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Published on: June 18, 2020
Transcutaneous bilirubin levels in an outpatient and office population
M J Maisels1, W D Engle, S Wainer
1Department of Pediatrics, Oakland University William Beaumont School of Medicine and Division of Neonatology, Beaumont Children's Hospital, Royal Oak, MI 48073, USA. jmaisels@beaumont.edu
Insights
Transcutaneous bilirubin (TcB) measurements are a reliable outpatient screening tool for infant hyperbilirubinemia. This method accurately predicts high total serum bilirubin (TSB) levels, aiding pediatricians in clinical decision-making.
Area of Science:
- Neonatal Medicine
- Pediatric Healthcare
- Medical Diagnostics
Background:
- Transcutaneous bilirubin (TcB) measurements are widely used in newborns but understudied in outpatient settings.
- Few studies have evaluated TcB in pediatric offices, limiting its adoption in primary care.
Purpose of the Study:
- To assess the efficacy of TcB measurements as a screening tool in outpatient pediatric settings.
- To evaluate the correlation between TcB and total serum bilirubin (TSB) levels in jaundiced infants.
- To determine the reliability of TcB for identifying hyperbilirubinemia risk in diverse clinical environments.
Main Methods:
- TcB measurements were performed on 120 jaundiced infants (≥ 35 weeks gestation) across hospital clinics, public health programs, and pediatric offices.
- Three TcB readings were taken from the mid-sternum, with average and maximum values recorded.
- Data were analyzed to correlate TcB with TSB levels and assess predictive accuracy.
Main Results:
- A strong correlation (r=0.78, P=0.0) was observed between TcB and TSB measurements.
- TcB successfully predicted the risk of TSB levels ≥ 15 mg/dL, despite an increase in false negatives at higher TSB values.
- The JM-103 device demonstrated utility in identifying hyperbilirubinemia risk in outpatient settings.
Conclusions:
- TcB measurement using the JM-103 is a dependable screening method for hyperbilirubinemia in outpatient pediatric practices.
- Utilizing the maximum of three TcB readings minimizes false negatives but may increase false positives.
- TcB offers a valuable, non-invasive tool for pediatricians managing jaundiced infants in ambulatory care settings.
Objective:
The use of transcutaneous bilirubin (TcB) measurements has been studied extensively in the newborn population, but there have been few studies in outpatient populations and none from the offices of practicing pediatricians.
Study Design:
We performed TcB measurements on a mixed-race population of 120 jaundiced infants, ≥ 35 weeks of gestation, in two hospital-based outpatient clinics, a regional public health nurse follow-up program and two pediatric office practices. Three individual TcB readings were obtained from the mid-sternum, and the average and maximum values were recorded.
Result:
There was good correlation between the TcB and total serum bilirubin (TSB) measurements (r=0.78, P=0.0). 59% of TSB's were ≥15 mg dl(-1) and, although the number of false-negative readings increased when the TSB values exceeded 15 mg dl(-1), it was nevertheless possible to use TcB measurements to accurately predict the risk of TSB levels ≥ 15 mg dl(-1).
Conclusion:
In outpatient settings, a TcB measurement with the JM-103 provides a reliable screening method for the identification of hyperbilirubinemia even when the TSB level exceeds 15 mg dl(-1). Using the maximum of three independent measurements reduces the number of false negatives, but increases the number of false positives. The use of TcB measurements in an outpatient practice should be a valuable tool for the practitioner.
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