ORIGINAL ARTICLE

Can transcutaneous bilirubinometry reduce the need for blood tests in jaundiced full term babies?

L Briscoe, S Clark and C W Yoxall

Liverpool Womens Hospital, Crown Street, Liverpool L8 7SS, UK

Correspondence to:
Correspondence to:
Dr Yoxall, Liverpool Womens Hospital, Crown Street, Liverpool L8 7SS, UK;
Bill.Yoxall{at}lwh-tr.nwest.nhs.uk

Background: Previous studies have suggested that transcutaneous bilirubinometry (TcB) may provide a useful method for screening for significant jaundice, thereby reducing unnecessary blood tests. These studies have not allowed an estimation of the magnitude of such a benefit.

Objectives: To evaluate the accuracy of TcB as a method of determining the need for serum bilirubin (SBR) measurements in full term babies and to quantify the magnitude of any benefit.

Subjects: Babies born at more than 34 weeks gestation who had not previously been exposed to phototherapy and were requiring blood sampling in the first week of life.

Method: TcB measurements were made at the same time as blood sampling. SBR was measured in all blood samples. For jaundiced babies, the ability of TcB to detect significant jaundice (SBR > 249 µmol/l) was evaluated.

Results: There was a correlation between SBR and TcB measurements (n = 303, r = 0.76, p < 0.0001), but the 95% prediction interval for SBR from TcB was wide (± 88.3 µmol/l). For the 285 jaundiced babies, the area under the receiver operator characteristic curve was 0.89. A TcB value of 18 detected significant jaundice with a sensitivity of 100% and a specificity (95% confidence interval) of 45% (39% to 51%). If blood samples had only been taken from babies with a TcB value greater than 18, the number of samples taken would have been reduced by 34%.

Conclusions: SBR cannot be measured accurately by TcB. However, TcB measurements can be used to determine the need for blood sampling in jaundiced babies and will reduce the number of blood samples taken. Recent improvements in TcB may improve the performance of this method.

Keywords: jaundice; blood; bilirubin; transcutaneous bilirubinometry

Abbreviations: SBR, serum bilirubin; TcB, transcutaneous bilirubinometry

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Kirk, J. M (2008). Neonatal jaundice: a critical review of the role and practice of bilirubin analysis. Ann Clin Biochem 45: 452-462 [Abstract] [Full Text]  
• Kolman, K. B., Mathieson, K. M., Frias, C. (2007). A Comparison of Transcutaneous and Total Serum Bilirubin in Newborn Hispanic Infants at 35 or More Weeks of Gestation. J Am Board Fam Med 20: 266-271 [Abstract] [Full Text]  
• Ho, H T, Ng, T K, Tsui, K C, Lo, Y C (2006). Evaluation of a new transcutaneous bilirubinometer in Chinese newborns. Arch. Dis. Child. Fetal Neonatal Ed. 91: F434-F438 [Abstract] [Full Text]  
• Grohmann, K., Roser, M., Rolinski, B., Kadow, I., Muller, C., Goerlach-Graw, A., Nauck, M., Kuster, H. (2006). Bilirubin Measurement for Neonates: Comparison of 9 Frequently Used Methods. Pediatrics 117: 1174-1183 [Abstract] [Full Text]  
• Petersen, J. R., Okorodudu, A. O., Mohammad, A. A., Fernando, A., Shattuck, K. E. (2005). Association of Transcutaneous Bilirubin Testing in Hospital with Decreased Readmission Rate for Hyperbilirubinemia. Clin. Chem. 51: 540-544 [Abstract] [Full Text]  
• Maisels, M. J., Ostrea, E. M. Jr, Touch, S., Clune, S. E., Cepeda, E., Kring, E., Gracey, K., Jackson, C., Talbot, D., Huang, R. (2004). Evaluation of a New Transcutaneous Bilirubinometer. Pediatrics 113: 1628-1635 [Abstract] [Full Text]  
• (2003). Perinatal medicine. Arch. Dis. Child. 88: A17-21 [Full Text]