Evaluation of a new transcutaneous bilirubinometer in Chinese newborns

Transcutaneous Bilirubin Accuracy Before, During, and After Phototherapy: A Meta-Analysis

CONTEXT

Transcutaneous bilirubinometry (TcB) is used as a valid screening to identify neonates requiring measurement of total serum bilirubin (TSB) before phototherapy. Its use during and after phototherapy is not advised yet because of unknown reliability.

OBJECTIVES

To determine the agreement of TcB and TSB measurements before, during, and after phototherapy.

DATA SOURCES

PubMed Medline, Cochrane Library, and references of eligible studies were searched.

STUDY SELECTION

Prospective and retrospective cohort and cross-sectional studies reporting Bland-Altman statistics of paired TcB and TSB measurements in term and preterm newborns.

DATA EXTRACTION

Meta-analysis was performed using the Mantel-Haenszel weighted approach. The agreement between TcB and TSB in μmol/L was described by pooled mean differences (MDs) and limits of agreement (LoA).

RESULTS

Fifty-four studies were included. The pooled MD before phototherapy is 2.5 μmol/L (LoA -38.3 to 43.3). The pooled MD during phototherapy is -0.3 μmol/L (LoA -34.8 to 34.2) on covered skin and -28.6 μmol/L (LoA -105.7 to 48.5) on uncovered skin. The pooled MD after phototherapy is -34.3 μmol/L (LoA -86.7 to 18.1) on covered skin and -21.1 μmol/L (LoA -88.6 to 46.4) on uncovered skin. Subgroup analysis revealed the best agreement at the forehead. We did not find any difference in agreement between term and preterm neonates.

LIMITATIONS

Language restriction.

CONCLUSIONS

TcB measurements before and during phototherapy on covered skin show good agreement compared with TSB in term and preterm newborns. More studies are needed to evaluate the accuracy after phototherapy.

Transcutaneous bilirubinometry versus total serum bilirubin measurement for newborns

BACKGROUND

Jaundice is a very common condition in newborns, affecting up to 60% of term newborns and 80% of preterm newborns in the first week of life. Jaundice is caused by increased bilirubin in the blood from the breakdown of red blood cells. The gold standard for measuring bilirubin levels is obtaining a blood sample and processing it in a laboratory. However, noninvasive transcutaneous bilirubin (TcB) measurement devices are widely available and used in many settings to estimate total serum bilirubin (TSB) levels.

OBJECTIVES

To determine the diagnostic accuracy of transcutaneous bilirubin measurement for detecting hyperbilirubinaemia in newborns.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL and trial registries up to 18 August 2022. We also checked the reference lists of all included studies and relevant systematic reviews for other potentially eligible studies.

SELECTION CRITERIA

We included cross-sectional and prospective cohort studies that evaluated the accuracy of any TcB device compared to TSB measurement in term or preterm newborn infants (0 to 28 days postnatal age). All included studies provided sufficient data and information to create a 2 × 2 table for the calculation of measures of diagnostic accuracy, including sensitivities and specificities. We excluded studies that only reported correlation coefficients.

DATA COLLECTION AND ANALYSIS

Two review authors independently applied the eligibility criteria to all citations from the search and extracted data from the included studies using a standard data extraction form. We summarised the available results narratively and, where possible, we combined study data in a meta-analysis.

MAIN RESULTS

We included 23 studies, involving 5058 participants. All studies had low risk of bias as measured by the QUADAS 2 tool. The studies were conducted in different countries and settings, included newborns of different gestational and postnatal ages, compared various TcB devices (including the JM 101, JM 102, JM 103, BiliChek, Bilitest and JH20-1C) and used different cutoff values for a positive result. In most studies, the TcB measurement was taken from the forehead, sternum, or both. The sensitivity of various TcB cutoff values to detect significant hyperbilirubinaemia ranged from 74% to 100%, and specificity ranged from 18% to 89%.

AUTHORS' CONCLUSIONS

The high sensitivity of TcB to detect hyperbilirubinaemia suggests that TcB devices are reliable screening tests for ruling out hyperbilirubinaemia in newborn infants. Positive test results would require confirmation through serum bilirubin measurement.

Evaluation of the Relationship Between Transcutaneous Bilirubin Measurement and Total Serum Bilirubin in Neonatal Patients Followed for Jaundice

Objectives:

Jaundice is a physiological condition caused by hyperbilirubinemia, which is common in neonatal period. However, severe hyperbilirubinemia can cause kernicterus, which is a serious condition that leads to neurological problems. In this study, we aimed to investigate whether it is safe to use transcutaneous bilirubin (TcB) instead of blood for the evaluation of jaundice by comparing TcB measurement with standard total serum bilirubin (TSB) measurement values.

Methods:

A total of 105 term and early term infants with gestational ages between 37 and 42 weeks were included in the study. MBJ20 TcB measuring device was used for TcB measurement. TcB was measured from the forehead and sternum. To evaluate the relationship between TcB measurements and TSB measurements, we performed Pearson correlation, Spearman correlation, linear regression analysis, and Bland-Altman analysis in which we evaluated the scatter plot of the differences between the average values of the measurements.

Results:

There was a positive and statistically significant correlation between TcB forehead and TSB measurements and TcB sternum and TSB measurements (p<0.001). Linear regression analysis showed a positive directional correlation between TcB forehead and TSB measurements (R²=0.85) and TcB sternum and TSB measurements (R²=0.87). Bland-Altman analysis showed a good consistency between TSB and TcB forehead measurement methods (mean difference: 0.39±1.46, 95% CI: [−2.47]–[3.26]), and between TSB and TcB sternum measurement methods (mean difference: 0.49±1.32 95% CI: [−2.1]–[3.07]).

Conclusion:

As a result of our study, we found that TcB measurement can be reliable instead of taking blood for jaundice evaluation.

Screen-Printed Sensor Based on Potentiometric Transduction for Free Bilirubin Detection as a Biomarker for Hyperbilirubinemia Diagnosis

Novel reliable and cost-effective potentiometric screen-printed sensors for free bilirubin (BR) detection were presented. The sensors were fabricated using ordered mesoporous carbon (OMC) as an ion-to-electron transducer. The ion-association complex [Ni(bphen)3]2+[BR]2− was utilized as a sensory recognition material in the plasticized Polyvinyl Chloride (PVC) membrane. The membrane was drop-casted on the OMC layer, which is attached on a carbon conductor (2-mm diameter). In a 50 mM phosphate solution of pH 8.5, the electrodes offered a Nernstian slope of −26.8 ± 1.1 (r2 = 0.9997) mV/decade with a range of linearity 1.0 × 10−6–1 × 10−2 M towards free bilirubin with a detection limit 8.8 × 10−7 M (0.52 µg/mL). The presented sensors offered good features in terms of reliability, ease of design, high potential stability, high specificity and good accuracy and precision. Chronopotentiometric and electrochemical impedance spectrometric measurements were used for short-term potential stability and interfacial capacitance calculations. The sensors were used for the determination of free bilirubin in biological fluids. The data obtained are fairly well consistent with those obtained by the reference spectophotometric method. Based on the interaction of free BR with albumin (1:1), the sensors were also utilized for the assessment of albumin in human serum.

Evaluation of transcutaneous bilirubinometer (DRAEGER JM 103) use in Zimbabwean newborn babies

Background

Acute Bilirubin Encephalopathy in the neonatal period is a major cause of permanent disability. Effective screening and surveillance are essential in the newborn period to enable timely management. Noninvasive transcutaneous bilirubin devices have been successfully used for screening in many settings. We evaluated the accuracy of the Draeger JM 103 (Medical Systems, USA) for estimating serum bilirubin in Zimbabwean newborns.

Methods

Paired transcutaneous (forehead and sternum) and serum bilirubin measurements were compared on 283 infants consecutively recruited between 01 August and 30 November 2015 at Harare Hospital Neonatal Unit. Using serum bilirubin as gold standard, Pearson Correlation Coefficient (r) was calculated for the two transcutaneous measurement sites. Linear regression plots of transcutaneous versus serum estimates were performed. Comparison was made between preterm and term babies. Specificity, sensitivity, positive predictive value and negative predictive value of the JM103 were calculated including ROC curves to assess the accuracy of the diagnostic tests.

Results

Fifty-five percent of the babies were male. Median gestational age was 38 weeks (range 28–42). One hundred and fifteen (41%) were preterm. Median postnatal age was 3 days (range 0–10). Serum bilirubin ranged 85–408 μmol/l, transcutaneous bilirubin sternum; 170–544 μmol/l and forehead; 119–510 μmol/l. Correlation between serum and transcutaneous bilirubin (sternum) was 0.77 and between serum and transcutaneous (forehead) was 0.72. Preterm babies correlation for sternum was 0.77 and forehead was 0.75. Term babies correlation for sternum was 0.76 and forehead was 0.70. The sensitivity for the sternum site was 76%, specificity 90%, Positive Predictive Value of 70 and Negative Predictive Value 92. Sensitivity for forehead site was 62%, specificity 95% with a Positive Predictive Value of 80 and Negative Predictive Value of 90. Bland-Altman plot of serum versus transcutaneous measurements showed agreement between the tests. The ROC curves showed that the accuracy of the two diagnostic tests were good with no significant difference between the two, p = 0.2954.

Conclusion

The study demonstrated a strong positive correlation for both sternum and forehead sites with serum bilirubin in this Zimbabwean population of African origin. However, the sternum is a better site for identifying babies with jaundice compared to forehead. The Draeger JM-103 can be used to screening for neonatal jaundice in this population.

Transcutaneous bilirubin measurement to estimate serum bilirubin in neonates in a multi-ethnic cohort: a literature review

Neonatal jaundice (NNJ) is common in Singapore and is usually monitored with serum bilirubin (SB). This paper reviews literature on the accuracy of transcutaneous bilirubin (TcB) measurement compared to SB to monitor jaundice in neonates of major ethnic groups of Singapore, i.e. Chinese, Malay, and Indian. 15 studies with Chinese babies, 5 with Malay babies, and 15 with Indian babies were identified (total of 28 articles, some with more than one race). Correlation coefficient is good for all three races. Chest is a better site for TcB measurement than forehead, though both are good. Infants with TcB levels more than 160–200 μmol/L should have SB checked. While post-phototherapy infants may benefit from TcB 24 hours after cessation of phototherapy, more needs to be done to ascertain its usefulness. Premature babies should have SB measurements. TcB measurement is suitable to monitor NNJ in term and healthy Chinese, Malay, and Indian babies.

Transcutaneous bilirubinometry

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.

Validation of transcutaneous bilirubin nomogram for identifying neonatal hyperbilirubinemia in healthy Chinese term and late-preterm infants: a multicenter study

OBJECTIVE

to prospectively validate a previously constructed transcutaneous bilirubin (TcB) nomogram for identifying severe hyperbilirubinemia in healthy Chinese term and late-preterm infants.

METHODS

this was a multicenter study that included 9,174 healthy term and late-preterm infants in eight hospitals of China. TcB measurements were performed using a JM-103 bilirubinometer. TcB values were plotted on a previously developed TcB nomogram, to identify the predictive ability for subsequent significant hyperbilirubinemia.

RESULTS

in the present study, 972 neonates (10.6%) developed significant hyperbilirubinemia. The 40(th) percentile of the nomogram could identify all neonates who were at risk of significant hyperbilirubinemia, but with a low positive predictive value (PPV) (18.9%). Of the 453 neonates above the 95(th) percentile, 275 subsequently developed significant hyperbilirubinemia, with a high PPV (60.7%), but with low sensitivity (28.3%). The 75(th) percentile was highly specific (81.9%) and moderately sensitive (79.8%). The area under the curve (AUC) for the TcB nomogram was 0.875.

CONCLUSIONS

this study validated the previously developed TcB nomogram, which could be used to predict subsequent significant hyperbilirubinemia in healthy Chinese term and late-preterm infants. However, combining TcB nomogram and clinical risk factors could improve the predictive accuracy for severe hyperbilirubinemia, which was not assessed in the study. Further studies are necessary to confirm this combination.

Validation of a transcutaneous bilirubin meter in Mongolian neonates: comparison with total serum bilirubin

BACKGROUND

Neonatal hyperbilirubinemia, especially kernicterus, can be prevented by screening for neonatal jaundice. The transcutaneous bilirubin (TcB) meter is a non-invasive medical device for screening neonates. The study aimed to investigate the validity of a TcB meter in a resource-limited setting such as Mongolia.

METHODS

Term and late preterm neonates from the National Center for Maternal and Child Health of Ulaanbaatar in Mongolia who met the inclusion criteria (gestational age ≥35 weeks, birth weight ≥2000 g, postnatal age ≤ 1 month) were enrolled in the study. We used a TcB meter, JM-103 to screen for neonatal jaundice. TcB measurements at the infant's forehead and midsternum were performed within 3 h of obtaining samples for total serum bilirubin (TSB) measurement. We analyzed the correlation between TcB measurements and TSB measurements to validate the meter.

RESULTS

A total of 47 term and six late preterm neonates were included in the study. TcB measured by the meter at both the forehead and the midsternum showed a strong correlation with TSB measured in the laboratory. The correlation equations were TSB = 1.409+0.8655 × TcB (R2=0.78871) at the forehead, and TSB = 0.7555+0.8974 × TcB (R2=0.78488) at the midsternum. Bland-Altman plots and the Bradley-Blackwood test showed no significant differences between the two methods at all measured ranges of bilirubin. The mean areas under the curves of TcB at the forehead and midsternum at three TSB levels (>10 mg/dL, >13 mg/dL, >15 mg/dL) of TcB were greater than 0.9, and all had high sensitivity and specificity.

CONCLUSIONS

This study established the validity of the JM-103 meter as a screening tool for neonatal jaundice in term and late preterm infants in Mongolia. Future studies are needed, including the establishment of a TcB hour-specific nomogram, for more effective clinical practice to prevent severe hyperbilirubinemia.

Point-of-care testing: where is the evidence? A systematic survey

Point-of-care testing (POCT) has had rapid technological development and their use is widespread in clinical laboratories to assure reduction of turn-around-time and rapid patient management in some clinical settings where it is important to make quick decisions. Until now the papers published about the POCT have focused on the reliability of the technology used and their analytical accuracy. We aim to perform a systematic survey of the evidence of POCT efficacy focused on clinical outcomes, selecting POCT denoted special analytes characterized by possible high clinical impact. We searched in Medline and Embase. Two independent reviewers assessed the eligibility, extracted study details and assessed the methodological quality of studies. We analyzed 84 studies for five POCT instruments: neonatal bilirubin, procalcitonin, intra-operative parathyroid hormone, troponin and blood gas analysis. Studies were at high risk of bias. Most of the papers (50%) were studies of correlation between the results obtained by using POCT instruments and those obtained by using laboratory instruments. These data showed a satisfactory correlation between methods when similar analytical reactions were used. Only 13% of the studies evaluated the impact of POCT on clinical practice. POCT decreases the time elapsed for making decisions on patient management but the clinical outcomes have never been adequately evaluated. Our work shows that, although POCT has the potential to provide beneficial patient outcome, further studies may be required, especially for defining its real utility on clinical decision making.

Neonatal bilirubin triage with transcutaneous meters: when is a blood draw necessary?

OBJECTIVE

To find the optimal transcutaneous bilirubin (TcB) screening level in term neonates that minimizes the discomfort of phlebotomy, while protecting the child from harm and controlling costs.

METHODS

All available TcB and total serum bilirubin (TSB) measurements taken between 27 and 51 hours of life from a cohort of term newborns were analyzed in a retrospective chart review. TcB cutoffs between 6 and 12 mg/dL were evaluated for their negative predictive values (NPVs) for high risk (HR) and for the combination of high-intermediate risk and HR on the Bhutani TSB risk nomogram.

RESULTS

One thousand seventy-one full-term newborns were entered into the study. Of 601 newborns with TcB < 7 mg/dL, none were HR by TSB. Of newborns with a TcB of < 8 mg/dL, 1 in 759 was HR. The NPVs for screening levels of 7 and 8 mg/dL were of 100% and 99.9%, respectively, for HR and 99% and 97.60%, respectively, for high-intermediate/HR. A cutoff at 12 mg/dL had NPVs of 99.3% for HR, with 7 neonates, and 92.7% for high-intermediate/HR, with 76 infants of 1041.

CONCLUSIONS

In our center, term infants with a TcB of < 8 mg/dL may be safely discharged without a follow-up TSB, with the understanding that -1/1000 infants may be at HR for developing severe hyperbilirubinemia. Practices with universal follow-up may safely choose cutoffs up to 12 mg/dL. An institution's degree of comfort and confidence in follow-up of the newborn cohort will guide the choice of an appropriate TcB cutoff requiring a TSB.

Estudo comparativo entre a medida plasmática e transcutânea de bilirrubina em recém-nascidos

OBJETIVO: Comparar as medidas transcutânea e plasmática da bilirrubina antes e durante a fototerapia, em área de pele exposta e coberta, analisando-se a associação com variáveis do recém-nascido (RN). MÉTODOS: Estudo de corte transversal, que avaliou 44 RN entre abril e outubro de 2008. Realizaram-se dosagens transcutâneas (região frontal e esternal) e plasmáticas da bilirrubina antes e 24 horas após o início da fototerapia. Tanto na região frontal como na esternal, ocluiu-se pequena região de pele e obteve-se a medida transcutânea da área coberta e de área adjacente exposta. Calculou-se a associação entre as medidas e variáveis do RN (peso, sexo, raça/cor, idade gestacional e pós-natal) e presença de fatores de risco para hiperbilirrubinemia significativa. RESULTADOS: Houve forte correlação entre a bilirrubina plasmática e a transcutânea, no momento da indicação e após 24 horas de fototerapia, nas regiões frontal e esternal, com intervalos de confiança estreitos tanto a 95 como a 99%. Observou-se que, com relação à medida transcutânea na área coberta, 24 horas após o início da fototerapia, a medida esternal apresentou correlação mais forte com a plasmática (r=0,86; p<0,001). As variáveis do RN analisadas não interferiram nas medidas de bilirrubina. CONCLUSÕES: As dosagens transcutânea e plasmática apresentam correlação forte antes da fototerapia nas regiões frontal e esternal. Após 24 horas de fototerapia, a medida transcutânea esternal em área coberta apresentou melhor correlação.

Transcutaneous bilirubin nomogram for predicting neonatal hyperbilirubinemia in healthy term and late-preterm Chinese infants

Identifying infants that will develop significant hyperbilirubinemia with the risk of kernicterus, and planning appropriate follow-up strategies, is particularly challenging. In this study, 36,921 transcutaneous bilirubin (TcB) measurements were obtained from 6,035 healthy neonates (gestational age ≥ 35 weeks and birth weight ≥ 2,000 g) between January 1 and December 31, 2009. All measurements were performed with the JM-103 bilirubinometer at designated times between 0 and 168 postnatal hours. TcB percentiles were calculated and used to develop an hour-specific nomogram. The rate of increase in TcB was higher during the first 72 h of age, after which levels declined to a plateau by 72-108 h of age. We constructed a TcB nomogram by using the 40th, 75th, and 95th percentile values of TcB for every 12 h of the studied interval. The 75th percentile curve of the nomogram may be an ideal cutoff point for intensive follow-up of the neonate for hyperbilirubinemia as it carries very high sensitivity (78.7%) and negative predictive value (98.5%). The specificity (45.7%) and positive predictive value (15.5%) decreased to reach their lowest levels at the 40th percentile. Of the neonates in the high-risk zone, 167 (48.8%) infants had persistent subsequent hyperbilirubinemia post-discharge, compared with 292 (27.0%) infants in the high-intermediate-risk zone at discharge. One-hundred and seventeen (5.5%) infants in the low-intermediate-risk zone moved into the high-risk zone during follow-up. No newborn infants in the low-risk zone became high-risk during follow-up. We provide an hour-specific TcB nomogram to predict neonatal hyperbilirubinemia in healthy term and late-preterm Chinese infants.

The circadian rhythm of expression of Bmal1 and Cry1 in peripheral blood mononuclear cells of preterm neonates

OBJECTIVE

To determine circadian rhythms of circadian genes in the peripheral blood mononuclear cells in preterm neonates.

STUDY DESIGN

Ten premature neonates, gestational age from 30 to 31 weeks were recruited. Infants with birth asphyxia, RDS, apnea, malformation, infection or haemolytic diseases were excluded. At 7AM and 7PM on the 1st day, 7th day and 14th day of hospitalisation, peripheral venous blood was obtained from the premature babies and real-time RTPCR was used to determine the expression of Bmal1 and Cry1.

RESULTS

The expression of bmal1 did not have statistical difference between 7AM and 7PM on the 1st day, 7th day and 14th day. Neither did the cry1.

CONCLUSION

There was no circadian rhythm of bmal1 and cry1 in PBMC of preterm neonates in our NICU.

Impact of skin tone on the performance of a transcutaneous jaundice meter

AIM

To evaluate the performance of the Konica Minolta/Air-Shields JM-103 jaundice meter on the basis of infant skin tone during the early neonatal period.

METHODS

Infants were prospectively categorized into light, medium and dark skin tone groups relative to two reference colours. Transcutaneous bilirubin readings were taken at predetermined intervals through the early neonatal period on a convenience sample of 938 healthy infants > or =37 weeks gestation. Serum bilirubin measurements were drawn routinely with metabolic studies and repeated in the presence of an elevated transcutaneous reading or clinically significant jaundice.

RESULTS

Multivariate linear regression analysis showed a significant impact on serum and transcutaneous bilirubin agreement by skin tone. Highest precision and lowest bias were observed for medium skin toned infants. Greater disagreement between serum and transcutaneous measurements was noted at serum bilirubin concentrations >200 micromol/L. Insufficient numbers of dark skin toned infants were enrolled to evaluate fully the performance of the jaundice meter for this group.

CONCLUSION

The JM-103 jaundice meter displayed good correlation with serum bilirubin concentrations in light and medium skin tone infants, although it showed a tendency to under-read in the lighter skin tone group and to over-read in the darker skin tone group. The device shows excellent performance characteristics for use as a screening device.

Bhutani-based nomograms for the prediction of significant hyperbilirubinaemia using transcutaneous measurements of bilirubin

AIM

Prospectively establish the relationship between transcutaneous bilirubin (TcB) and total serum bilirubin (TSB), and develop nomograms similar to Bhutani's nomograms, based on our TcB data.

METHODS

Our study sample was from a total population of 1069 infants, near term and term healthy newborns, admitted during 2.5 month period of the study. TSB was performed on all infants who were felt to be clinically jaundiced. Before obtaining the TSB, a TcB was performed (Jaundice Meter Minolta/Draeger JM-103). Measurements were performed on two sites: forehead and mid-sternum, and the mean of both measurements was calculated.

RESULTS

A total of 1091 paired measurements were obtained from 628 infants. Linear regression showed a significant relation between TSB and TcB (R(2) of 0.846). In multiple regression analysis, all independent variables studied, i.e. gestational age (or birthweight), age at sampling and ethnicity had a negligible influence on the relationship. We subsequently developed our local-nomograms of hour-specific mean TcB with 40, 75 and 95 percentile lines.

CONCLUSIONS

In our local settings and population, we found a reliable correlation between laboratory measurements of TSB and TcB. We were able to develop our local-Bhutani-based TcB nomograms for screening babies during hospital stay and pre-discharge for assessing the risk of hyperbilirubinaemia.

Systematic review of screening for bilirubin encephalopathy in neonates

CONTEXT

Severe neonatal hyperbilirubinemia is associated with chronic bilirubin encephalopathy (kernicterus).

OBJECTIVE

To systematically review the effectiveness of specific screening modalities to prevent neonatal bilirubin encephalopathy.

METHODS

We identified studies through Medline searches, perusing reference lists and by consulting with US Preventive Services Task Force lead experts. We included English-language publications evaluating the effects of screening for bilirubin encephalopathy using early total serum bilirubin (TSB), transcutaneous bilirubin (TcB) measurements, or risk scores. Severe hyperbilirubinemia was used as a surrogate for possible chronic bilirubin encephalopathy, because no studies directly evaluated the latter as an outcome. We calculated the sensitivity and specificity of early TSB, TcB measurements, or risk scores in detecting hyperbilirubinemia.

RESULTS

Ten publications (11 studies) were eligible. Seven (2 prospective) studies evaluated the ability of risk factors (n = 3), early TSB (n = 3), TcB (n = 2), or combinations of risk factors and early TSB (n = 1) to predict hyperbilirubinemia (typically TSB > 95th hour-specific percentile 24 hours to 30 days postpartum). Screening had good ability to detect hyperbilirubinemia: reported area-under-the-curve values ranged between 0.69 and 0.84, and reported sensitivities and specificities suggested similar diagnostic ability. Indirect evidence from 3 descriptive uncontrolled studies suggests favorable associations between initiation of screening and decrease in hyperbilirubinemia rates, and rates of treatment or readmissions for hyperbilirubinemia compared with the baseline of no screening. No study assessed harms of screening.

CONCLUSIONS

Effects of screening on the rates of bilirubin encephalopathy are unknown. Although screening can predict hyperbilirubinemia, there is no robust evidence to suggest that screening is associated with favorable clinical outcomes.

Visual screening versus transcutaneous bilirubinometry for predischarge jaundice assessment

OBJECTIVE

Comparison of visual screening with transcutaneous bilirubinometry (TcB) in identifying neonates with plasma total bilirubin (PTB) > or =75th percentile.

DESIGN

In 100 paired readings PTB was 34 +/- 24 micromol/L higher than the TcB counterpart. A TcB reading of 154 micromol/L was therefore regarded as equivalent to a PTB of 188 micromol/L, corresponding to the 75th percentile at 48 h. Predischarge, all newborns were evaluated for jaundice, first by visual inspection and then transcutaneously. PTB was ordered as indicated by visual assessment or if the TcB reading was > or =154 micromol/L.

RESULTS

Of 346 newborns tested, 25 (7.2%) had a PTB concentration > or =75th percentile. Forty-nine had PTB determinations based on TcB compared with 83 by visual assessment. However, a similar number of affected newborns was identified by each method (21/25 (84%) by visual screening vs. 18/25 (72%) by TcB). PTB concentrations of those who had been chosen by TcB were higher than those selected visually (202 +/- 24 micromol/L vs. 186 +/- 31 micromol/L).

CONCLUSIONS

A practical method for predischarge detection of neonates with plasma total bilirubin concentration > or = 75th percentile, implementing transcutaneous bilirubinometry, is described. The transcutaneous technique required fewer blood tests than visual assessment for similar yield.

Management of jaundice and prevention of severe neonatal hyperbilirubinemia in infants >or=35 weeks gestation

Kernicterus is still occurring but should be largely preventable if health care personnel follow the recommendations listed in this guideline. These recommendations emphasize the importance of universal, systematic assessment of the risk of severe hyperbilirubinemia, lactation support, close follow-up, and prompt intervention when necessary. A systems-based approach to prevent severe neonatal hyperbilirubinemia should be implemented at all birthing facilities and coordinated with continuing ambulatory care. Translational research is needed to better understand the mechanisms of bilirubin neurotoxicity and potential therapeutic interventions.