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Transcutaneous Microcirculatory Imaging in Preterm Neonates
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Transcutaneous bilirubin estimation in extremely low birth weight infants receiving phototherapy: a prospective

Vidit Bhargava1, Daniel Tawfik2, Bruce Niebuhr3

  • 1Department of Pediatrics, Division of Pediatric Critical Care, Lucile Salter Packard Children's Hospital, 770 Welch Road, Suite 435, Palo Alto, CA, 94304, USA. viditbhumi@yahoo.com.

BMC Pediatrics
|July 12, 2018
PubMed

Insights

Transcutaneous bilirubin (TcB) measurements from covered areas (TcB-C) overestimate total serum bilirubin (TSB) in extremely low birth weight (ELBW) infants during phototherapy. TcB from exposed areas (TcB-E) underestimates TSB, indicating neither is a reliable surrogate for TSB in this population.

Area of Science:

  • Neonatal Medicine
  • Pediatric Gastroenterology
  • Medical Technology

Background:

  • Transcutaneous bilirubin (TcB) measurement is a non-invasive method for assessing hyperbilirubinemia.
  • TcB from covered areas (TcB-C) correlates with serum bilirubin in term and preterm infants during phototherapy (PHT).
  • Limited data exists on TcB accuracy in extremely low birth weight (ELBW) infants during PHT.

Purpose of the Study:

  • To evaluate the correlation between TcB measurements from covered (TcB-C) and exposed (TcB-E) areas and total serum bilirubin (TSB) in ELBW infants undergoing PHT.
  • To determine if TcB-C or TcB-E can serve as a reliable surrogate for TSB monitoring in ELBW infants during PHT.

Main Methods:

  • A prospective observational study involving 19 ELBW infants (mean gestational age 26 weeks, mean weight 827g).
  • TcB-C and TcB-E levels were measured alongside TSB within 30 minutes of each other, at birth and every 24 hours for 5 days.
  • Statistical analysis included Wilcoxon signed rank test and a mixed effects model to account for repeated measurements.

Main Results:

  • TcB-C consistently overestimated TSB, with a mean difference of 2.68 mg/dl (p < 0.001).
  • TcB-E consistently underestimated TSB, with a mean difference of -0.51 mg/dl (p = 0.02).
  • Significant discrepancies were observed between TcB measurements and TSB levels in ELBW infants during PHT.

Conclusions:

  • TcB-C measurements do not correlate with TSB values in ELBW infants during phototherapy.
  • TcB-C cannot be reliably used as a surrogate for TSB measurement in ELBW infants undergoing PHT.
  • TcB-E also demonstrates significant underestimation, highlighting the need for direct TSB measurements in this vulnerable population.
Abstract

Keywords:
ELBWHyperbilirubinemiaKernicterusTranscutaneous bilirubinometry

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