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Use of Transcutaneous Bilirubin to Determine the Need for Phototherapy in Resource-Limited Settings
Bolajoko O Olusanya1, Abieyuwa A Emokpae
1Center for Healthy Start Initiative, Lagos, Nigeria.
Insights
Transcutaneous bilirubin (TcB) measurements can help identify infants who do not need phototherapy for neonatal hyperbilirubinemia. However, TcB may lead to many false positives, posing a challenge in resource-limited settings.
Area of Science:
- Neonatal Medicine
- Medical Diagnostics
- Public Health
Background:
- Neonatal hyperbilirubinemia is a significant health concern, particularly in resource-limited areas.
- Accurate and timely measurement of total serum bilirubin (TSB) is often challenging in these settings.
- Transcutaneous bilirubin (TcB) offers a potential non-invasive alternative for bilirubin assessment.
Purpose of the Study:
- To compare the number of infants requiring phototherapy based on different TSB criteria.
- To evaluate the predictive performance of TcB in identifying infants needing phototherapy.
Main Methods:
- Paired TcB and TSB measurements were collected from infants in Lagos, Nigeria.
- Phototherapy decisions were based on TSB criteria from AAP, NICE, WHO, and an absolute threshold (≥12 mg/dL).
- Receiver operating curve analysis was used to assess TcB's predictive performance.
Main Results:
- Out of 1,011 infants, 60 (5.9%) required phototherapy based on at least one TSB criterion.
- The TSB ≥12 mg/dL criterion identified 91.7% of infants needing phototherapy.
- TcB demonstrated high negative predictive values (99.0-99.9%) but low positive predictive values (7.7-15.5%).
Conclusions:
- The number of infants requiring phototherapy varies significantly depending on the chosen TSB criteria.
- TcB is effective in ruling out the need for phototherapy but generates a high rate of false positives.
- The utility of TcB in resource-limited settings is limited by its potential to overburden healthcare systems with unnecessary follow-up assessments.
Background:
Routine and timely determination of total serum bilirubin (TSB) remains a challenge in many resource-limited countries with substantial burden of severe neonatal hyperbilirubinemia. Limited evidence exists on the potential usefulness of transcutaneous bilirubin (TcB) to identify infants who may require phototherapy based on possible treatment criteria in such settings.
Objective:
To compare the number of infants requiring phototherapy across different TSB criteria and determine the predictive performance of TcB under each criterion.
Methods:
Infants with paired TcB and TSB measurements in a maternity hospital in Lagos, Nigeria, were assessed for phototherapy based on TSB criteria by the American Academy of Pediatrics (AAP), National Institute for Health and Clinical Excellence (NICE) UK, and World Health Organization (WHO), and an absolute threshold of ≥12 mg/dL. The predictive performance of TcB across treatment criteria was evaluated with receiver operating curve analysis.
Results:
A total of 1,011 infants with a mean TcB of 10.54 ± 3.19 (range: 2.7-19.9) mg/dL and TSB of 9.63 ± 2.61 (range: 0.3-19.5) mg/dL were assessed. Some 60 (5.9%) infants required phototherapy by 1 or more TSB criteria, with TSB ≥12 mg/dL identifying 55 (91.7%) and AAP 27 (45%) of these infants. All infants identified by the NICE and WHO criteria were equally detected by the AAP criterion. TcB showed negative predictive values of 99.0-99.9%, and positive predictive values of 7.7-15.5% across all criteria.
Conclusions:
The number of infants requiring phototherapy varies significantly across treatment criteria. TcB may be useful in identifying infants who do not require phototherapy, but may also identify a high proportion of false positives that is burdensome in resource-limited settings.
