NeoNotes Journal Club
Andrew B. Kairalla MD, Editor
3-031 | Additional Comments | Previous Article | Next Article | List of Articles | Submit Comments | Index | FSN Home Page
Transcutaneous Bilirubinometry
Assessment of a Transcutaneous Device in the Evaluation of Neonatal Hyperbilirubinemia in a Primarily Hispanic Population. Engle WD, Jackson GL, Sendelbach D, et al. PEDIATRICS (July 2002); 110 : 61-67.
Objective. To compare estimates of serum bilirubin as determined by a transcutaneous device (BiliChek [BC]) with laboratory-measured total serum bilirubin (TSB) in a predominately Hispanic population in which a significant number of TSB values > 15 mg/dl was anticipated.
Methods. A total of 248 Hispanic and 56 non-Hispanic neonates were studied. Transcutaneous measurements were performed by 1 investigator within 30 minutes of blood sampling for TSB; TSB was determined in a large clinical laboratory using the diazo Jendrassik-Grof with blank method. Agreement between BC and TSB determinations was assessed using Bland-Altman plots and the Bradley-Blackwood test. Interdevice comparisons were made among the BC devices. Predictive indices for TSB >10 mg/dl and >15 mg/dl were determined using various BC cutoff values.
Results. TSB was >15 mg/dl in 31% of the Hispanic neonates. BC generally tended to underestimate TSB determinations, and this trend was more pronounced when TSB was >10 mg/dl. Very high sensitivities were observed only when relatively low BC cutoff values were used to predict TSB >10 mg/dl or >15 mg/L. Relatively small numbers of infants had BC values in these low ranges.
Conclusions. The tendency of BC to underestimate TSB limits its usefulness in neonates with relatively high TSB. In this population, most infants would have required additional evaluation to ensure that TSB was not >10 mg/dl or >15 mg/dl. It seems that the discrepancy between this study and previous studies of BC is related to our relatively large number of TSB values >15 mg/dl.
Comment. I had high hopes that this transcutaneous device for bilirubinometry would decrease the need for serum bilirubin measurements in neonates. The device has the advantages of being quick, painless, bloodless, and relatively easy to use. Unfortunately, the correlation between the BC results and the TSB appears to be suboptimal at higher bilirubin levels (>15), especially in Hispanic neonates. This severely limits the usefulness of the device as a screening tool in term babies. The device may have more potential for following bilirubin levels in premature infants, since it appears to be more accurate at lower bilirubin levels and there may be less interference from skin pigmentation in premature babies. To my knowledge, the efficacy of this device in infants < 34 weeks gestation has not yet been reported. ABK.
Date: 08 Mar 2006
Time: 12:48:03
My question is how can you correlate bilirubin measured transcutaneously to
bilirubin in serum I believe the bilirubin in the serum of the blood leaks into
the derims and epidermis part of the skin and bilirubin always fluctuates
between the two compartments i.e blood and skin. when we mean transcutaneous
what are we measuring skin bilirubin or blood bilirubin or brain bilirubin .
UserName: suresh
Institution: university of cincinnati
telephone: 513 293 5159
email: allas@email.uc.edu
Additional Comments: You may add your own comments to the discussion of this topic by selecting : Submit Comments.