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Transcutaneous bilirubinometry: its role in the assessment of neonatal jaundice
1Department of Clinical Biochemistry, St. Boniface General Hospital, Winnipeg, Manitoba, Canada.
Insights
Transcutaneous bilirubinometry (TcB) is a useful screening tool for neonatal jaundice, but it cannot replace serum bilirubin tests for critical treatment decisions. Careful selection of TcB decision levels is essential to prevent missed diagnoses.
Area of Science:
- Neonatal Medicine
- Medical Devices
- Diagnostic Tools
Background:
- Neonatal jaundice affects approximately 50% of newborns, with 6% developing hyperbilirubinemia, potentially leading to kernicterus.
- Traditional serum bilirubin (SB) measurement requires invasive skin punctures, posing risks of trauma and infection.
- Transcutaneous bilirubinometry (TcB) offers a noninvasive method to estimate bilirubin levels, reducing the need for blood draws.
Purpose of the Study:
- To determine the precise role of transcutaneous bilirubinometry in preventing kernicterus or bilirubin encephalopathy.
- To evaluate the efficacy of TcB as a screening tool for neonatal hyperbilirubinemia.
Main Methods:
- Comprehensive literature searches were conducted using Medline and Current Contents databases.
- Review of existing studies on transcutaneous bilirubinometry devices, including the Minolta AirShields Jaundice Meter.
- Analysis of the correlation and limitations of TcB measurements compared to serum bilirubin levels.
Main Results:
- TcB measurements show a good correlation with serum bilirubin levels.
- However, TcB cannot accurately predict serum bilirubin levels due to various error factors.
- The Minolta AirShields Jaundice Meter is a widely studied noninvasive device for TcB estimation.
Conclusions:
- Transcutaneous bilirubinometry is a valuable screening tool for identifying neonates requiring serum bilirubin testing.
- TcB should not be directly used for decisions regarding transfusions or phototherapy.
- Careful selection of TcB decision levels is crucial to avoid false-negative results and ensure timely laboratory testing.
Objective:
To review the literature on transcutaneous bilirubinometry so that its exact role in the prevention of kernicterus or bilirubin encephalopathy could be determined.
Design And Methods:
Literature searches were done in Medline and Current Contents.
Results:
It is estimated that about 50% of newborns have an episode of jaundice in the first few days of life. Six percent of newborns may develop hyperbilirubinemia (> 220 mumol/L), which can potentially cause bilirubin encephalopathy or kernicterus, a severe neonatal disease. In the past, serum bilirubin (SB) has been the preferred method of detecting hyperbilirubinemia in newborns. The ordering of SB in neonates is based on visual evaluation by either physicians or nursing staff. Skin puncture collection of blood exposes the neonate to trauma and risk of infection. A noninvasive device for predicting serum bilirubin levels in newborns diminishes the need to do skin punctures. One such device that has been very extensively studied is the Minolta AirShields Jaundice Meter. It is a portable light-weight instrument that uses reflectance measurements on the skin to determine the amount of yellow color present in the skin, namely transcutaneous bilirubin (TcB). Although the TcB measurements correlate well with serum bilirubin (SB) levels, they cannot accurately predict serum bilirubin because of error related to a variety of factors.
Conclusions:
TcB cannot be used directly to make decisions about transfusions or phototherapy in neonates. It is a good tool for screening neonates to determine when a laboratory measurement of serum bilirubin is needed. Such a practice requires careful selection of the decision level so that false-negative TcB values do not prevent appropriate serum bilirubin tests from being done.