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Candel-Pau J, Maya-Enero S, Garcia-Garcia J, Duran-Jordà X, López-Vílchez MÁ. Transcutaneous bilirubin reliability during and after phototherapy depending on skin color. Eur J Pediatr 2024; 183:2819-2830. [PMID: 38581462 PMCID: PMC11192662 DOI: 10.1007/s00431-024-05516-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 04/08/2024]
Abstract
Measurement of transcutaneous bilirubin (TcB) is a non-invasive, widely used technique to estimate serum bilirubin (SB). However, its reliability in multiethnic populations during and after phototherapy is still controversial even in covered skin. The aim of this study was to determine the reliability of TcB in covered (cTcB) and exposed (eTcB) skin during and after phototherapy in a multiethnic population of term and preterm neonates according to Neomar's neonatal skin color scale. Prospective, observational study comparing SB and TcB. We determined SB when clinically indicated and, at the same time, measured cTcB under a photo-opaque patch and eTcB next to it with a jaundice meter (Dräger JM-105TM). All dyads TcB-SB were compared, both globally and according to skin color. We obtained data from 200 newborns (color1: 44, color2: 111, color3: 41, color4: 4) and compared 296 dyads TcB/SB. Correlation between cTcB and SB is strong during (0.74-0.83) and after (0.79-0.88) phototherapy, both globally and by color group. The SB-cTcB bias depends on gestational age during phototherapy and on skin color following phototherapy. The correlation between eTcB and SB during phototherapy is not strong (0.54), but becomes so 12 h after discontinuing phototherapy (0.78). Conclusions: Our study supports the reliability of cTcB to assess SB during and after phototherapy, with differences among skin tones after the treatment. The use of cTcB and Neomar's scale during and mainly after phototherapy may help reduce the number of blood samples required. What is Known: • Controversies exist on the reliability of jaundice meters during and after phototherapy in covered skin. Only a few studies have analyzed their accuracy in multiethnic populations, but none has used a validated neonatal skin color scale. What is New: • We verified correlation between serum and transcutaneous bilirubin in covered skin in a multiethnic population depending on skin color based on our own validated neonatal skin color scale during and after phototherapy.
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Affiliation(s)
- Júlia Candel-Pau
- Department of Neonatology, Service of Pediatrics, Hospital del Mar, Universitat Pompeu Fabra, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
| | - Silvia Maya-Enero
- Department of Neonatology, Service of Pediatrics, Hospital del Mar, Universitat Pompeu Fabra, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Jordi Garcia-Garcia
- Department of Neonatology, Service of Pediatrics, Hospital del Mar, Universitat Pompeu Fabra, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Xavier Duran-Jordà
- AMIB (Methodological and Biostatistical Consultancy), IMIM (Hospital del Mar Institute for Medical Research), Doctor Aiguader 88, 08003, Barcelona, Spain
| | - María Ángeles López-Vílchez
- Department of Neonatology, Service of Pediatrics, Hospital del Mar, Universitat Pompeu Fabra, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
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Abstract
Although the modern era of transcutaneous bilirubin monitoring (TcB) began only about 35 years ago, this screening tool is now widely used in newborn nurseries and outpatient clinics, offices, and emergency departments to obtain a rapid and non-invasive estimate of the degree of hyperbilirubinemia. TcB devices have become more sophisticated, and major breakthroughs include the following: (a) ability to report a bilirubin value rather than an index value, (b) enhanced correction for chromophores other than bilirubin, and (c) technologic improvements including interface with electronic medical records. Good agreement with laboratory bilirubin measurement has been demonstrated, and the ability of TcB screening to predict and decrease the incidence of subsequent hyperbilirubinemia has been well-documented. To date, it has not been shown that this screening results in improved long-term outcomes.
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Affiliation(s)
- William D Engle
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9063.
| | - Gregory L Jackson
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9063
| | - Nancy G Engle
- College of Nursing, University of Texas Arlington, Arlington, TX
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