Correlation between Transcutaneous Bilirubinemia and Blood Bilirubinemia in Screening Term Newborn for Neonatal Jaundice at the Essos Hospital Centre (EHC), Yaoundé, Cameroon

Background: Early and non-invasive diagnosis of neonatal hyperbilirubinemia remains critical in dark skinned babies of low resource settings. Objective: To assess correlation/agreement between transcutaneous bilirubin (Tcb) and serum bilirubin (Tsb) values in full term neonates with jaundice. Methodology: An analytical cross-sectional study was conducted at the neonatology unit of the Essos Hospital Centre (EHC) from January to June 2019. All full-term neonates aged 0 to 7 days with suspected jaundice who did not receive phototherapy were eligible for the study. The enrolled neonates in the study were assessed clinically, then with the MBJ20 transcutaneous bilirubinometer (TcB). The MBJ20 transcutaneous bilirubinometer highest measurement over the forehead and the sternum were compared to TsB. Data were entered and then analysed with the CsPro7.2 and R (version 3.6.0) software. Correlation was captured by Bland & Alman plots and Concordance Correlation Coefficient (CCC) estimates. The Pearson correlation coefficient and Student test for paired data were used for descriptions purposes, and the significance level was 5%. Results: We recruited 88 neonates. The sex ratio of the babies included was 1.25 favouring males. Median Post-natal age was 3 days with 62% aged 72 hours or more. The mean TcB corresponding to the maximum average between frontal and sternal measurement was 153 mg/dl ± 48 and the average Tsb was 123.80 mg/dl ± 50.48. A good linear correlation was found between TcB and total serum bilirubin level r = 0.86 [0.80;0.91]. Positive correlation was noted between both (forehead and sternum) TcB measurements sites, namely r = 0.78 and r = 0.86. The Bland & Altman plot measured the bias at -29.68 mg/l (confidence interval at 95%, 21.14 - 80.50). The CCC estimate was 0.2 varying from -0.22 to 0.76 according to TcB measurement threshold and post-natal age. The ROC area under the curve value for a threshold < 100 mg/l equals 90% proving to be a good predictor for this threshold. Conclusion: A good linear correlation was found despite a poor agreement between TcB and Tsb. TcB method systematically overestimated the value of TsB.

Measurement of Transcutaneous Bilirubin with Bilicheck as a Jaundice Screening Method in Neonates in Pediatric Emergency Departments

Objectives: To study the reliability of a transcutaneous bilirubinometer (Bilicheck) to determine bilirubin levels in neonates consulting for jaundice in a Paediatric Emergency Department (ED), and to evaluate its usefulness as a screening method. Methods: Prospective observational study realized between June of 2005 and December of2005 inneonates consulting at a paediatric emergency department for jaundice, in whom we realized both transcutaneous and total serum bilirubin measurements (TcB and TSB). We collected demographic variables, analytical variables (serum and transcutaneous bilirubin levels), length of stay in the ED, and need for treatment. Results: 66 children were included aged 2 to 31 days (81% of the sample were 2 to 7 days old). There was a close and statistically significant correlation between TcB and TSB (r = 0.81, p < 0.001). The area under the ROC curve was of 0.90, allowing detecting newborns with jaundice susceptible of treatment with TcB levels ≥ 13 mg/dL (sensitivity 92%, specificity 63, 5%, a positive predictive value 39% and a negative predictive value 97%). The number of venous punctures could be reduced in 50%. The medium stay in the ED was of 2 hours when performing serum measurements. Conclusions: A linear correlation exists between TcB-TSB. TcB measurement cannot replace that of TsB, however it could be used as a screening method in an ED to determine which neonates need confirmation by TsB measurement. The use of transcutaneous bilirubinometer would reduce both the number of painful interventions in neonates and the medium length of stay in ED, consequently reducing iatrogenesis.

Transcutaneous bilirubin nomogram for evaluating the risk of hyperbilirubinemia in Iranian healthy newborns

Background Hyperbilirubinemia,which is mostly benign,is one of the most common problems in neonates.This study was conducted to draw a skin bilirubin nomogram for evaluating the risk of hyperbilirubinemia requiring treatment.Methods This cross-sectional study recruited 1066 healthy infants.The first transcutaneous bilirubin(TcB)measurement was performed before hospital discharge and within 12-48 h of birth.The neonates were followed up for 6 days after discharge based on their age at the time of discharge.The neonates were divided into four groups based on the TcB values before discharge and age in hours,including the low-risk,medium-low-risk,medium-high-risk and high-risk groups.The percentage of neonates who progressed toward severe hyperbilirubinemia was then calculated in each percentile based on the follow-up TcB measurement.Stata software was used to draw the nomogram.Based on the TcB values at discharge and the neonate's age in hours,the skin bilirubin nomogram was drawn in 40,75 and 95 percentiles.Results A total of 4.9%of the neonates were in the high-risk group,18.9%in the medium-high-risk group,34.8%in the medium-low-risk group and 41.2%in the low-risk group.The risk of severe jaundice in the follow-up of the neonates in the highest-risk to the lowest-risk groups was 48.9,14.5,9.7 and 3.3%,respectively.Conclusion The skin bilirubin nomogram can be used to predict severe hyperbilirubinemia in Iranian infants.

Sixth hour transcutaneous bilirubin predicting significant hyperbilirubinemia in ABO incompatible neonates

Background:Neonates with ABO hemolytic disease are at greater risk for developing significant hyperbilirubinemia.We aimed to determine whether sixth hour transcutaneous bilirubin(TcB)could predict such a risk.Methods:TcB measurements were obtained at the 6th hour of life in blood group A or B neonates born to blood group O,rhesus factor compatible mothers.Subsequent hyperbilirubinemia was monitored and considered significant if a neonate required phototherapy/exchange transfusion.The predictive role of sixth hour TcB was estimated.Results:Of 144 ABO incompatible neonates,41(OA,24;O-B,17)had significant hyperbilirubinemia.Mean sixth hour TcB was significantly higher among neonates who developed significant hyperbilirubinemia than those who did not(5.83±1.35 mg/dL vs.3.65±0.96 mg/dL,P<0.001).Sixth hour TcB value>4 mg/dL had the highest sensitivity of 93.5%and>6 mg/dL had the highest specifi city of 99%.Area under receiver operating characteristic curve was 0.898.Conclusion:Sixth hour TcB predicts subsequent significant hyperbilirubinemia in ABO incompatible neonates.

Bilirubin nomograms for identifi cation of neonatal hyperbilirubinemia in healthy term and late-preterm infants:a systematic review and meta-analysis

Background:Hyperbilirubinemia occurs in most healthy term and late-preterm infants,and must be monitored to identify those who might develop severe hyperbilirubinemia.Total serum bilirubin(TSB)or transcutaneous bilirubin(TcB)nomograms have been developed and validated to identify neonatal hyperbilirubinemia.This study aimed to review previously published studies and compare the TcB nomograms with the TSB nomogram,and to determine if the former has the same predictive value for signifi cant hyperbilirubinemia as TSB nomogram does.Methods:A predefined search strategy and inclusion criteria were set up.We selected studies assessing the predictive ability of TSB/TcB nomograms to identify significant hyperbilirubinemia in healthy term and late-preterm infants.Two independent reviewers assessed the quality and extracted the data from the included studies.Meta-Disc 1.4 analysis software was used to calculate the pooled sensitivity,specificity,and positive likelihood ratio of TcB/TSB nomograms.A pooled summary of the receiver operating characteristic of the TcB/TSB nomograms was created.Results:After screening 187 publications from electronic database searches and reference lists of eligible articles,we included 14 studies in the systematic review and meta-analysis.Eleven studies were of medium methodological quality.The remaining three studies were of low methodological quality.Seven studies evaluated the TcB nomograms,and seven studies assessed TSB nomograms.There were no differences between the predictive abilities of the TSB and TcB nomograms(the pooled area under curve was 0.819 vs.0.817).Conclusions:This study showed that TcB nomograms had the same predictive value as TSB nomograms,both of which could be used to identify subsequent signifi cant hyperbilirubinemia.But this result should be interpreted cautiously because some methodological limitations of these included studies were identifi ed in this review.