Transcutaneous bilirubin testing is feasible in neonates

Last Updated: 2016-11-07

By Will Boggs MD

NEW YORK (Reuters Health) - Transcutaneous bilirubinometry (TcB) is feasible and safe for evaluation of jaundiced neonates, researchers report.

"I strongly favor the use of the transcutaneous bilirubinometry, like any non-invasive procedure, over invasive and painful procedures in children, as long as it is safe and effective," Dr. Jolita Berkhof from Amalia Children's Clinic, Zwolle, The Netherlands told Reuters Health by email. "The only drawback is the cost. The device is costly, so poor resource countries might be reluctant to invest in the method."

TcB is a valid method for assessing the severity of jaundice, but it is uncommonly used in sick neonates because blood sampling in these children is often done for other indications and serum bilirubin can be measured simultaneously.

In a randomized trial involving 430 hospitalized jaundiced newborns, Dr. Berkhof and colleagues sought to quantify the reduction in blood draws as a result of implementing TcB from 32 weeks' gestational age, compared with visual assessment with subsequent blood sampling for determination of serum bilirubin.

Use of the Air-Shields Jaundice Meter-103 (Drager Konica Minolta, Lubeck, Germany) was associated with a 38.5% reduction in the number of blood draws per neonate (21.1% of those in the neonatal ward for sick neonates and 44.4% of those in the maternity ward), according to the November 4th Pediatrics online report.

There were no significant differences in secondary outcomes (highest serum bilirubin level, phototherapy, severe serum bilirubin, length of hospitalization, and serum bilirubin value above exchange transfusion threshold) between the TcB and control groups.

There were no cases of clinical kernicterus, and none of the measured serum bilirubin values was extreme (at or above 425 umol/L) or hazardous (at or above 512 umol/L).

In 158 paired samples, TcB bilirubin values were an average 7.0 umol/L higher than the respective serum bilirubin levels, with limits of agreement between -56.9 and 71.0 umol/L.

"We should further investigate if the use of the bilirubinometer can be applied during and after phototherapy as well; this would further reduce the number of blood draws and costs," Dr. Berkhof said.

Dr. Jeffrey Maisels from Beaumont Children's Hospital, Royal Oak, Michigan told Reuters Health, "This study confirms numerous previous observations of the safety and utility of transcutaneous bilirubin measurements in newborn infants and that transcutaneous measurements significantly reduce the number of serum bilirubin measurements required. This is, however, the first randomized controlled trial in a Western population documenting the reduction in serum bilirubin measurements."

"As I've written before, the benefits to infants, parents, and care providers of an instantaneous, noninvasive estimate of the serum bilirubin level, are abundant," Dr. Maisels concluded. "The authors note the benefit of these measurements in hospitalized infants, but even greater benefits could be derived from having these instruments available in every hospital outpatient clinic, every emergency department, and in the office of every pediatrician and family practitioner."

Isala's Foundation for Innovation and Research funded this study. The authors had no financial conflicts to declare.

SOURCE: http://bit.ly/2fMravD

Pediatrics 2016.