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Updated: May 28, 2026
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Accuracy of neonatal transcutaneous bilirubin measurement in the outpatient setting
Andrea C Wickremasinghe1, Brad S Karon, Walter J Cook
1Mayo Clinic, Rochester, MN, USA.
Insights
Transcutaneous bilirubin (TcB) screening may not be safe for predicting neonatal hyperbilirubinemia risk in outpatient settings. This method showed lower accuracy compared to total serum bilirubin (TSB) measurements, potentially leading to missed high-risk cases.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Medical Diagnostics
Background:
- Neonatal hyperbilirubinemia is a common condition requiring careful monitoring.
- Accurate prediction of hyperbilirubinemia risk is crucial for timely intervention.
- Transcutaneous bilirubin (TcB) measurement offers a non-invasive alternative to total serum bilirubin (TSB) testing.
Purpose of the Study:
- To assess the efficacy of transcutaneous bilirubin (TcB) measurements in outpatient settings.
- To determine if TcB accurately predicts the risk of neonatal hyperbilirubinemia.
- To compare TcB accuracy with established total serum bilirubin (TSB) nomograms.
Main Methods:
- Infants up to 8 days old in an outpatient clinic were enrolled.
- Total serum bilirubin (TSB) and transcutaneous bilirubin (TcB) levels were measured.
- Data were plotted on an hour-specific nomogram to assess hyperbilirubinemia risk.
Main Results:
- Mean bias between TcB and TSB was 1.5 ± 2.1 mg/dL in outpatients.
- TcB demonstrated 87% sensitivity and 58% specificity in predicting high-risk TSB.
- One infant with low-risk TcB required phototherapy due to high-risk TSB.
Conclusions:
- Transcutaneous bilirubin screening in outpatient environments may lack sufficient safety and efficiency.
- TcB's accuracy in predicting neonatal hyperbilirubinemia risk in this setting requires further investigation.
- Potential for underestimating risk necessitates caution when using TcB for outpatient screening.
Abstract:
OBJECTIVE. To evaluate the effectiveness of transcutaneous bilirubin (TcB) measurement in predicting risk for neonatal hyperbilirubinemia in outpatients. DESIGN. Subjects were infants ≤8 days old seen in an outpatient clinic. Infants discharged with high-risk (HR) or high-intermediate risk (HIR) total serum bilirubin (TSB) values and jaundiced infants were recruited. TSB and TcB (BiliChek) levels were plotted on an hour-specific nomogram to determine risk for hyperbilirubinemia. RESULTS. A total of 79 infants provided 87 sets of TcB and TsB values. Mean bias and standard deviation between TcB and TsB was 1.5 ± 2.1 mg/dL for outpatients, compared with 2.7 ± 1.3 mg/dL for inpatients. The sensitivity and specificity of HR or HIR TcB for predicting an HR or HIR TSB were 87% and 58%, respectively. Of 9 infants readmitted for phototherapy, 1 had a low-risk TcB and high-risk TSB. CONCLUSIONS. TcB screening in the outpatient environment may not be safe and efficient.
