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Evaluation of a new transcutaneous bilirubinometer in Chinese newborns

¹ Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
² Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital
³ Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital

Correspondence to:
Correspondence to:
H-T Ho
Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong SAR, China;brianyon{at}netvigator.com

Objective: To evaluate the use of a new transcutaneous bilirubinometer (JM-103 Minolta Airshields) for detection of hyperbilirubinaemia in term or near-term healthy Chinese newborns.

Methods: Transcutaneous bilirubin (TcB) was used to screen for severe hyperbilirubinaemia in newborn infants. Blood was taken for total serum bilirubin (TSB) measurement if the initial TcB level was higher than the 40th centile in Bhutani’s nomogram. Paired TcB and TSB results were then reviewed over 6 months. The correlation as well as the mean difference between the two methods were calculated. The clinical application of TcB with Bhutani’s nomogram in the prediction of severe hyperbilirubinaemia in low-risk, medium-risk and high-risk thresholds for phototherapy was also analysed.

Results: 997 paired TcB and TSB measurements were evaluated in term or near-term newborns. TcB was significantly correlated with TSB, with a correlation coefficient of 0.83 (p<0.001). Their mean difference was 21.7 µmol/l (SD 21.2, p<0.001), with the 95% limits of agreement between –19.9 and 63.3 µmol/l. In both low-risk and medium-risk thresholds for phototherapy, using the 75th centile of Bhutani’s nomogram as threshold, TcB could identify all cases and had a sensitivity and negative predictive value of 100% each, a specificity of 56% and positive predictive value of 23%. For high-risk cases, using the 75th centile as cut-off, the sensitivity and negative predictive value were reduced to 86.7% and 97.0%, respectively.

Conclusion: An accurate point-of-care bilirubin analyser facilitates bilirubin screening and avoids unnecessary blood tests. Although using the transcutaneous bilirubinometer JM-103 might result in a significant difference between TcB and TSB measured in Chinese newborns, combining the use of TcB and the 75th centile in Bhutani’s nomogram as the cut-off level can identify all cases of significant hyperbilirubinaemia.

Abbreviations: NPV, negative predictive value; PPV, positive predictive value; TcB, transcutaneous bilirubin; TSB, total serum bilirubin