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Published on: May 28, 2013
Transcutaneous Bilirubin Accuracy Before, During, and After Phototherapy: A Meta-Analysis
Lisa Ten Kate1, Tiemen van Oorschot2, Jessica Woolderink3
1Medical Mission Suriname, Brownsweg, Suriname.
Context:
Transcutaneous bilirubinometry (TcB) is used as a valid screening to identify neonates requiring measurement of total serum bilirubin (TSB) before phototherapy. Its use during and after phototherapy is not advised yet because of unknown reliability.
Objectives:
To determine the agreement of TcB and TSB measurements before, during, and after phototherapy.
Data Sources:
PubMed Medline, Cochrane Library, and references of eligible studies were searched.
Study Selection:
Prospective and retrospective cohort and cross-sectional studies reporting Bland-Altman statistics of paired TcB and TSB measurements in term and preterm newborns.
Data Extraction:
Meta-analysis was performed using the Mantel-Haenszel weighted approach. The agreement between TcB and TSB in μmol/L was described by pooled mean differences (MDs) and limits of agreement (LoA).
Results:
Fifty-four studies were included. The pooled MD before phototherapy is 2.5 μmol/L (LoA -38.3 to 43.3). The pooled MD during phototherapy is -0.3 μmol/L (LoA -34.8 to 34.2) on covered skin and -28.6 μmol/L (LoA -105.7 to 48.5) on uncovered skin. The pooled MD after phototherapy is -34.3 μmol/L (LoA -86.7 to 18.1) on covered skin and -21.1 μmol/L (LoA -88.6 to 46.4) on uncovered skin. Subgroup analysis revealed the best agreement at the forehead. We did not find any difference in agreement between term and preterm neonates.
Limitations:
Language restriction.
Conclusions:
TcB measurements before and during phototherapy on covered skin show good agreement compared with TSB in term and preterm newborns. More studies are needed to evaluate the accuracy after phototherapy.
