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Updated: May 6, 2026
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Reliability of transcutaneous bilirubin devices in preterm infants: a systematic review
Gaurav Nagar1, Ben Vandermeer, Sandra Campbell
1MSc (Clinical Epidemiology), Department of Pediatrics, Edmonton Clinical Health Academy, Room 3-528, 11405 87 Ave NW, Edmonton, AB, Canada T6G 1C9. manojk@ualberta.ca.
Insights
Transcutaneous bilirubin (TcB) devices accurately estimate bilirubin levels in preterm infants, potentially reducing the need for blood draws. This review confirms their reliability for clinical use in this vulnerable population.
Area of Science:
- Neonatal Medicine
- Medical Devices
- Diagnostic Accuracy
Background:
- Transcutaneous bilirubin (TcB) devices are standard for estimating serum bilirubin in term and near-term infants.
- Limited data exists on the diagnostic accuracy of TcB devices specifically in preterm infants.
Purpose of the Study:
- To systematically review the diagnostic accuracy of transcutaneous bilirubinometers in preterm infants.
- To assess the reliability of TcB devices for bilirubin estimation in this population.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (Medline, Embase, Cochrane, CINAHL, Scopus) up to December 2012.
- Studies comparing TcB measurements with total serum bilirubin in preterm infants before phototherapy were included.
- Data extraction and risk of bias assessment were performed using standardized methods.
Main Results:
- Twenty-two studies met the inclusion criteria, reporting pooled correlation coefficients (r) of 0.83 for TcB devices.
- Pooled estimates for infants <32 weeks gestation were r = 0.89, similar to the overall preterm population.
- Both JM103 and BiliCheck devices showed comparable accuracy at the forehead; JM103 demonstrated better correlation at the sternum with less measurement bias.
Conclusions:
- Transcutaneous bilirubin devices reliably estimate bilirubin levels in preterm infants.
- TcB devices can be integrated into clinical practice to minimize invasive blood sampling.
- These findings support the use of TcB devices for routine monitoring in preterm neonates.
Background And Objective:
Transcutaneous bilirubin (TcB) devices are widely used for the estimation of serum bilirubin levels in term and near-term infants. Our objective was to review the diagnostic accuracy of TcB devices in preterm infants.
Methods:
Medline, Embase, Cochrane library, Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched (from database inception date until December 2012). Additional citations were identified by using the bibliographies of selected articles and from conference proceedings. The studies were included if they compared TcB with total serum bilirubin in preterm infants before phototherapy and presented data as correlation coefficients or as Bland-Altman difference plots. Data were extracted by 1 reviewer and checked for accuracy by the second reviewer. An assessment tool (quality assessment of diagnostic accuracy studies) was used for risk of bias assessments.
Results:
Twenty-two studies met the inclusion criteria; 21 studies reported results as correlation coefficients, with pooled estimates of r = 0.83 for each site of measurement. Pooled estimates in infants <32 weeks' gestation were similar to the overall preterm population (r = 0.89 [95% confidence interval: 0.82-0.93]). For the 2 commonly used TcB devices (ie, JM103 and BiliCheck), the results were comparable at the forehead site, although the JM103 device exhibited better correlation at the sternum. Analysis of the Bland-Altman plots (13 studies) revealed negligible bias in measurement at the forehead or sternum site by using either the JM-103 or BiliCheck device; however, the JM-103 device exhibited better precision than the BiliCheck (SD for TcB - total serum bilirubin differences: 24.3 and 31.98 µmol/L, respectively).
Conclusions:
The TcB devices reliably estimated bilirubin levels in preterm infants and could be used in clinical practice to reduce blood sampling.
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