants before, during, and after phototherapy. J Matern Fetal Neonatal Med 31(10):1323–1326. https://doi.org/10.1080/14767058.2017.1315662

    Article  CAS  PubMed  Google Scholar 

  23. Pendse A, Jasani B, Nanavati R, Kabra N (2017) Comparison of transcutaneous bilirubin measurement with total serum bilirubin levels in preterm neonates receiving phototherapy. Indian Pediatr 54:641–643. https://doi.org/10.1007/s13312-017-1126-y

    Article  PubMed  Google Scholar 

  24. Radfar M, Hashemieh M, Shirvani F, Madani R (2016) Transcutaneous bilirubinometry in preterm and term newborn infants before and during photo-therapy. Arch Iran Med 19:323–328

    PubMed  Google Scholar 

  25. De Luca D, Dell’Orto V (2017) Patched skin bilirubin assay to monitor neonates born extremely preterm undergoing phototherapy. J Pediatr 188:122–127. https://doi.org/10.1016/j.jpeds.2017.05.080

    Article  CAS  PubMed  Google Scholar 

  26. Taylor JA, Burgos AE, Flaherman V et al (2015) Better outcomes through Research for Newborns Network. Discrepancies between transcutaneous and serum bilirubin measurements. Pediatrics. 135(2):224–231. https://doi.org/10.1542/peds.2014-1919

    Article  PubMed  PubMed Central  Google Scholar 

  27. Jeon J, Lim G, Oh KW, Lee NM, Park HW, Chung ML (2020) The forehead is a better site than the sternum to check transcutaneous bilirubin during phototherapy in sick infants. BMC Pediatr 20(1):548

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, SMS Medical College, Jaipur, Rajasthan, India

    Sunil Gothwal, Neelam Singh, Sadasivam Sitaraman, Ramesh Choudhary & Kailash Kumar Meena

  2. Department of Pediatrics, RUHS, Jaipur, Rajasthan, India

    Ghan Shyam Bairwa

  3. Department of Preventive and Social Medicine, All India Institute of Medical Science, New Delhi, India

    Mohan Bairwa

  4. NWRH, Burnie, TAS3, Australia

    Amrit Jeevan

Authors
  1. Sunil Gothwal
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Neelam Singh
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Sadasivam Sitaraman
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Ramesh Choudhary
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Kailash Kumar Meena
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Ghan Shyam Bairwa
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Mohan Bairwa
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Amrit Jeevan
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

SG, Study conception and design, Acquisition of data. Analysis and interpretation of data, Drafting of manuscript, Critical revision, Final approval of manuscript; NS, Study conception and design, Acquisition of data. Analysis and interpretation of data, Drafting of manuscript, Final approval of manuscript; SS, Study conception and design, Acquisition of data. Analysis and interpretation of data, Critical revision, Final approval of manuscript; RC, Study conception and design, Acquisition of data, Analysis and interpretation of data, Drafting of manuscript, Final approval of manuscript; KKM, Study conception and design, Analysis and interpretation of data, Critical revision, Final approval of manuscript; GSB, Study conception and design, Drafting of manuscript, Critical revision, Final approval of manuscript; MB, Study conception and design, Analysis and interpretation of data, Drafting of manuscript, Critical revision, Final approval of manuscript; AJ, Study conception and design, Analysis and interpretation of data, Drafting of manuscript, Critical revision, Final approval of manuscript.

Corresponding author

Correspondence to Sunil Gothwal.

Ethics declarations

Ethics approval

Approved by Institutional Ethics Committee- 2823 MC/EC/2016.

Consent to participate/publication

Written informed consent was taken from parents/guardian.

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Daniele De Luca

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gothwal, S., Singh, N., Sitaraman, S. et al. Efficacy of transcutaneous bilirubinometry as compared to serum bilirubin in preterm newborn during phototherapy. Eur J Pediatr 180, 2629–2636 (2021). https://doi.org/10.1007/s00431-021-04148-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-021-04148-2

Keywords