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Published on: August 24, 2011
Screening for Hyperbilirubinemia in Japanese Very Low Birthweight Infants Using Transcutaneous Bilirubinometry
Daisuke Kurokawa1, Hajime Nakamura1, Tomoyuki Yokota2
1Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
Insights
Transcutaneous bilirubin (TcB) measurements in Japanese very low birthweight (VLBW) infants are most accurate on the sternum or upper back. A TcB of 8 or higher at these sites reliably detects high total serum bilirubin (TB) levels.
Area of Science:
- Neonatology
- Bilirubin Metabolism
- Infant Health
Background:
- Hyperbilirubinemia is common in newborns, especially very low birthweight (VLBW) infants.
- Accurate monitoring of total serum bilirubin (TB) is crucial for timely intervention.
- Transcutaneous bilirubinometry offers a non-invasive method for bilirubin assessment.
Purpose of the Study:
- To evaluate the accuracy of transcutaneous bilirubin (TcB) measurements at five distinct body sites in Japanese VLBW infants.
- To establish a reliable TcB threshold for identifying TB levels ≥10 mg/dL in this population.
Main Methods:
- A prospective multicenter study involving 85 Japanese VLBW infants.
- TcB measurements were taken at the forehead, sternum, upper back, lower abdomen, and waist within one hour of blood collection.
- Linear regression, Bland-Altman plots, and ROC curve analysis were employed to assess TcB accuracy and determine cut-off values.
Main Results:
- TcB measurements showed significant correlation with TB levels, with varying coefficients of determination across sites (waist: 0.7396, sternum: 0.6488, upper back: 0.6321, lower abdomen: 0.5430, forehead: 0.5294).
- A TcB threshold of ≥8 demonstrated 100% sensitivity for detecting TB ≥10 mg/dL when measured on the sternum or upper back.
- Lower sensitivity was observed at the waist (85%), forehead (84%), and lower abdomen (64%) for the same TB threshold.
Conclusions:
- The accuracy of TcB measurements in Japanese VLBW infants is site-dependent.
- TcB measurements at the sternum or upper back are more reliable for detecting TB levels ≥10 mg/dL compared to the forehead, lower abdomen, or waist.
- A TcB value of ≥8 at the sternum or upper back serves as a dependable indicator for elevated TB in this infant population.
Objectives:
To assess the accuracy of transcutaneous bilirubin (TcB) measurements at 5 different body sites in Japanese very low birthweight (VLBW) infants and to determine a cut-off value of TcB to detect total serum/plasma bilirubin (TB) levels ≥10 mg/dL (171 μM).
Study Design:
In a prospective multicenter study, 85 Japanese VLBW infants were enrolled from 5 neonatal intensive care units during the study period. A total of 383 blood samples from infants not receiving phototherapy or ≥24 hours postphototherapy were analyzed. TcB was measured at the forehead, sternum, upper back, lower abdomen, and waist within 1 hour of blood collection. Linear regression analysis and Bland-Altman plots were used to compare TcB values at each site with TB levels. The TcB cut-off value for detecting TB ≥10 mg/dL was determined by receiver operating characteristics curve analysis.
Results:
TcB significantly correlated with TB, but the coefficient of determination varied among the sites (forehead: 0.5294, sternum: 0.6488, upper back: 0.6321, lower abdomen: 0.5430, waist: 0.7396). At a TcB value ≥8, the sensitivity was 100% at the sternum and upper back, 85% at the waist, 84% at the forehead, and 64% at the lower abdomen to detect TB ≥10 mg/dL.
Conclusions:
In Japanese VLBW infants, the accuracy of TcB measurements varies according to body site. TcB ≥8 on the sternum or upper back is more reliable than that on the forehead, lower abdomen, or waist to detect TB levels ≥10 mg/dL.
