Related Experiment Video
Updated: Aug 9, 2026
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Transcutaneous Bilirubin Monitoring in Preterm Infants of 23 to 34 Weeks' Gestation
Jennifer Weber1,2, Nataly Vadasz-Chates3, Christine Wade4
1Division of Neonatology, Phoenix Children's Hospital, Phoenix, Arizona.
Insights
Transcutaneous bilirubin (TcB) measurements are reliable for screening preterm infants for hyperbilirubinemia. This noninvasive tool can reduce painful procedures and blood loss when used alongside serum bilirubin tests.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Medical Diagnostics
Background:
- Hyperbilirubinemia is a common condition in preterm infants.
- Accurate monitoring of bilirubin levels is crucial for preventing complications.
- Current methods involve invasive total serum bilirubin (TSB) measurements.
Purpose of the Study:
- To validate transcutaneous bilirubin (TcB) measurements at three distinct sites (sternum, interscapular, buttock) in premature infants.
- To compare the accuracy of TcB measurements against total serum bilirubin (TSB) levels.
- To assess the utility of TcB as a noninvasive screening tool in preterm neonates.
Main Methods:
- A prospective study involving 166 premature infants (23 to 34 weeks' gestational age).
- TcB measurements were taken from the sternum, interscapular, and buttock areas within 30 minutes of TSB collection.
- Statistical analyses included sensitivity, specificity, predictive values, and AUROC curves.
Main Results:
- Interscapular TcB measurements showed high sensitivity and specificity for TSB levels >5.0 mg/dL in infants 23-28 weeks' GA.
- Sternal TcB measurements were most sensitive and specific for TSB levels >8.0 mg/dL in infants 29-34 weeks' GA.
- All three TcB sites demonstrated excellent AUROCs and negative predictive values across both cohorts.
Conclusions:
- Transcutaneous bilirubin (TcB) meters serve as reliable noninvasive screening tools for hyperbilirubinemia in preterm infants.
- Utilizing TcB can potentially decrease painful stimuli and iatrogenic blood loss.
- TcB monitoring can be a valuable adjunct to TSB monitoring in the neonatal intensive care unit.
Objective:
The study aimed to evaluate the validity of transcutaneous bilirubin (TcB) measurements at three sites in premature infants born at 230/7 to 346/7 weeks' gestational age (GA) compared with total serum bilirubin (TSB) measurements.
Study Design:
A prospective study was conducted at Banner - University Medical Center Phoenix, where informed consent was obtained from the infant's parent or legally authorized representative. Cohort A was comprised of infants 230/7 to 286/7 weeks' GA and Cohort B contained subjects 290/7 to 346/7 weeks' GA. Baseline TSB measurements were collected at approximately 24 hours of life, as the standard of care and the TcB measurements were obtained from the sternum, interscapular, and buttock areas at approximately ± 30 minutes from collection of the TSB. Statistical analysis of measurements including sensitivity, specificity, positive, and negative predictive values, and the area under the receiver operator characteristic curve (AUROC) were performed.
Results:
A total of 166 infants were included in the study population. Cohort A consisted of 41 subjects and Cohort B contained 125 subjects. The results showed that baseline TcB measurements from the interscapular area were the most sensitive and specific with TSB levels >5.0 mg/dL in Cohort A. Baseline TcB measurements from the sternum demonstrated greatest sensitivity and specificity when the TSB level was >8.0 mg/dL in Cohort B. In general, each of the three sites in both cohorts demonstrated excellent AUROCs and negative predictive values.
Conclusion:
The use of a TcB meter in preterm infants can be a reliable noninvasive screening tool for hyperbilirubinemia, and it may be beneficial in decreasing painful stimuli and iatrogenic blood loss when used as an adjunct to TSB monitoring.
Key Points:
· Interscapular TcB is sensitive/specific in 23 to 29 weeks' GA.. · Sternal TcB is sensitive/specific in 29 to 35 weeks' GA.. · TcB readings are reliable in preterm infants.. · TcB is reliable when serum bilirubin is >5.0 mg/dL..
