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Updated: Jul 31, 2025
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Transcutaneous bilirubinometry versus total serum bilirubin measurement for newborns
Charles I Okwundu1, Abiola Olowoyeye2, Olalekan A Uthman3
1Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Insights
Transcutaneous bilirubin (TcB) devices are reliable for screening newborn jaundice, showing high sensitivity in detecting hyperbilirubinemia. Further confirmation with serum bilirubin tests is needed for positive results.
Area of Science:
- Neonatal Medicine
- Medical Diagnostics
- Biomedical Engineering
Background:
- Jaundice affects a significant percentage of newborns, necessitating accurate monitoring.
- Elevated bilirubin levels, or hyperbilirubinemia, are a common concern in neonates.
- Traditional serum bilirubin testing requires blood samples, while noninvasive transcutaneous methods offer an alternative.
Purpose of the Study:
- To evaluate the diagnostic accuracy of transcutaneous bilirubin (TcB) measurements for detecting hyperbilirubinemia in newborns.
- To assess the reliability of noninvasive TcB devices compared to standard serum bilirubin (TSB) measurements.
Main Methods:
- A systematic review and meta-analysis of cross-sectional and prospective cohort studies.
- Searched multiple databases (CENTRAL, MEDLINE, Embase, CINAHL) up to August 2022.
- Included 23 studies with 5058 participants, assessing various TcB devices and cutoff values.
Main Results:
- Transcutaneous bilirubin (TcB) devices demonstrated high sensitivity (74%–100%) in detecting significant hyperbilirubinemia.
- Specificity ranged from 18% to 89%, indicating TcB's effectiveness as a screening tool.
- Included studies involved diverse newborn populations and TcB devices, with low risk of bias.
Conclusions:
- TcB devices are highly sensitive and reliable for screening and ruling out hyperbilirubinemia in newborns.
- Positive TcB results warrant confirmation with serum bilirubin measurements.
- Noninvasive TcB testing can streamline the management of neonatal jaundice.
Background:
Jaundice is a very common condition in newborns, affecting up to 60% of term newborns and 80% of preterm newborns in the first week of life. Jaundice is caused by increased bilirubin in the blood from the breakdown of red blood cells. The gold standard for measuring bilirubin levels is obtaining a blood sample and processing it in a laboratory. However, noninvasive transcutaneous bilirubin (TcB) measurement devices are widely available and used in many settings to estimate total serum bilirubin (TSB) levels.
Objectives:
To determine the diagnostic accuracy of transcutaneous bilirubin measurement for detecting hyperbilirubinaemia in newborns.
Search Methods:
We searched CENTRAL, MEDLINE, Embase, CINAHL and trial registries up to 18 August 2022. We also checked the reference lists of all included studies and relevant systematic reviews for other potentially eligible studies.
Selection Criteria:
We included cross-sectional and prospective cohort studies that evaluated the accuracy of any TcB device compared to TSB measurement in term or preterm newborn infants (0 to 28 days postnatal age). All included studies provided sufficient data and information to create a 2 × 2 table for the calculation of measures of diagnostic accuracy, including sensitivities and specificities. We excluded studies that only reported correlation coefficients.
Data Collection And Analysis:
Two review authors independently applied the eligibility criteria to all citations from the search and extracted data from the included studies using a standard data extraction form. We summarised the available results narratively and, where possible, we combined study data in a meta-analysis.
Main Results:
We included 23 studies, involving 5058 participants. All studies had low risk of bias as measured by the QUADAS 2 tool. The studies were conducted in different countries and settings, included newborns of different gestational and postnatal ages, compared various TcB devices (including the JM 101, JM 102, JM 103, BiliChek, Bilitest and JH20-1C) and used different cutoff values for a positive result. In most studies, the TcB measurement was taken from the forehead, sternum, or both. The sensitivity of various TcB cutoff values to detect significant hyperbilirubinaemia ranged from 74% to 100%, and specificity ranged from 18% to 89%.
Authors' Conclusions:
The high sensitivity of TcB to detect hyperbilirubinaemia suggests that TcB devices are reliable screening tests for ruling out hyperbilirubinaemia in newborn infants. Positive test results would require confirmation through serum bilirubin measurement.
