How accurate is transcutaneous bilirubin testing in newborns with darker skin tones?

Area of Science:

• Neonatal Medicine
• Medical Devices
• Bilirubin Metabolism

Background:

• Transcutaneous bilirubin (TcB) testing is a non-invasive method for estimating total serum bilirubin (TSB) in newborns.
• Accurate bilirubin assessment is crucial for diagnosing and managing neonatal jaundice.
• Concerns exist regarding the accuracy of TcB testing across diverse neonatal populations, particularly concerning skin pigmentation.

Purpose of the Study:

• To evaluate the accuracy of photometric transcutaneous bilirubin (TcB) testing in neonates with varying skin tones.
• To determine if TcB testing systematically overestimates or underestimates total serum bilirubin (TSB) levels based on skin pigmentation.
• To assess the overall reliability of TcB meters in a diverse neonatal population.

Main Methods:

• Analysis of diagnostic cohort studies comparing TcB measurements with TSB levels.
• Inclusion of studies with neonates across a spectrum of skin tones.
• Assessment of mean differences and potential biases in TcB readings related to skin pigmentation.

Main Results:

• Photometric TcB testing demonstrated fair accuracy across all infant skin tones.
• TcB testing showed a tendency to overestimate TSB levels in neonates with darker skin tones (mean overestimation of 0.68 to > 2 mg/dL).
• Conversely, TcB testing was more likely to underestimate TSB levels in neonates with lighter skin tones.

Conclusions:

• TcB meters maintain acceptable accuracy for neonates of all skin tones, but systematic biases exist based on skin pigmentation.
• Overestimation of TSB in darker-skinned neonates warrants consideration, although its clinical impact on management (e.g., blood draws) remains unclear.
• Further research is needed to clarify the clinical significance of TcB overestimation in darker-skinned infants and its effect on healthcare practices.