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The Impact of Phototherapy on the Accuracy of Transcutaneous Bilirubin Measurements in Neonates: Optimal Measurement Site and Timing.

ABSTRACT: Transcutaneous bilirubinometer devices are widely applied to assess neonatal hyperbilirubinemia. However, the optimal skin site and timing of transcutaneous bilirubin (TCB) measurements for the strongest correlation with total serum bilirubin (TSB) levels after phototherapy are still unclear. We conducted a retrospective observational study evaluating the correlation of TCB and TSB levels in neonates postphototherapy. The TCB measurements on the forehead and mid-sternum at 0 and 30 min postphototherapy were assessed by using a JM-103 bilirubinometer. Paired TCB and TSB measurements were assessed by Pearson correlation and Bland-Altman plots. We analyzed 40 neonates with 96 TSB and 384 TCB measurements. The TSB level correlated moderately with the forehead TCB level at 30 min postphototherapy (r = 0.65) and less strongly with the midsternum TCB level at 0 min postphototherapy (r = 0.52). The forehead at 30 min after cessation of phototherapy was the best time point and location of TCB measurement for the assessment of neonatal jaundice status. The reliability of TCB measurements varied across skin sites and durations after phototherapy. The effectiveness of TCB measurement to assess neonatal hyperbilirubinemia is much better on covered skin areas (foreheads) 30 min postphototherapy. The appropriate application of transcutaneous bilirubinometers could aid in clinical practice and avoid unnecessary management.

SUBMITTER: Ho SR

PROVIDER: S-EPMC8466921 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Should transcutaneous bilirubin be measured in preterm infants receiving phototherapy? The relationship between transcutaneous and total serum bilirubin in preterm infants with and without phototherapy.

Project description:Our objective was to analyze the relationship between transcutaneous bilirubin (TcB) measured on an unexposed area of skin and total serum bilirubin (TSB) in preterm infants before, during, and after phototherapy (PT). For this purpose paired TSB and TcB levels were measured daily during the first ten days after birth in preterm infants of less than 32 weeks' gestation. TcB was measured with a Dräger Jaundice Meter JM-103 on the covered hipbone. Agreement between TSB and TcB levels was assessed before, during, and after PT. True negative and corresponding false negative percentages were calculated using different TcB cut-off levels. Data are presented as mean (±SD). We obtained 856 paired TcB and TSB levels in 109 preterm infants (66 boys, gestational age 29.4 ± 1.6 weeks and birth weight 1282 g ± 316 g). We found that the difference between TSB and TcB before PT was significantly lower, 44 (±36) μmol/L, than the difference during and after PT, 61 (±29) μmol/L and 63 (±25) μmol/L, respectively; P < 0.01. Blood sampling could be reduced by 42%, with 2% false negatives, when 50 μmol/L was added to the TcB level at 70% of the PT threshold. Our conclusion is that phototherapy enhances underestimation of TSB by TcB in preterms, even if measured on unexposed skin. The use of specific TcB cut-off levels substantially reduces the need for TSB measurements.

| S-EPMC6568417 | biostudies-literature

Transcutaneous bilirubin level to predict hyperbilirubinemia in preterm neonates.

Project description:Background: Hyperbilirubinemia is common in neonates, with higher prevalence among preterm neonates, which can lead to severe hyperbilirubinemia. Assessment of total serum bilirubin (TSB) and the use of a transcutaneous bilirubinometry (TcB) are existing methods that identify and predict hyperbilirubinemia. This study aimed to determine TcB cut-off values during the first day for preterm neonates to predict hyperbilirubinemia at 48 and 72 hours. Methods: This cohort study was conducted at Dr. Soetomo General Hospital from September 2018 to January 2019 a total of 90 neonates born ≤35 weeks. They were divided into two groups (Group I: 1000-1500 grams; Group II: 1501-2000 grams). The bilirubin levels were measured on the sternum using TcB at the ages of 12, 24, and 72 hours. TSB measurements were taken on the third day or if the TcB level reached phototherapy threshold ± 1.24 mg/dL and if TcB showed abnormal results (Group I: 5.76-8.24 mg/dL; Group II: 8.76-11.24 mg/dL). Hyperbilirubinemia was defined as TSB ≥7 mg/dL for Group I and >10 mg/dL for Group II. Results: In total, 38 Group I neonates and 48 Group II neonates were observed. Almost half of the neonates in Group I (45%) suffered from hyperbilirubinemia at the age of 48 hours, along with 46% of Group II at 72 hours. The best 24-hour-old TcB cut-off values to predict hyperbilirubinemia at 48 hours were calculated to be 4.5 mg/dL for Group I and 5.8 mg/dL for Group II. The determined 24-hour-old TcB value to predict hyperbilirubinemia at 72 hours was 5.15 mg/dL for Group II. Conclusion: TcB values in the early days of life can be used as hyperbilirubinemia predictors on the following days for preterm neonates. Close monitoring should be managed for those with TcB values higher than the calculated cut-off values.

| S-EPMC7499403 | biostudies-literature

The use of transcutaneous bilirubin nomograms for the prevention of bilirubin neurotoxicity in the neonates.

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| S-EPMC10395091 | biostudies-literature

The smartphone camera as a potential method for transcutaneous bilirubin measurement.

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| S-EPMC5983497 | biostudies-literature

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| S-EPMC9276810 | biostudies-literature

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Effectiveness of transcutaneous bilirubin measurement in managing neonatal jaundice in postnatal ward of a tertiary care hospital in Pakistan.

Project description:Introduction:Neonatal jaundice is a common cause of concern in immediate newborn period for parents as well as for the caregivers. Babies with visible jaundice are identified by the healthcare provider, and blood samples are sent for confirmation. Clinical expertise varies from person to person and may lead to sending excessive blood sampling. Obtaining blood bilirubin samples is a painful procedure; it predisposes the baby to infections and requires skilled health personnel. Moreover, laboratory tests are costly and time consuming, leading to unnecessary delays in commencing phototherapy and discharge from hospital. Transcutaneous bilirubinometer has been in use for a long time as screening tool in postnatal wards. With passage of time, its accuracy and validity have improved tremendously. Methodology:We aim to implement a quality improvement initiative to reduce the number of blood bilirubin samples using transcutaneous bilirubin (TcBR) nomogram in full-term, low-risk babies who are born at our hospital and are admitted in postnatal ward after birth. Using preanalysis and postanalysis study design, this study will be performed in two phases of 6 months each. Data regarding total number of admissions in postnatal wards, demographics, serum bilirubin(TSBR) samplings and need for phototherapy will be recorded in both phases. TcBR will be done and recorded in postimplementation phase. Analysis and results:Comparisons between the two groups will be made. Primary outcome will be reduction in blood bilirubin samples for TSBR after the implementation of TcBr protocol. The proportion of infants having TSBR performed in both periods will be compared. Crude sampling cost of TSBR will be obtained from laboratory, and cost comparison between two phases will be done to look for difference.

| S-EPMC5862169 | biostudies-literature

Quality improvement initiative using transcutaneous bilirubin nomogram to decrease serum bilirubin sampling in low-risk babies.

Project description:BackgroundScreening for neonatal hyperbilirubinaemia in the postnatal ward has traditionally been performed using serum bilirubin sampling, but this has significant drawbacks such as risk of infection and slower reporting time.ObjectiveWe aimed to assess the impact of introducing transcutaneous bilirubin (TcBR) testing using TcBR nomogram on the number of serum bilirubin samples sent.MethodsA before-and-after study was performed following the introduction of a protocol integrating the use of the Dragger JM-105 transcutaneous bilirubinometer in the postnatal ward. Only babies born at ≥37 weeks of gestation, weighing ≥2500 g who presented with jaundice after the first 24 hours and within the first 7 days of life were included in the study. The number of total serum bilirubin samples (TSBRs) sent were compared for the 6-month periods before and after (a total of 12 months) implementation of the new protocol.ResultsIn the pre-implementation phase, a total of 882 (49%) out of 1815 babies had at least one serum bilirubin sample taken as opposed to a total of 236 (17%) out of 1394 babies in the post-implementation phase. The odds of performing TSBRs at least one time among babies in post-implementation phase were 79% lower than in pre-implementation phase (OR 0.21, 95% CI 0.18 to 0.25). We also estimated a significant cost saving of approximately US$1800 over a period of 6 months.ConclusionTcBR testing used in conjunction with our proposed nomogram significantly reduces the need for serum bilirubin sampling.

| S-EPMC6542442 | biostudies-literature

Cost savings with transcutaneous screening versus total serum bilirubin measurement for newborn jaundice in hospital and community settings: a cost-minimization analysis.

Project description:BackgroundLeading authorities in North America recommend universal screening via total serum bilirubin (TSB) measurement or transcutaneous bilirubinometry (TcB) for kernicterus prevention. We assessed costs associated with these 2 screening methods in hospital and in urban and rural community settings.MethodsOur tertiary care centre in Saskatoon, with about 5600 births per year, serves the local population of 300 000; in addition, 30% of patients are referred from outside the local community and surrounding area. We obtained health administrative data for two 6-month periods: before (June 1 to Nov. 30, 2015 [TSB program]) and after (June 1 to Nov. 30, 2016 [TcB-TSB program]) implementation of universal screening with TcB. Data on nurses' time and mileage were collected to assess the mean time for screening and sample transportation. We performed a cost-minimization analysis.ResultsThe observed requirement for TSB blood draws decreased by 71.4% after implementation of TcB (1383.2/1000 live births to 397.8/1000 live births), whereas the overall number of screens increased from 1383.2 to 2758.6/1000 live births. The mean time per screen decreased from 12.52 (95% confidence interval [CI] 10.44-14.59) minutes with TSB to 2.94 (95% CI 2.55-3.33) minutes with TcB (p < 0.001). The estimated cost per TcB screen in hospital and community (urban and rural) settings was $3.54 and $3.76, respectively, and the estimated cost per TSB screen in hospital and in urban and rural community settings was $15.82, $50.21 and $65.03, respectively. The estimated overall 6-month savings with the TcB-TSB hospital and community programs were $19 760 and $6417, respectively.InterpretationThe TcB-TSB program reduced nurses' time to screen and provided immediate results at the point of care. Transcutaneous bilirubinometry reduced the requirement for painful heel pokes while improving access to screening and decreasing the overall program cost.

| S-EPMC6182126 | biostudies-literature

Highly Emissive Biological Bilirubin Molecules: Shedding New Light on the Phototherapy Scheme.

Project description:Bilirubin (BR) is the main end-product of the hemoglobin catabolism. For decades, its photophysics has been mainly discussed in terms of ultrafast deactivation of the excited state in solution, where, indeed, BR shows a very low green emission quantum yield (EQY), 0.03%, resulting from an efficient nonradiative isomerization process. Herein, we present, for the first time, unique and exceptional photophysical properties of solid-state BR, which amend by changing the type of crystal, from a closely packed α crystal to an amorphous loosely packed β crystal. BR α crystals show a very bright red emission with an EQY of ca. 24%, whereas β crystals present, in addition, a low green EQY of ca. 0.5%. By combining density functional theory (DFT) calculations and time-resolved emission spectroscopy, we trace back this dual emission to the presence of two types of BR molecules in the crystal: a "stiff" monomer, M1, distorted by particularly strong internal H-bonds and a "floppy" monomer, M2, having a structure close to that of BR in solution. We assign the red strong emission of BR crystals to M1 present in both the α and β crystals, while the low green emission, only present in the amorphous (β) crystal, is interpreted as M2 emission. Efficient energy-transfer processes from M2 to M1 in the closely packed α crystal are invoked to explain the absence of the green component in its emission spectrum. Interestingly, these unique photophysical properties of BR remain in polar solvents such as water. Based on these unprecedented findings, we propose a new model for the phototherapy scheme of BR inside the human body and highlight the usefulness of BR as a strong biological fluorescent probe.

| S-EPMC8389986 | biostudies-literature

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