Accuracy and correlation of transcutaneous bilirubin with total serum bilirubin in preterm neonates born at 28-34 weeks of gestation during the first week of life
DOI:
https://doi.org/10.18203/2349-3291.ijcp20262783Keywords:
Transcutaneous bilirubin, Neonatal hyperbilirubinemia, BilirubinometerAbstract
Background: Transcutaneous bilirubin (TcB) measurement is a non-invasive method for screening neonatal hyperbilirubinemia and may reduce the need for repeated blood sampling. Although its accuracy has been well established in term and late preterm neonates, evidence in preterm infants remains limited. This study aimed to evaluate the correlation between TcB and total serum bilirubin (TSB) levels in preterm neonates born between 28 and 34 weeks of gestation during the first seven days of life.
Methods: This prospective observational study included 100 preterm neonates (28-34 weeks' gestation) admitted to the neonatal intensive care unit of a tertiary care hospital over a two-year period. TcB was measured using the BiliCare™ device on the helix of the ear immediately before or within five minutes of blood sampling for TSB estimation. The correlation between TcB and TSB values was evaluated by using Spearman's and Pearson's correlation coefficients.
Results: The mean gestational age was 31.4±1.97 weeks, and the mean birth weight was 1.56±0.35 kg. TcB and TSB mean values were 10.74±2.77 mg/dl and 10.16±3.59 mg/dl, respectively. It showed positive correlation between TcB and TSB (Spearman's rho=0.794, p<0.05; Pearson's correlation=0.870, p<0.05). The linear regression analysis showed the equation: TSB=1.6667×TcB-8.3333. This shows good predictive ability of TcB for serum bilirubin levels estimation.
Conclusions: TcB measurement showed positive correlation with TSB in preterm neonates of 28-34 weeks' gestation before initiation of phototherapy. TcB is a reliable, non-invasive screening tool that may avoid the need for invasive blood sampling in neonates, while TSB estimation should continue to guide therapeutic decisions.
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References
Bhutani VK, Wong RJ. Bilirubin neurotoxicity in preterm infants: risk and prevention. J Clin Neonatol. 2013;2(2):61-9. DOI: https://doi.org/10.4103/2249-4847.116402
Taylor JA, Burgos AE, Flaherman V, Chung EK, Simpson EA, Goyal NK, et al. Discrepancies between transcutaneous and serum bilirubin measurements. Pediatrics. 2015;135(2):224-31. DOI: https://doi.org/10.1542/peds.2014-1919
Huang MJ, Kua KE, Teng HC, Tang KS, Weng HW, Huang CS. Risk factors for severe hyperbilirubinemia in neonates. Pediatr Res. 2004;56(5):682. DOI: https://doi.org/10.1203/01.PDR.0000141846.37253.AF
Tiwari MM, Pise HN. Comparative study between serum and transcutaneous bilirubin measurements in newborns. Int J Contemp Pediatr. 2019;6(2):817. DOI: https://doi.org/10.18203/2349-3291.ijcp20190735
Maisels MJ, McDonagh AF. Phototherapy for neonatal jaundice. N Engl J Med. 2008;358(9):920-8. DOI: https://doi.org/10.1056/NEJMct0708376
Click R, Dahl-Smith J, Fowler L, DuBose J, Deneau-Saxton M, Herbert J. An osteopathic approach to reduction of readmissions for neonatal jaundice. Osteopath Fam Physician. 2013;5(1):17-23. DOI: https://doi.org/10.1016/j.osfp.2012.09.005
Das S, van Landeghem FKH. Clinicopathological spectrum of bilirubin encephalopathy/kernicterus. Diagnostics (Basel). 2019;9(1):24. DOI: https://doi.org/10.3390/diagnostics9010024
Billing BH. Bilirubin metabolism. Postgrad Med J. 1963;39(450):176-87. DOI: https://doi.org/10.1136/pgmj.39.450.176
Sassa S, Kappas A, Bernstein SE, Alvares AP. Heme biosynthesis and drug metabolism in mice with hereditary hemolytic anemia. J Biol Chem. 1979;254(3):729-35. DOI: https://doi.org/10.1016/S0021-9258(17)37866-3
Burchell B, Coughtrie M, Jackson M, Harding D, Fournel-Gigleux S, Leakey J, et al. Development of human liver UDP-glucuronosyltransferases. Dev Pharmacol Ther. 1989;13(2-4):70-7. DOI: https://doi.org/10.1159/000457587
Kawade N, Onishi S. The prenatal and postnatal development of UDP glucuronyl transferase activity towards bilirubin and the effect of premature birth on this activity in the human liver. Biochem J. 1981;196(1):257-60. DOI: https://doi.org/10.1042/bj1960257
Cloherty JP. Manual of Neonatal Care. Philadelphia: Lippincott Williams and Wilkins. 2012.
Murray RK, Granner DK, Mayes PA, Rodwell VW. Harper's Illustrated Biochemistry. 26th ed. New York: McGraw-Hill. 2009.
Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med. 2001;344(8):581-90. DOI: https://doi.org/10.1056/NEJM200102223440807
Usman F, Diala UM, Shapiro SM, Le Pichon JB, Slusher TM. Acute bilirubin encephalopathy and its progression to kernicterus: current perspectives. Res Rep Neonatol. 2018;8:33-44. DOI: https://doi.org/10.2147/RRN.S125758
Melton K, Akinbi HT. Neonatal jaundice: strategies to reduce bilirubin-induced complications. Postgrad Med. 1999;106(6):167-78. DOI: https://doi.org/10.3810/pgm.1999.11.775
Keenan WJ, Perlstein PH, Light IJ, Sutherland JM. Kernicterus in small sick premature infants receiving phototherapy. Pediatrics. 1972;49(5):652-5. DOI: https://doi.org/10.1542/peds.49.5.652
Shapiro SM. Chronic bilirubin encephalopathy: diagnosis and outcome. Semin Fetal Neonatal Med. 2010;15(3):157-63. DOI: https://doi.org/10.1016/j.siny.2009.12.004
Maisels MJ, Newman TB. Kernicterus in otherwise healthy, breast-fed term newborns. Pediatrics. 1995;96(4):730-3. DOI: https://doi.org/10.1542/peds.96.4.730
Moyer VA, Ahn C, Sneed S. Accuracy of clinical judgment in neonatal jaundice. Arch Pediatr Adolesc Med. 2000;154(4):391-4. DOI: https://doi.org/10.1001/archpedi.154.4.391
Wood B, Culley P, Roginski C, Powell J, Waterhouse J. Factors affecting neonatal jaundice. Arch Dis Child. 1979;54(2):111-5. DOI: https://doi.org/10.1136/adc.54.2.111
Riskin A, Tamir A, Kugelman A, Hemo M, Bader D. Is visual assessment of jaundice reliable as a screening tool to detect significant neonatal hyperbilirubinemia? J Pediatr. 2008;152(6):782-7. DOI: https://doi.org/10.1016/j.jpeds.2007.11.003
Maisels MJ, Ostrea EM, Touch S, Clune SE, Cepeda E, Kring E, et al. Evaluation of a new transcutaneous bilirubinometer. Pediatrics. 2004;113(6):1628-35. DOI: https://doi.org/10.1542/peds.113.6.1628
Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics. 1999;103(1):6-14. DOI: https://doi.org/10.1542/peds.103.1.6
Ip S, Chung M, Kulig J, O'Brien R, Sege R, Glicken S, et al. An evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics. 2004;114(1):e130-53. DOI: https://doi.org/10.1542/peds.114.1.e130
Puppalwar PV. Review on evolution of methods of bilirubin estimation. IOSR J Dent Med Sci. 2012;1(3):17-28. DOI: https://doi.org/10.9790/0853-0131728
Bhutani VK, Wong RJ, Stevenson DK. Hyperbilirubinemia in preterm neonates. Clin Perinatol. 2016;43(2):215-32. DOI: https://doi.org/10.1016/j.clp.2016.01.001
Lodha R, Deorari AK, Jatana V, Paul VK. Non-invasive estimation of total serum bilirubin by multi-wavelength spectral reflectance in neonates. Indian Pediatr. 2000;37(7):771-5.
Schmidt ET, Wheeler CA, Jackson GL, Engle WD. Evaluation of transcutaneous bilirubinometry in preterm neonates. J Perinatol. 2009;29(8):564-9. DOI: https://doi.org/10.1038/jp.2009.38
Willems WA, van den Berg LM, de Wit H, Molendijk A. Transcutaneous bilirubinometry with the Bilicheck® in very premature newborns. J Matern Fetal Neonatal Med. 2004;16(4):209-14. DOI: https://doi.org/10.1080/jmf.16.4.209.214
Nanjundaswamy S, Petrova A, Mehta R, Bernstein W, Hegyi T. The accuracy of transcutaneous bilirubin measurements in neonates: a correlation study. Neonatology. 2004;85(1):21-5. DOI: https://doi.org/10.1159/000074953
Panda SK, Gaurav A, Das P, Swain N, Rath S. A comparison between transcutaneous bilirubin and total serum bilirubin levels for the management of jaundice in preterm neonates by Bland-Altman plot. Cureus. 2021;13(10):e18442. DOI: https://doi.org/10.7759/cureus.18442
Nagar G, Vandermeer B, Campbell S, Kumar M. Reliability of transcutaneous bilirubin devices in preterm infants: a systematic review. Pediatrics. 2013;132(5):871-81. DOI: https://doi.org/10.1542/peds.2013-1713
Ahmed M, Mostafa S, Fisher G, Reynolds TM. Comparison between transcutaneous bilirubinometry and total serum bilirubin measurements in preterm infants <35 weeks gestation. Ann Clin Biochem. 2010;47(1):72-7. DOI: https://doi.org/10.1258/acb.2009.009072
Arman D, Topcuoğlu S, Gürsoy T, Ovalı F, Karatekin G. The accuracy of transcutaneous bilirubinometry in preterm infants. J Perinatol. 2020;40(2):212-8. DOI: https://doi.org/10.1038/s41372-019-0445-3
Rubio A, Epiard C, Gebus M, Deiber M, Samperiz S, Genty C, et al. Diagnosis accuracy of transcutaneous bilirubinometry in very preterm newborns. Neonatology. 2017;111(1):1-7. DOI: https://doi.org/10.1159/000447736
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