Skin bilirubin measurement during phototherapy in preterm and term newborn infants
Introduction
Transcutaneous bilirubinometry (TCB), first introduced in neonatal practice by Yamanouchi et al. [1], is an easy, safe and convenient method for the evaluation of the severity of jaundice since no invasive procedure is involved. Several studies have documented its reliability in this respect [1], [2], [3], [4]. In the last years, technological improvements provided new devices for noninvasive bilirubin assay, and transcutaneous bilirubinometry is now becoming widespread diffuse. Among these devices, BiliCheckTM (BC; Respironics, Murrysville, PA, USA) has been reported as very accurate and it constitutes a more useful screening method compared to the visual estimate [5], [6]. In a recent review, the AAP recognized it as a significant improvement over the older devices [7]. Phototherapy is a widely accepted treatment for neonatal indirect hyperbilirubinemia. Phototherapy has been reported to adversely affect the correlation between TCB and blood measurements [8], [9], [10], [11], [12], [13], and available data do not allow clear recommendations about the TCB use during phototherapy [14], [15]. However, it is well known that blanching effect of the light exposure occurs only on exposed areas, while shaded sites remain icteric. This prospective cohort study was designed to evaluate the accuracy of TCB measurement on exposed and not exposed skin areas during phototherapy treatment in newborn infants with the aim to reduce painful blood collection for serum bilirubin.
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Materials and methods
The study was performed in the Neonatology Unit of our University Hospital, a tertiary referral centre with approximately 3100 deliveries a year, between June 2006 and May 2008. Although transcutaneous bilirubin measurement is generally considered less accurate in preterm infant [5] we included preterm infants in our study because they usually require phototherapy and serum bilirubin determinations more frequently than full term babies. The institutional review board of our department approved
Results
We studied 364 newborn infants with a mean (SD) gestational age of 34.6 (3) weeks and a mean birth weight of 2371 (805) grams (Table 1). Study population included 69.5% of infants less than 37 weeks of gestation, with a slight prevalence of males (59.3%), almost all Caucasian. The incidence of caesarean section was 75.5%. The mean (SD) age at start of phototherapy was 76 (44) hours of life. TSB (13.6 ±3.8 mg/dL), PTCB (13.3 ± 3.5 mg/dL) and UTCB (13.2 ± 4.1 mg/dL) were not different before
Discussion
Previous studies suggested that transcutaneous measurement of bilirubin is an useful screening device for neonatal hyperbilirubinemia [19], [20]. However, first generation bilirubinometers had several limitation and their accuracy was dependent on gestational age, skin pigments amount and environmental light intensity [21], [22], [23]. A recently developed device, the BiliCheck, with inbuilt algorithms to correct the influence of skin pigments other than bilirubin, is claimed to be more
Ethical statement
The institutional review board of our department approved this study which was considered a non-invasive one, and the parents of all children gave verbal informed consent.
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Patched Skin Bilirubin Assay to Monitor Neonates Born Extremely Preterm Undergoing Phototherapy
2017, Journal of PediatricsCitation Excerpt :Two sample-size calculations were performed: one to detect a given TSB-TcB bias and another to detect a given correlation between TSB and TcB. Data from a previous study on transcutaneous bilirubinometry in infants born late preterm undergoing phototherapy were used to estimate the first sample size.7 Assuming a power of 90% and an α-error of 0.05, a sample size of 49 would detect a clinically significant mean bias TSB-TcB of 1.75 mg/dL with an estimated SD of 3.1 mg/dL as previously published.7
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