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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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Dam-Vervloet AJ, Morsink CF, Krommendijk ME, Nijholt IM, van Straaten HLM, Poot L, Bosschaart N. Skin color influences transcutaneous bilirubin measurements: a systematic in vitro evaluation. Pediatr Res 2024:10.1038/s41390-024-03081-y. [PMID: 38368497 DOI: 10.1038/s41390-024-03081-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Concerns have been raised about the effect of skin color on the accuracy of transcutaneous bilirubin (TcB) measurements, a widely used method for hyperbilirubinemia diagnosis in newborns. Literature is inconclusive, with both reported under- and overestimations of the TcB with increasing skin pigmentation. Therefore, the influence of skin color on TcB measurements was systematically evaluated in a controlled, in vitro setting. METHODS A bilirubin meter (JM-105) was evaluated on layered phantoms that mimic neonatal skin with varying dermal bilirubin concentrations (0-250 µmol/L) and varying epidermal melanosome volume fractions (0-40%; light-dark skin color). RESULTS TcB measurements were influenced by skin pigmentation. Larger mimicked melanosome volume fractions and higher bilirubin levels led to larger underestimations of the measured TcB, compared to an unpigmented epidermis. In the in vitro setting of this study, these underestimations amounted to 26-132 µmol/L at a TcB level of 250 µmol/L. CONCLUSION This in vitro study provides insight into the effect of skin color on TcB measurements: the TcB is underestimated as skin pigmentation increases and this effect becomes more pronounced at higher bilirubin levels. Our results highlight the need for improved TcB meter design and cautious interpretation of TcB readings on newborns with dark skin. IMPACT Key message: Skin color influences transcutaneous bilirubin measurements: the darker the skin, the larger the underestimation. What this study adds to existing literature: Existing literature is inconclusive regarding the influence of skin color on transcutaneous bilirubin measurements. This study systematically evaluates and clarifies the influence of skin color on transcutaneous bilirubin measurements in a controlled, in vitro setting. IMPACT This study aids to better interpret the measured TcB level in patients with varying skin colors, and is particularly important when using TcB meters on patients with dark skin colors.
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Affiliation(s)
- Alida J Dam-Vervloet
- Biomedical Photonic Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
- Medical Physics Department, Isala hospital, Zwolle, The Netherlands.
| | - Claudia F Morsink
- Biomedical Photonic Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Marleen E Krommendijk
- Biomedical Photonic Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Ingrid M Nijholt
- Innovation & Science Department, Isala hospital, Zwolle, The Netherlands
- Radiology Department, Isala hospital, Zwolle, The Netherlands
| | | | - Lieke Poot
- Medical Physics Department, Isala hospital, Zwolle, The Netherlands
| | - Nienke Bosschaart
- Biomedical Photonic Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Clemence P, Moshiro R, Manji K. Validity of BiliDx as a point-of-care bilirubin measurement device to diagnose and monitor neonatal jaundice at Muhimbili National Hospital, an observational study. BMC Pediatr 2024; 24:114. [PMID: 38350890 PMCID: PMC10863160 DOI: 10.1186/s12887-024-04565-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 01/14/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Neonatal jaundice is a condition caused by elevated levels of bilirubin in the bloodstream. Laboratory determination of serum bilirubin concentration by total serum bilirubin (TSB) test is still considered as gold standard for clinical guidance and practice. In developed countries, diagnosis of neonatal jaundice is shifting towards point-of-care medical devices. BiliDx is a device developed to allow a fast, blood-based determination of bilirubin levels at the point of care. This study aimed to determine the accuracy of the BiliDx device relative to a standard laboratory total serum bilirubin to diagnose and monitor jaundice among neonates admitted at Muhimbili National Hospital (MNH). MATERIAL AND METHODOLOGY This was a prospective hospital-based observational study conducted at the Neonatal Ward - MNH, Dar-es-Salaam, Tanzania from November 2022 to January 2023. A total of 180 neonates admitted at the neonatal ward with jaundice and whose parents consented were enrolled in the study. Blood samples were collected; 2 ml of venous blood into the vacutainer bottle for standard laboratory measurement of total serum bilirubin (TSB) and 25µL blood collected into a transfer pipette tube and applied to BiliDx. STATA version 15.1 was used for data analysis. RESULTS Out of 180 neonates, 39.4% (71/180) had birth weight between 1500 - 2499.9 g, approximately 2/3rd (120/180) were preterm, 92/180 (51.1%) were males and 100/180 (55.6%) were undergoing phototherapy treatment the moment sample taken. The mean bilirubin concentration was 92 mmol/l for BiliDx and 118 mmol/l for standard laboratory TSB. The minimum and maximum values obtained with BiliDx were, 3.4 and 427.5 mmol/l respectively, compared with 10.7 and 382.1 mmol/l using standard laboratory TSB. A linear relationship and correlation coefficient of 0.8408 (p = 0.000) between BiliDx and standard laboratory TSB was found. The regression analysis showed the presence of constant error [coefficient of BiliDx/slope = 0.91, 95% CI (0.82-0.99), p = 0.000] and random error exclusively [coefficient of constant/y-intercept = 48.52, 95%CI (37.70-59.34), p = 0.000]. The Bland-Altman plot showed an acceptable mean difference of 39.1mmol/l, limits of agreement of -48.3mmol/l to 126.4mmol/l, and 179 points (179/180 = 99.4%) lying inside the limits of agreement. CONCLUSION The results support the use of BiliDx for rapid and accurate testing of elevated levels of bilirubin in the bloodstream among neonates since 99.4% of the differences between BiliDx and standard laboratory TSB lie between the lines of agreement.
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Affiliation(s)
- Pascal Clemence
- Department of Paediatrics and child health, Muhimbili University of Health and Allied Sciences, P.O BOX 65001, Dar es Salaam, Tanzania.
| | - Robert Moshiro
- Department of Paediatrics and Child Health, Muhimbili National Hospital, P.O BOX 65000, Dar es Salaam, Tanzania
| | - Karim Manji
- Department of Paediatrics and child health, Muhimbili University of Health and Allied Sciences, P.O BOX 65001, Dar es Salaam, Tanzania
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Abiha U, Banerjee DS, Mandal S. Demystifying non-invasive approaches for screening jaundice in low resource settings: a review. Front Pediatr 2023; 11:1292678. [PMID: 38054187 PMCID: PMC10694303 DOI: 10.3389/fped.2023.1292678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/18/2023] [Indexed: 12/07/2023] Open
Abstract
All national and international pediatric guidelines universally prescribe meticulous bilirubin screening for neonates as a critical measure to mitigate the incidence of acute bilirubin encephalopathy (ABE) and Kernicterus. The prevailing gold standard for jaundice detection in neonates necessitates invasive blood collection, followed by subsequent biochemical testing. While the invasive procedure provides dependable bilirubin measurements and continues to be the sole gold standard diagnostic method for assessing bilirubin concentration. There exists a pressing need to innovate non-invasive screening tools that alleviate the sampling stress endured by newborns, mitigate iatrogenic anemia, and expedite the turnaround time for obtaining results. The exploration of non-invasive modalities for bilirubin measurements is gaining momentum, driven by the overarching goal of minimizing the number of pricks inflicted upon neonates, thereby rendering screening a swift, efficient, comfortable, and dependable process. This comprehensive review article delves extensively into the array of non-invasive approaches and digital solutions that have been proposed, implemented, and utilized for neonatal bilirubin screening, with a particular emphasis on their application in low-resource settings. Within this context, the review sheds light on the existing methodologies and their practical applications, with a specific focus on transcutaneous bilirubin meters. Moreover, it underscores the prevailing open challenges in this domain and outlines potential directions for future research endeavors. Notably, the review underscores the imperative need for robust educational programs targeted at both families and healthcare personnel to expedite the process of seeking timely care for neonatal jaundice. Additionally, it underscores the necessity for the development of enhanced screening and diagnostic tools that can offer greater accuracy in clinical practice.
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Affiliation(s)
- Umme Abiha
- Department of Smart Healthcare, Indian Institute of Technology, Jodhpur, India
- All India Institute of Medical Science, Jodhpur, India
| | - Dip Sankar Banerjee
- Computer Science and Engineering, Indian Institute of Technology, Jodhpur, India
| | - Saptarshi Mandal
- Transfusion Medicine and Blood Bank, All India Institute of Medical Science, Jodhpur, India
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Okwundu CI, Olowoyeye A, Uthman OA, Smith J, Wiysonge CS, Bhutani VK, Fiander M, Gautham KS. Transcutaneous bilirubinometry versus total serum bilirubin measurement for newborns. Cochrane Database Syst Rev 2023; 5:CD012660. [PMID: 37158489 PMCID: PMC10167941 DOI: 10.1002/14651858.cd012660.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
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.
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Affiliation(s)
- Charles I Okwundu
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Abiola Olowoyeye
- Phoenix Children's Hospital and University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Olalekan A Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Johan Smith
- Department of Paediatrics and Child Health, Stellenbosch University, Faculty of Health Sciences, Stellenbosch, South Africa
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Vinod K Bhutani
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford School of Medicine, Lucile Packard Children's Hospital, Palo Alto, California, USA
| | | | - Kanekal S Gautham
- Chair of Pediatrics and Pediatrician-in-Chief, Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, Florida, USA
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Pan J, Xu W, Li W, Chen S, Dai Y, Yu S, Zhou Q, Xia F. Electrochemical Aptamer-Based Sensors with Tunable Detection Range. Anal Chem 2023; 95:420-432. [PMID: 36625123 DOI: 10.1021/acs.analchem.2c04498] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Jing Pan
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Wenxia Xu
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Wanlu Li
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Shuwen Chen
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Yu Dai
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Shanwu Yu
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Qitao Zhou
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Fan Xia
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
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Satrom KM, Farouk ZL, Slusher TM. Management challenges in the treatment of severe hyperbilirubinemia in low- and middle-income countries: Encouraging advancements, remaining gaps, and future opportunities. Front Pediatr 2023; 11:1001141. [PMID: 36861070 PMCID: PMC9969105 DOI: 10.3389/fped.2023.1001141] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/17/2023] [Indexed: 02/15/2023] Open
Abstract
Neonatal jaundice (NJ) is common in newborn infants. Severe NJ (SNJ) has potentially negative neurological sequelae that are largely preventable in high resource settings if timely diagnosis and treatment are provided. Advancements in NJ care in low- and middle-income countries (LMIC) have been made over recent years, especially with respect to an emphasis on parental education about the disease and technological advancements for improved diagnosis and treatment. Challenges remain, however, due to lack of routine screening for SNJ risk factors, fragmented medical infrastructure, and lack of culturally appropriate and regionally specific treatment guidelines. This article highlights both encouraging advancements in NJ care as well as remaining gaps. Opportunities are identified for future work in eliminating the gaps in NJ care and preventing death and disability related to SNJ around the globe.
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Affiliation(s)
- Katherine M Satrom
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN, United States
| | - Zubaida L Farouk
- Department of Pediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria.,Centre for Infectious Diseases Research, Bayero University, Kano, Nigeria
| | - Tina M Slusher
- Department of Pediatrics, Global Health Program, Critical Care Division, University of Minnesota, Minneapolis, MN, United States.,Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States
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8
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Harrison-Smith B, Dumont AP, Arefin MS, Sun Y, Lawal N, Dobson D, Nwaba A, Grossarth S, Paed AM, Farouk ZL, Weitkamp JH, Patil CA. Development of a mobile phone camera-based transcutaneous bilirubinometer for low-resource settings. BIOMEDICAL OPTICS EXPRESS 2022; 13:2797-2809. [PMID: 35774304 PMCID: PMC9203089 DOI: 10.1364/boe.449625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 05/19/2023]
Abstract
Newborns in high-income countries are routinely screened for neonatal jaundice using transcutaneous bilirubinometery (TcB). In low-and middle-income countries, TcB is not widely used due to a lack of availability; however, mobile-phone approaches for TcB could help expand screening opportunities. We developed a mobile phone-based approach for TcB and validated the method with a 37 patient multi-ethnic pilot study. We include a custom-designed snap-on adapter that is used to create a spatially resolved diffuse reflectance detection configuration with the illumination provided by the mobile-phone LED flash. Monte-Carlo models of reflectance from neonatal skin were used to guide the design of an adapter for filtered red-green-blue (RGB) mobile-phone camera reflectance measurements. We extracted measures of reflectance from multiple optimized spatial-offset regions-of-interest (ROIs) and a linear model was developed and cross-validated. This resulted in a correlation between total serum bilirubin and mobile-phone TcB estimated bilirubin with a R 2= 0.42 and Bland-Altman limits of agreement of +6.4 mg/dL to -7.0 mg/dL. These results indicate that a mobile phone with a modified adapter can be utilized to measure neonatal bilirubin values, thus creating a novel tool for neonatal jaundice screening in low-resource settings.
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Affiliation(s)
- Brandon Harrison-Smith
- Department of Bioengineering, Temple University, 1801 N. Broad St., Philadelphia, PA 19121, USA
| | - Alexander P. Dumont
- Department of Bioengineering, Temple University, 1801 N. Broad St., Philadelphia, PA 19121, USA
| | | | - Yu Sun
- Department of Bioengineering, Temple University, 1801 N. Broad St., Philadelphia, PA 19121, USA
| | - Nuradeen Lawal
- Department of Pediatrics, Aminu Kano Teaching Hospital(AKTH), Kano 7002 31, Nigeria
| | - Dorianna Dobson
- Department of Pediatrics, Vanderbilt University Medical Center(VUMC), Nashville, TN 37203, USA
| | - Amy Nwaba
- Department of Pediatrics, Vanderbilt University Medical Center(VUMC), Nashville, TN 37203, USA
| | - Sarah Grossarth
- Department of Pediatrics, Vanderbilt University Medical Center(VUMC), Nashville, TN 37203, USA
| | | | - Zubaida L. Farouk
- Department of Pediatrics, Aminu Kano Teaching Hospital(AKTH), Kano 7002 31, Nigeria
| | - Jorn-Hendrik Weitkamp
- Department of Pediatrics, Vanderbilt University Medical Center(VUMC), Nashville, TN 37203, USA
| | - Chetan A. Patil
- Department of Bioengineering, Temple University, 1801 N. Broad St., Philadelphia, PA 19121, USA
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9
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Evaluation of a new transcutaneous bilirubinometer in newborn infants. Sci Rep 2022; 12:5835. [PMID: 35393482 PMCID: PMC8989875 DOI: 10.1038/s41598-022-09788-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/18/2022] [Indexed: 11/09/2022] Open
Abstract
To avoid brain damage in newborn infants, effective tools for prevention of excessive neonatal hyperbilirubinemia are needed. The objective of this study was to evaluate a new transcutaneous bilirubinometer (JAISY). For this purpose, 930 bilirubin measurements were performed in 141 newborn infants born near-term or at term (gestational age 35–41 weeks; postnatal age 1–6 days; 71 boys; including 29 infants with darker skin) and compared to those of a previously validated instrument (JM105). In each infant, the mean of three repeated measurements in the forehead was calculated for each instrument, followed by a similar measurement on the chest. The bilirubin values varied between 0 and 320 µmol/l (0–18.8 mg/dl). There was a high degree of agreement with significant correlations between bilirubin values measured with the two devices on the forehead (Pearson’s r = 0.94, p < 0.001) and the chest (r = 0.94, p < 0.001). The correlations remained after stratifying the data by gestational age, postnatal age and skin color. The coefficient of variation for repeated bilirubin measurements was 8.8% for JAISY and 8.0% for JM105 (p = 0.79). In conclusion, JAISY provides accurate and reproducible information on low to moderately high bilirubin levels in newborn infants born near-term or at term.
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10
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Efficacy of transcutaneous bilirubinometry as compared to serum bilirubin in preterm newborn during phototherapy. Eur J Pediatr 2021; 180:2629-2636. [PMID: 34120212 DOI: 10.1007/s00431-021-04148-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Transcutaneous measurement of bilirubin is being used for neonatal jaundice. Its utility during phototherapy in preterm babies is not established. The objective of our study was to assess the efficacy of transcutaneous bilirubin (TcB) measurement in comparison to total serum bilirubin in preterm newborns at admission and during phototherapy at the covered skin area (glabella). It was a prospective observational study and conducted at the neonatal intensive care unit of a tertiary care hospital from January 2017 to January 2019. One hundred eligible preterm neonates were enrolled. Babies who were very sick, with poor peripheral circulation, edematous, having conjugated hyperbilirubinemia, with major congenital malformations, already received phototherapy or exchange transfusion were excluded. Paired total serum bilirubin and transcutaneous bilirubin were measured at admission and 6 h and 24 h during phototherapy. TcB was measured from the area (glabella) covered by an eye protector during phototherapy. The sample for TsB was taken within 10 min of TcB measurement. The mean differences between TsB and TcB values at admission and 6 h and 24 h of phototherapy were - 0.005 (0.353) mg/dl, - 0.350 (0.611) mg/dl, and - 0.592 (0.353) mg/dl, respectively. At admission or before starting of phototherapy, the difference (TsB-TcB) was statistically not significant (p = .125), while the difference in these values was statistically significant at 6 h and 24 h of phototherapy.Conclusion: TcB measurements from the covered skin area in jaundiced preterm infants during phototherapy were not correlated with TsB and cannot be used as an alternate of serum bilirubin testing. What is known • HPLC bilirubin measurement is a gold standard test for bilirubin measurement but impractical for day to day use. Serum total bilirubin is used for clinical testing.. • There is evidence for use of transcutaneous bilirubinometry for assessment of bilirubin in term newborn. What is new • TcB measurements from a covered skin area in jaundiced preterm newborns under phototherapy were not correlated significantly at 6 h and 24 h of phototherapy, but correlated before phototherapy. • TcB cannot be used as an alternate of serum bilirubin testing in preterm infants during phototherapy.
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11
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Paul HA, Adams BJ, Venner AA. Improving quality of transcutaneous bilirubin measurements: Value of in-house developed quality control. Pract Lab Med 2021; 24:e00206. [PMID: 33598521 PMCID: PMC7868991 DOI: 10.1016/j.plabm.2021.e00206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 01/24/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Quality assurance (QA) plays an integral role in Point of Care Testing (POCT) programs. Quality control (QC) is an important QA program component to ensure high quality results and enhanced patient care. The measurement of transcutaneous bilirubin (TcB) in the POCT setting is an essential part of newborn care in Alberta, Canada. However, there is currently no available commercial QC material for TcB meters. An in-house developed QC material has been in use within a single TcB POCT program within Alberta. The objective of this study was to determine the performance of this QC material by other POCT staff and clinical end-users to assess whether its use could be expanded. DESIGN AND METHODS Two levels of QC material were measured by POCT staff and clinical end-users across 12 different sites using the Dräger Jaundice Meter JM-103® and JM-105® meters. RESULTS The performance of the QC material was acceptable when tested by POCT staff, was stable and reliable over time, and had an acceptable CV (≤8%). However, the data does not support use of the QC material by clinical end-users. CONCLUSIONS The use of the QC material could be expanded into other TcB settings for use by POCT staff. Additional training and experience with the QC material by end-users is needed to facilitate QC use in the clinical setting.
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Affiliation(s)
- Heather Anne Paul
- Alberta Precision Laboratories, 3535, Research Rd NW, Calgary, AB, T2L 2K8, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, 3330, Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Brenda Joanne Adams
- Alberta Precision Laboratories, 3535, Research Rd NW, Calgary, AB, T2L 2K8, Canada
| | - Allison Anne Venner
- Alberta Precision Laboratories, 3535, Research Rd NW, Calgary, AB, T2L 2K8, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, 3330, Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
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Transcutaneous bilirubin measurements: useful, but also reproducible? Pediatr Res 2021; 89:725-726. [PMID: 33173170 DOI: 10.1038/s41390-020-01242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
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Reliability of transcutaneous bilirubin determination based on skin color determined by a neonatal skin color scale of our own. Eur J Pediatr 2021; 180:607-616. [PMID: 33409587 DOI: 10.1007/s00431-020-03885-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
Measurement of transcutaneous bilirubin (TcB) is widely used to estimate serum bilirubin (SB). However, its reliability depending on skin tone is still controversial. Ethnic classification does not correlate well with skin tone. We aimed to determine the reliability of transcutaneous bilirubin in a multiethnic population based on skin color according to our neonatal skin color scale. We conducted a prospective, observational study comparing SB and TcB among different skin colors. With the blood sample routinely obtained at 48-72 h for the screening of inborn errors of metabolism, we determined SB and TcB with a jaundice meter. We obtained data from 1359 newborns (color 1 337, color 2 750, color 3 249, color 4 23) and analyzed 1549 dyads SB/TcB. Correlation between TcB and serum bilirubin was very good (R2 = 0.908-0.956), globally and by color group, with slight differences between darker and lighter skin colors. Bland-Altman plots showed different mean bias depending on skin color. Conclusions: Our study not only supports the reliability of TcB to assess SB regardless of skin color, but also supports the fact that TcB tends to overestimate SB in a higher degree in dark-skinned neonates. This may help reduce the number of blood samples for newborns. What is Known: • Jaundice meters are extensively used to diagnose neonatal hyperbilirubinemia, although controversies exist on their reliability depending on skin color. • 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 a multiethnic population depending on skin color after classifying our neonates into color groups with our own validated neonatal skin color scale.
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Abstract
New technologies have become available for noninvasive assessments of neonatal hyperbilirubinemia. Our objective is to review the noninvasive methods for measuring bilirubin in the newborn. We searched relevant literature from 1966 to January 1, 2020, which included cross-sectional studies to define the accuracy of any noninvasive methods for measuring or estimating total serum/plasma bilirubin (TB) levels in newborns. We identified and included 83 relevant studies of direct visual assessment, icterometry, mobile phone applications, and transcutaneous bilirubinometry (TcB). Compared with laboratory TB measurements, visual assessment was the least accurate and least reliable (r: 0.37 to 074), while TcB was the most accurate, but not always near-equivalent (r: 0.45 to 0.99). The sensitivity and specificity of TcB cut-off values to detect significant hyperbilirubinemia (TB>95th percentile for age in hours) ranged from 74% to 100% and 18% to 89%, respectively.
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Affiliation(s)
- Charles I Okwundu
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Shiv Sajan Saini
- Department of Pediatrics, Division of Neonatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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15
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Accuracy of enhanced transcutaneous bilirubinometry according to various measurement sites. Turk Arch Pediatr 2021; 56:15-21. [PMID: 34013224 DOI: 10.14744/turkpediatriars.2020.54514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/21/2020] [Indexed: 11/20/2022]
Abstract
Objective The goal of the study was to provide missing data on the accuracy of enhanced transcutaneous bilirubinometry in a monoracial population of term neonates, considering three different measurement sites. Material and Methods Transcutaneous bilirubin was measured using the JM-105 device on the forehead, chest, and abdomen. Blood sampling for total serum bilirubin concentration has been performed within 10 minutes of transcutaneous measurements. Paired transcutaneous bilirubin and total serum bilirubin measurements were statistically analyzed. Results The study group consisted of 102 healthy term Slovak infants. The correlation between total serum bilirubin and transcutaneous bilirubin was significant (coefficient of determination R2: 0.9045 forehead, 0.8808 sternum, 0.8467 abdomen). Transcutaneous measurements underestimated serum bilirubin levels significantly when total serum bilirubin values were higher than 15 mg/dL, irrespective of the site of transcutaneous measurements. The lowest mean difference between total serum bilirubin and transcutaneous bilirubin was identified on the sternum (median: -1.1 mg/dL). The area under the curve was >0.97 and >0.93 for detecting total serum bilirubin levels >10 mg/dL and >13 mg/dL, respectively, for all measurement sites. Transcutaneous measurements on the forehead and sternum provided very high sensitivity, with the best performance at the forehead. Conclusion Transcutaneous bilirubinometry using an enhanced device is an accurate, sensitive, and convenient screening method in term Caucasian neonates. Transcutaneous bilirubin measurements on the forehead, sternum, and abdomen are reliable, with the best performance on the forehead. It is necessary to confirm higher transcutaneous bilirubin values with a total serum bilirubin measurement.
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Validation of a neonatal skin color scale. Eur J Pediatr 2020; 179:1403-1411. [PMID: 32157460 DOI: 10.1007/s00431-020-03623-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/20/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
Ethnic classification does not correlate well with skin tone. As there are no neonatal skin color scales, we aimed to create and validate one of our own. After creating the scale and briefly training our staff, we conducted a prospective, observational study to assess reproducibility and correlation of each scale color with the melanin and erythema indexes and transcutaneous bilirubin. The reliability of our color scale was measured using Kappa agreement (and its 95% confidence interval) and the concordance index by comparing inter-observer classification of neonatal skin color. We also calculated inter-rater agreement with the intraclass correlation coefficient (ICC). The Kendall tau-b correlation coefficient was used to test the correlation between our color scale and the Mexameter® MX 18. We obtained data from 258 newborns. Inter-observer agreement on color assignment was 83.2%. Median melanin index was significantly different among the 4 color groups, whereas erythema index and transcutaneous bilirubin were not.Conclusions: Our proposed neonatal skin color scale correlates well with the melanin index at 24 h of life, increasing from colors 1 to 4, and the only chromophore different among our four color groups is melanin. Scale color assignment is reproducible. Therefore, it can be used to classify neonatal skin color. Further research is warranted to assess the clinical relevance of these findings. What is known: • Classifying neonates by skin color is difficult because to date there are no skin color scales available based on real skin tone regardless of ethnicity or country of origin. • Skin color differs among individuals from a given ethnic group and depends, among others, on melanin and hemoglobin. What is new: • We created a neonatal skin color scale based on real skin color. • We conducted a study to validate it, and confirmed a good inter-observer agreement in color assignment as well as a good correlation between each color in the scale and the median melanin level.
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Starowicz O, Edwards P, Schmidt P, Birch P. Evaluation of the Kejian KJ-8000 bilirubinometer in an Australian setting. J Paediatr Child Health 2020; 56:283-288. [PMID: 31464033 DOI: 10.1111/jpc.14597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 06/28/2019] [Accepted: 07/20/2019] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the accuracy of the Kejian 8000 (KJ-8000) transcutaneous bilirubinometer in infants of differing ethnicity and gestational age. METHODS This was a prospective study of infants in the Newborn Care Unit at Gold Coast University Hospital. Transcutaneous bilirubin (TcB) and serum bilirubin (SBR) results were compared using linear regression and a Bland-Altman plot. Predicted indices were calculated to assess the KJ-8000 as a screening tool using local jaundice management guidelines. RESULTS A total of 416 paired samples were collected from 201 infants. There was a strong correlation between TcB and SBR with a Pearson correlation coefficient of 0.8 (<0.00001). The bias was -5.9 μmol/L (95% confidence interval: -101, 89). The bias was not evenly spread, with the KJ-8000 tending to underestimate at higher SBR levels. Infants <32 weeks' gestation had a poor correlation of 0.48. Non-Caucasian infants were more likely to have TcB overestimation, and measurements were less precise. As a screening tool using local guidelines, the KJ-8000 had a sensitivity, specificity, positive predictive value and negative predictive value of 83, 53, 20 and 96%, respectively, and is predicted to avoid blood tests in 48% of infants screened. CONCLUSIONS In this study, the correlation and agreement of TcB measurements using the KJ-8000 were not as good as has been reported with other more studied devices but may still have value as a screening tool. The poor correlation in preterm infants suggests that use should be restricted to term infants. The overall results of this study are affected by an underrepresentation of term infants, and so, further clinical assessment of this device should be undertaken before it can be recommended for widespread use.
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Affiliation(s)
- Olivia Starowicz
- Newborn Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Philippa Edwards
- Newborn Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Peter Schmidt
- Newborn Care Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Pita Birch
- Department of Neonatology, Mater Health Services, Brisbane, Queensland, Australia
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Karamavuş Y, Özkan M. Newborn jaundice determination by reflectance spectroscopy using multiple polynomial regression, neural network, and support vector regression. Biomed Signal Process Control 2019. [DOI: 10.1016/j.bspc.2019.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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19
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van der Geest BAM, de Graaf JP, Bertens LCM, Poley MJ, Ista E, Kornelisse RF, Reiss IKM, Steegers EAP, Been JV. Screening and treatment to reduce severe hyperbilirubinaemia in infants in primary care (STARSHIP): a factorial stepped-wedge cluster randomised controlled trial protocol. BMJ Open 2019; 9:e028270. [PMID: 31005942 PMCID: PMC6500291 DOI: 10.1136/bmjopen-2018-028270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Jaundice caused by hyperbilirubinaemia is a physiological phenomenon in the neonatal period. However, severe hyperbilirubinaemia, when left untreated, may cause kernicterus, a severe condition resulting in lifelong neurological disabilities. Although commonly applied, visual inspection is ineffective in identifying severe hyperbilirubinaemia. We aim to investigate whether among babies cared for in primary care: (1) transcutaneous bilirubin (TcB) screening can help reduce severe hyperbilirubinaemia and (2) primary care-based (versus hospital-based) phototherapy can help reduce hospital admissions. METHODS AND ANALYSIS A factorial stepped-wedge cluster randomised controlled trial will be conducted in seven Dutch primary care birth centres (PCBC). Neonates born after 35 weeks of gestation and cared for at a participating PCBC for at least 2 days within the first week of life are eligible, provided they have not received phototherapy before. According to the stepped-wedge design, following a phase of 'usual care' (visual assessment and selective total serum bilirubin (TSB) quantification), either daily TcB measurement or, if indicated, phototherapy in the PCBC will be implemented (phase II). In phase III, both interventions will be evaluated in each PCBC. We aim to include 5500 neonates over 3 years.Primary outcomes are assessed at 14 days of life: (1) the proportion of neonates having experienced severe hyperbilirubinaemia (for the TcB screening intervention), defined as a TSB above the mean of the phototherapy and the exchange transfusion threshold and (2) the proportion of neonates having required hospital admission for hyperbilirubinaemia treatment (for the phototherapy intervention in primary care). ETHICS AND DISSEMINATION This study has been approved by the Medical Research Ethics Committee of the Erasmus MC Rotterdam, the Netherlands (MEC-2017-473). Written parental informed consent will be obtained. Results from this study will be published in peer-reviewed journals and presented at (inter)national meetings. TRIAL REGISTRATION NUMBER NTR7187.
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Affiliation(s)
- Berthe A M van der Geest
- Division of Neonatology, Department of Paediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Johanna P de Graaf
- Department of Obstetrics and Gynaecology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Loes C M Bertens
- Department of Obstetrics and Gynaecology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Marten J Poley
- Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, Netherlands
- Paediatric Intensive Care Unit, Department of Paediatrics, Erasmus MC - Sophia Childen's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Erwin Ista
- Paediatric Intensive Care Unit, Department of Paediatrics, Erasmus MC - Sophia Childen's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Nursing Science, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - René F Kornelisse
- Division of Neonatology, Department of Paediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Paediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Jasper V Been
- Division of Neonatology, Department of Paediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
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Halder A, Banerjee M, Singh S, Adhikari A, Sarkar PK, Bhattacharya AM, Chakrabarti P, Bhattacharyya D, Mallick AK, Pal SK. A Novel Whole Spectrum-Based Non-Invasive Screening Device for Neonatal Hyperbilirubinemia. IEEE J Biomed Health Inform 2019; 23:2347-2353. [PMID: 30640639 DOI: 10.1109/jbhi.2019.2892946] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Careful screening of bilirubin level in newborns is mandatory as per American Academy of Pediatrics (2004), to reduce incidents of kernicterus and acute bilirubin encephalopathy. Although, invasive capillary collection of blood and subsequent biochemical test is considered a gold standard for jaundice detection in neonates, transcutaneous bilirubin measurement using various non-invasive instruments is also used sporadically across the globe. The major aim of this study was to develop a non-invasive spectrometry-based technique for measurement of neonatal bilirubin level as an alternative of total serum bilirubin (TSB) test without limitations of other available bilirubinometers. METHODS The instrument comprises of a light source and a spectroscopic detector. A light beam from source incident on the neonatal nail plate through optical fibers. The retro reflected light is acquired using the detector. An indigenously developed software is used to acquire and analyze the optical signal and to calculate the bilirubin value. The instrument was calibrated and validated in reference to TSB on 1033 subjects. MAJOR RESULTS The result (r = 0.95 and P < 0.001) indicates a strong correlation between the bilirubin value obtained from our method and TSB. Time variant analysis of the subjects undergoing phototherapy provided a good correlation (r = 0.98). The repeatability test result shows the mean coefficient of variation is less than 5.0%. CONCLUSIONS The indigenously developed non-invasive technique successfully detects the bilirubin level in newborns under various physiological conditions with high accuracy and precision.
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21
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Shah MH, Ariff S, Ali SR, Chaudhry RA, Lakhdir MPA, Qaiser F, Demas S, Hussain AS. Quality improvement initiative using transcutaneous bilirubin nomogram to decrease serum bilirubin sampling in low-risk babies. BMJ Paediatr Open 2019; 3:e000403. [PMID: 31206073 PMCID: PMC6542442 DOI: 10.1136/bmjpo-2018-000403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/04/2019] [Accepted: 01/07/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Screening for neonatal hyperbilirubinaemia in the postnatal ward has traditionally been performed using serum bilirubin sampling, but this has significant drawbacks such as risk of infection and slower reporting time. OBJECTIVE We aimed to assess the impact of introducing transcutaneous bilirubin (TcBR) testing using TcBR nomogram on the number of serum bilirubin samples sent. METHODS A before-and-after study was performed following the introduction of a protocol integrating the use of the Dragger JM-105 transcutaneous bilirubinometer in the postnatal ward. Only babies born at ≥37 weeks of gestation, weighing ≥2500 g who presented with jaundice after the first 24 hours and within the first 7 days of life were included in the study. The number of total serum bilirubin samples (TSBRs) sent were compared for the 6-month periods before and after (a total of 12 months) implementation of the new protocol. RESULTS In the pre-implementation phase, a total of 882 (49%) out of 1815 babies had at least one serum bilirubin sample taken as opposed to a total of 236 (17%) out of 1394 babies in the post-implementation phase. The odds of performing TSBRs at least one time among babies in post-implementation phase were 79% lower than in pre-implementation phase (OR 0.21, 95% CI 0.18 to 0.25). We also estimated a significant cost saving of approximately US$1800 over a period of 6 months. CONCLUSION TcBR testing used in conjunction with our proposed nomogram significantly reduces the need for serum bilirubin sampling.
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Affiliation(s)
- Muhammad Hussain Shah
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Shabina Ariff
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | | | - Rayaan Asad Chaudhry
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | | | - Fatima Qaiser
- Department of Pediatrics, Dow University of Health Sciences, Karachi, Pakistan
| | - Simon Demas
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Ali Shabbir Hussain
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
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McClean S, Baerg K, Smith-Fehr J, Szafron M. Cost savings with transcutaneous screening versus total serum bilirubin measurement for newborn jaundice in hospital and community settings: a cost-minimization analysis. CMAJ Open 2018; 6:E285-E291. [PMID: 30054296 PMCID: PMC6182126 DOI: 10.9778/cmajo.20170158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Leading authorities in North America recommend universal screening via total serum bilirubin (TSB) measurement or transcutaneous bilirubinometry (TcB) for kernicterus prevention. We assessed costs associated with these 2 screening methods in hospital and in urban and rural community settings. METHODS Our tertiary care centre in Saskatoon, with about 5600 births per year, serves the local population of 300 000; in addition, 30% of patients are referred from outside the local community and surrounding area. We obtained health administrative data for two 6-month periods: before (June 1 to Nov. 30, 2015 [TSB program]) and after (June 1 to Nov. 30, 2016 [TcB-TSB program]) implementation of universal screening with TcB. Data on nurses' time and mileage were collected to assess the mean time for screening and sample transportation. We performed a cost-minimization analysis. RESULTS The observed requirement for TSB blood draws decreased by 71.4% after implementation of TcB (1383.2/1000 live births to 397.8/1000 live births), whereas the overall number of screens increased from 1383.2 to 2758.6/1000 live births. The mean time per screen decreased from 12.52 (95% confidence interval [CI] 10.44-14.59) minutes with TSB to 2.94 (95% CI 2.55-3.33) minutes with TcB (p < 0.001). The estimated cost per TcB screen in hospital and community (urban and rural) settings was $3.54 and $3.76, respectively, and the estimated cost per TSB screen in hospital and in urban and rural community settings was $15.82, $50.21 and $65.03, respectively. The estimated overall 6-month savings with the TcB-TSB hospital and community programs were $19 760 and $6417, respectively. INTERPRETATION The TcB-TSB program reduced nurses' time to screen and provided immediate results at the point of care. Transcutaneous bilirubinometry reduced the requirement for painful heel pokes while improving access to screening and decreasing the overall program cost.
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Affiliation(s)
- Stephanie McClean
- School of Public Health (McClean, Szafron), University of Saskatchewan; Department of Pediatrics (Baerg), College of Medicine, University of Saskatchewan; Maternal Services (Smith-Fehr), Saskatchewan Health Authority - Saskatoon, Saskatoon, Sask
| | - Krista Baerg
- School of Public Health (McClean, Szafron), University of Saskatchewan; Department of Pediatrics (Baerg), College of Medicine, University of Saskatchewan; Maternal Services (Smith-Fehr), Saskatchewan Health Authority - Saskatoon, Saskatoon, Sask.
| | - Julie Smith-Fehr
- School of Public Health (McClean, Szafron), University of Saskatchewan; Department of Pediatrics (Baerg), College of Medicine, University of Saskatchewan; Maternal Services (Smith-Fehr), Saskatchewan Health Authority - Saskatoon, Saskatoon, Sask
| | - Michael Szafron
- School of Public Health (McClean, Szafron), University of Saskatchewan; Department of Pediatrics (Baerg), College of Medicine, University of Saskatchewan; Maternal Services (Smith-Fehr), Saskatchewan Health Authority - Saskatoon, Saskatoon, Sask
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Abdy NA, Martinez R, Chea I, Boczar B, Nuño T, Woolridge D. A pilot study demonstrating the efficacy of transcutaneous bilirubin meters to quantitatively differentiate contusions from Congenital Dermal Melanocytosis. CHILD ABUSE & NEGLECT 2018; 80:108-112. [PMID: 29587197 DOI: 10.1016/j.chiabu.2018.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/27/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Congenital Dermal Melanocytosis (CDM) can be difficult to differentiate from contusions. The need for a prompt and accurate diagnosis is best illustrated in cases where child abuse and maltreatment is of concern. Transcutaneous bilirubin (TCB) spectrophotometry has been well established to measure bilirubin under the skin for jaundice in infants. The use of TCB spectrometry has not been used to identify or differentiate contusions from CDM. We hypothesized that bilirubin, a degradation product of hemoglobin, would be elevated in contusions but not in CDM thus demonstrating the efficacy of a novel diagnostic technique to compliment or improve on physical assessment alone. METHODS Pilot study with thirty-seven infants and children noted to have CDM and fifty-six infants, children and adults with contusions underwent measurement of their lesion with TCB spectrometry. In each patient, the affected skin was scanned along with the adjacent unaffected native skin allowing an internal control for individual pigment variation. RESULTS TCB measurements of CDM resulted in lower transcutaneous bilirubin values that were not significantly different from adjacent native skin pigmentation. This was in contrast to cutaneous contusions, which resulted in a higher measured value (mean 5.01 mg/dL) compared to adjacent native tissue (1.24 mg/dL) demonstrating a four-fold increase in measurement at the lesion site (P < 0.001). Direct comparison of a ΔTCB value (lesion measurement minus the adjacent tissue) demonstrated a significantly higher value in contusions compared to CDM with a mean value of 3.77 and 0.12 mg/dL, respectively (P < 0.001). CONCLUSIONS TCB Spectrometry as a novel diagnostic technique has the potential to discern contusions from CDM and may therefore have the ability to compliment the use of physical assessment alone.
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Affiliation(s)
- Nicole A Abdy
- Department of Pediatrics, University of Arizona, Tucson, AZ, United States; Banner University Medical Center Tucson, Tucson, AZ, United States
| | | | | | | | - Tomas Nuño
- Emergency Medicine, University of Arizona, Tucson, AZ, United States
| | - Dale Woolridge
- Department of Pediatrics, University of Arizona, Tucson, AZ, United States; Emergency Medicine, University of Arizona, Tucson, AZ, United States; Banner University Medical Center Tucson, Tucson, AZ, United States.
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Kumra T, Weaver SJ, Prather K, Garnepudi L, Bartlett EL, Crocetti M. Correlation of Transcutaneous and Serum Bilirubin Measurements in the Outpatient Setting. Clin Pediatr (Phila) 2018; 57:231-234. [PMID: 28952368 DOI: 10.1177/0009922817693302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tina Kumra
- 1 Johns Hopkins Community Physicians, Baltimore, MD, USA
| | - Sallie J Weaver
- 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Bromiker R, Goldberg A, Kaplan M. Israel transcutaneous bilirubin nomogram predicts significant hyperbilirubinemia. J Perinatol 2017; 37:1315-1318. [PMID: 29192695 DOI: 10.1038/jp.2017.127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/10/2017] [Accepted: 07/05/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We constructed a transcutaneous bilirubin (TcB) nomogram to represent major sectors of the Israeli population. We studied the risk of hyperbilirubinemia, defined as meeting the requirements for phototherapy, per percentile risk category. STUDY DESIGN Newborns ⩾36 weeks gestation were tested daily for TcB, using Drager JM-103 devices, during birth hospitalization. A nomogram was constructed and divided into four risk groups and validated by calculating the need for phototherapy for each group. RESULTS A total of 3303 measurements were performed on 1059 consecutive newborns including Ashkenazi, Sephardic and mixed Ashkenazi/Sephardic Jews, Arab and Ethiopian Jewish. Phototherapy risk increased progressively and more than 100-fold, from 0/225 in the <40th percentile group through 27/120 (22.5%) for those >95th percentile (relative risk (95% confidence interval) 102 (6 to 1669) for those >95th percentile compared with those <40th percentile). The optimal risk for discriminating the need for phototherapy was >75th percentile (sensitivity 93.33, specificity 59.47). CONCLUSION The risk of significant hyperbilirubinemia increased progressively with increasing percentile. Newborns >75th percentile groups are at high risk for phototherapy and should be closely monitored.
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Affiliation(s)
- R Bromiker
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - A Goldberg
- Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - M Kaplan
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
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Majors CE, Smith CA, Natoli ME, Kundrod KA, Richards-Kortum R. Point-of-care diagnostics to improve maternal and neonatal health in low-resource settings. LAB ON A CHIP 2017; 17:3351-3387. [PMID: 28832061 PMCID: PMC5636680 DOI: 10.1039/c7lc00374a] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Each day, approximately 830 women and 7400 newborns die from complications during pregnancy and childbirth. Improving maternal and neonatal health will require bringing rapid diagnosis and treatment to the point of care in low-resource settings. However, to date there are few diagnostic tools available that can be used at the point of care to detect the leading causes of maternal and neonatal mortality in low-resource settings. Here we review both commercially available diagnostics and technologies that are currently in development to detect the leading causes of maternal and neonatal mortality, highlighting key gaps in development where innovative design could increase access to technology and enable rapid diagnosis at the bedside.
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Affiliation(s)
- Catherine E Majors
- Department of Bioengineering, Rice University, 6100 Main Street, MS-142, Houston, TX 77005, USA.
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Jones DF, McRea AR, Knowles JD, Lin FC, Burnette E, Reller LA, Lohr JA. A Prospective Comparison of Transcutaneous and Serum Bilirubin Within Brief Time Intervals. Clin Pediatr (Phila) 2017; 56:1013-1017. [PMID: 28366015 DOI: 10.1177/0009922817701170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The American Academy of Pediatrics recommends screening newborns ≥35 weeks' gestation with total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) to detect hyperbilirubinemia. Retrospective studies show TcB measurements strongly correlate with TSB; however, few prospective trials document this relationship. Furthermore, Dräger's newest TcB instrument, JM-105, remains unstudied in the United States. We measure TcB on foreheads and sternums of newborns using JM-105 and Bilichek devices within 30 minutes of TSB measurement. We find best overall TcB/TSB correlation with JM-105 on the sternum (mean TcB-TSB difference: -0.21 ± 1.15 mg/dL). Correlations between paired measurements for TcB on the sternum using JM-105 were 0.93 for all TSB levels (n = 178), 0.82 for TSB > 10 (n = 19), 0.69 for TSB > 12 (n = 11), and 0.52 for TSB > 15 (n = 6). TcB accuracy via JM-105 on the sternum significantly differed among races ( P < .001). For 5% of paired measurements, TcB with JM-105 on the sternum underestimated TSB by ≥2 mg/dL, and for <1% by ≥3 mg/dL.
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Affiliation(s)
- Denise F Jones
- 1 North Carolina Children's Hospital, Chapel Hill, NC, USA
| | | | | | - Feng-Chang Lin
- 1 North Carolina Children's Hospital, Chapel Hill, NC, USA
| | - Erin Burnette
- 1 North Carolina Children's Hospital, Chapel Hill, NC, USA
| | - Lara A Reller
- 1 North Carolina Children's Hospital, Chapel Hill, NC, USA
| | - Jacob A Lohr
- 1 North Carolina Children's Hospital, Chapel Hill, NC, USA.,2 University of North Carolina at Chapel Hill, NC, USA
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Comparison between Bilistick System and transcutaneous bilirubin in assessing total bilirubin serum concentration in jaundiced newborns. J Perinatol 2017; 37:1028-1031. [PMID: 28617429 DOI: 10.1038/jp.2017.94] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare the performance and accuracy of the JM-103 transcutaneous bilirubinometer and Bilistick System in measuring total serum bilirubin for the early identification of neonatal hyperbilirubinemia. STUDY DESIGN The study was performed on 126 consecutive term and near-term (⩾36 weeks' gestational age) jaundiced newborns in Cairo University Children Hospital NICU, Egypt. Total serum bilirubin was assayed concurrently by the clinical laboratory and Bilistick System and estimated using the JM-103 transcutaneous bilirubin instrument. Bland-Altman analysis was used to evaluate the agreement between determinations. RESULT The limits of agreement of the Bilistick System (-5.8 to 3.3 mg dl-1) and JM-103 system (-5.4 to 6.0 mg dl-1) versus the clinical laboratory results were similar. CONCLUSION The Bilistick System is an accurate alternative to transcutaneous (TcB) determination for early diagnosis and proper management of the neonatal jaundice.
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Hussain AS, Shah MH, Lakhdir M, Ariff S, Demas S, Qaiser F, Ali SR. Effectiveness of transcutaneous bilirubin measurement in managing neonatal jaundice in postnatal ward of a tertiary care hospital in Pakistan. BMJ Paediatr Open 2017; 1:e000065. [PMID: 29637112 PMCID: PMC5862169 DOI: 10.1136/bmjpo-2017-000065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/12/2017] [Accepted: 07/14/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Neonatal jaundice is a common cause of concern in immediate newborn period for parents as well as for the caregivers. Babies with visible jaundice are identified by the healthcare provider, and blood samples are sent for confirmation. Clinical expertise varies from person to person and may lead to sending excessive blood sampling. Obtaining blood bilirubin samples is a painful procedure; it predisposes the baby to infections and requires skilled health personnel. Moreover, laboratory tests are costly and time consuming, leading to unnecessary delays in commencing phototherapy and discharge from hospital. Transcutaneous bilirubinometer has been in use for a long time as screening tool in postnatal wards. With passage of time, its accuracy and validity have improved tremendously. METHODOLOGY We aim to implement a quality improvement initiative to reduce the number of blood bilirubin samples using transcutaneous bilirubin (TcBR) nomogram in full-term, low-risk babies who are born at our hospital and are admitted in postnatal ward after birth. Using preanalysis and postanalysis study design, this study will be performed in two phases of 6 months each. Data regarding total number of admissions in postnatal wards, demographics, serum bilirubin(TSBR) samplings and need for phototherapy will be recorded in both phases. TcBR will be done and recorded in postimplementation phase. ANALYSIS AND RESULTS Comparisons between the two groups will be made. Primary outcome will be reduction in blood bilirubin samples for TSBR after the implementation of TcBr protocol. The proportion of infants having TSBR performed in both periods will be compared. Crude sampling cost of TSBR will be obtained from laboratory, and cost comparison between two phases will be done to look for difference.
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Affiliation(s)
- Ali Shabbir Hussain
- Department of Pediatrics, The Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Muhammad Hussain Shah
- Department of Pediatrics, The Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Maryam Lakhdir
- Department of Community health sciences, he Aga Khan University Hospital, Karachi, Pakistan
| | - Shabina Ariff
- Department of Pediatrics, The Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Simon Demas
- Department of Pediatrics, The Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Fatima Qaiser
- Dow University of health sciences, Karachi, Pakistan
| | - Syed Rehan Ali
- Department of Pediatrics, The Aga Khan University Hospital, Karachi, Sindh, Pakistan
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Letamendia-Richard E, Ammar RB, Tridente A, De Luca D. Relationship between transcutaneous bilirubin and circulating unbound bilirubin in jaundiced neonates. Early Hum Dev 2016; 103:235-239. [PMID: 27838549 DOI: 10.1016/j.earlhumdev.2016.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/11/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Transcutaneous bilirubin (TcB) consists of the skin-deposited bilirubin. Free bilirubin represents the protein-unbound bilirubin (UB) that is able to pass into the tissues. We aimed to describe the relationship UB-TcB and study the passage of UB into the skin. METHODS We prospectively enrolled 194 neonates and we measured TcB, UB, serum bilirubin and albumin. Multiple sites TcB measurement was performed, bilirubin-albumin equilibrium constant and plasma bilirubin avidity (PBA) were calculated. RESULT TcB has a similar correlation with UB and TSB. There is a quadratic relationship between UB and TcB (R2=0.48; p<0.001), remaining significant (β for UB2=-0.8; p<0.001. β for UB=1.1; p<0.001) after adjustment for gestational age, birth weight, postnatal age and albumin (Adj-R2=0.72). UB contributes to the skin bilirubin deposition, as there are significant correlations between albumin and TcB (r=-0.202; p=0.01) and between PBA and ΔTcB (r=0.323; p=0.017). CONCLUSION TcB assay does not seem to directly replace UB measurement. However, TcB and UB are linked by a quadratic relationship: UB contributes to the skin bilirubin deposition but it is not the only bilirubin species measured by transcutaneous bilirubinometry.
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Affiliation(s)
- Emmanuelle Letamendia-Richard
- Division of Pediatrics and Neonatal Critical Care, South Paris University Hospitals, "A.Béclère" Medical Center, APHP, Paris, France
| | - Rafik Ben Ammar
- Division of Pediatrics and Neonatal Critical Care, South Paris University Hospitals, "A.Béclère" Medical Center, APHP, Paris, France
| | - Ascanio Tridente
- Intensive Care Unit, Whiston Hospital, Prescot, Liverpool, UK; Infection and Immunity, University of Sheffield, Sheffield, UK
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, South Paris University Hospitals, "A.Béclère" Medical Center, APHP, Paris, France.
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Olusanya BO, Imosemi DO, Emokpae AA. Differences Between Transcutaneous and Serum Bilirubin Measurements in Black African Neonates. Pediatrics 2016; 138:peds.2016-0907. [PMID: 27577578 DOI: 10.1542/peds.2016-0907] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Transcutaneous bilirubin (TcB) correlates positively with total serum bilirubin (TSB) across different racial populations. However, little is known about the pattern of divergence between TcB and TSB at individual patient-level and the relationship with TcB measuring techniques among African neonates. This study, therefore, investigates TcB-TSB discrepancies and the contribution of 2 models of transcutaneous bilirubinometers to the observed divergence in a black African population. METHODS Medical records were retrieved for late preterm and term infants with 1 to 3 pairs of TcB and TSB measurements between December 2011 to June 2015 in Nigeria. Divergence between TcB and TSB values for each infant was determined and the associated factors explored with generalized estimating equations for logistic regression. Contributions of BiliChek and JM-103 transcutaneous bilirubinometers to the divergence were further explored through linear regression and Bland-Altman analysis. RESULTS Overall, 2107 TcB/TSB measurements from 1553 infants were analyzed. TSB was overestimated by ≥2 mg/dL in 64.5%, ≥3 mg/dL in 42.7%, and ≥4 mg/dL in 25.7% of all measurements. In contrast, TSB was underestimated by ≥2 mg/dL in 1.1%, ≥3 mg/dL in 0.5%, and ≥4 mg/dL in 0.3% of all recordings. Postnatal age, feeding mode, and type of TcB instrument were predictive of TSB overestimation. The JM-103 was associated with greater imprecision than BiliChek at all TSB levels. CONCLUSIONS BiliChek and JM-103 bilirubinometers significantly overestimate TSB in black African neonates and may result in unnecessary or excessive treatments. Additional development of appropriate bilirubin determination devices for this racial group, especially in resource-limited settings, is warranted.
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Alsaedi SA. Transcutaneous bilirubin measurement in healthy Saudi term newborns. Saudi Med J 2016; 37:142-6. [PMID: 26837395 PMCID: PMC4800911 DOI: 10.15537/smj.2016.2.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives: To evaluate the accuracy of transcutaneous bilirubin (TcB) measurement in healthy, jaundiced Saudi term newborns. Methods: This prospective, cohort study was carried out from January 2009 to December 2012 on jaundiced, term infants admitted at the King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Paired TcB and total serum bilirubin (TSB) from healthy jaundiced term newborns were obtained. The correlation and the mean difference between the 2 methods were calculated, and Bhutani nomogram for prediction of TSB by TcB was used. Any bilirubin level at low and above the intermediate risk zone was considered significant. Results: We obtained 665 paired TcB and TSB measurements from 665 newborns. The mean age at bilirubin measurement was 44.2 ± 21 hour. Mean TSB was 147 ± 45 µmol/L, and TcB was 156 ± 50 µmol/L. Linear regression analysis showed a significant correlation between TcB and TSB (r: 0.84; 95% confidence interval [CI] = 0.82-0.86; p<0.001). The TcB tends to overestimate TSB. The mean difference between paired TcB and TSB was 17 µmol /L with a 95% CI of 40 ± 77 µmol/L. The TcB was sensitive, but less specific. The TcB sensitivity was 83% and specificity was 71% to predict TSB during the first 72 hours of life for the whole study group. The positive predictive value was 63%, and negative predictive value was 87%. Conclusion: As found in this study, among the jaundiced healthy term Saudi newborns, TcB measurement provided accurate estimates of TSB values. The TcB measurements can be used effectively to screen newborns for significant jaundice.
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Affiliation(s)
- Saad A Alsaedi
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Pratesi S, Boni L, Tofani L, Berti E, Sollai S, Dani C. Comparison of the transcutaneous bilirubinometers BiliCare and Minolta JM-103 in late preterm and term neonates. J Matern Fetal Neonatal Med 2015; 29:3014-8. [DOI: 10.3109/14767058.2015.1113521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Simone Pratesi
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy,
| | - Luca Boni
- Clinical Trials Coordinating Center, Istituto Toscano Tumori, Florence, Italy,
- Department of Human Pathology and Oncology, University of Florence, Florence, Italy, and
| | - Lorenzo Tofani
- Clinical Trials Coordinating Center, Istituto Toscano Tumori, Florence, Italy,
- Department of Human Pathology and Oncology, University of Florence, Florence, Italy, and
| | - Elettra Berti
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy,
| | - Sara Sollai
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy,
| | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Children’s Health, University of Florence, Florence, Italy
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Srinivas GL, Cuff CD, Ebeling MD, Mcelligott JT. Transcutaneous bilirubinometry is a reliably conservative method of assessing neonatal jaundice. J Matern Fetal Neonatal Med 2015; 29:2635-9. [PMID: 26483074 DOI: 10.3109/14767058.2015.1095881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In order to reduce invasive testing in newborns prior to discharge, we tested the direction of the correlation between transcutaneous bilirubin (TcB) and total serum bilirubin (TSB), the likelihood of missing high TSBs with a raised threshold for confirmatory testing, and also calculated potential cost savings from fewer laboratory testing. METHODS We performed a cross-sectional analysis of single paired TcB and TSB results measured at 36 ± 2 h of life in neonates ≥37 weeks admitted only to the Level 1 nursery. TcB was measured using the BiliChek® meter. RESULTS Of the 552 infants, 512 (92.8%) had TSB levels below TcB values. Correlation between TcB and TSB was 0.69. If TSB confirmation was to be performed at 11.7 mg/dL (medium risk threshold for phototherapy), the negative predictive value was 99.4%, with a potential cost savings of $6555.00 ($1500.00 per 100 patients). Of the 495 infants with TcB <11.7 mg/dL, only 3 had TSB levels higher than 11.7 mg/dL, and none met phototherapy threshold for low risk infants. CONCLUSIONS TcB screening at our institution has a high negative predictive value, and can be used as a stand-alone test until values are close to phototherapy threshold, thus reducing invasive testing and cost.
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Affiliation(s)
- Ganga L Srinivas
- a Department of Pediatrics , Medical University of South Carolina , Charleston , SC , USA
| | | | - Myla D Ebeling
- a Department of Pediatrics , Medical University of South Carolina , Charleston , SC , USA
| | - James T Mcelligott
- a Department of Pediatrics , Medical University of South Carolina , Charleston , SC , USA
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Neocleous C, Adramerina A, Limnaios S, Symeonidis S, Spanou C, Malakozi M, Mpampalis E. A Comparison between Transcutaneous and Total Serum Bilirubin in Healthy-term Greek Neonates with Clinical Jaundice. Prague Med Rep 2014; 115:33-42. [DOI: 10.14712/23362936.2014.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The accuracy of transcutaneous bilirubin meters has been assessed in newborns from various ethnic backgrounds. However, there are limited data on Greek newborns. Our study examined the accuracy of transcutaneous bilirubin measurements in clinically jaundiced healthy-term Greek newborns, using total serum bilirubin as the reference standard, in order to re-evaluate our local guidelines about neonatal jaundice. Clinically jaundiced newborns requiring total serum bilirubin level estimation were recruited prospectively. 368 pairs of total serum bilirubin/transcutaneous bilirubin measurements were taken in 222 newborns, using a direct spectrophotometric device and the BiliCheck device, respectively. The level of agreement between the obtained transcutaneous bilirubin and total serum bilirubin values was assessed. Our data were analysed using the Stata/SE 12.0 (StataCorp LP, USA) statistical programme. The mean (± SD) TSB was 225.4 ± 25.4 μmol/l and the mean (± SD) TcB was 237.9 ± 21.0 μmol/l. The correlation between the values was poor (Pearson’s correlation coefficient 0.439; Lin’s concordance coefficient 0.377 [95% CI 0.301 to 0.453]; P<0.001). The Bland-Altman analysis demonstrated that transcutaneous bilirubin measurements tended to overestimate the total serum bilirubin value (mean difference 12.5 ± 24.9 μmol/l), with wide 95% limits of agreement (–36.2 μmol/l to 61.3 μmol/l). Transcutaneous bilirubin values did not correlate well with total serum bilirubin values, being often imprecise in predicting the actual total serum bilirubin levels. This permits us to continue estimating total serum bilirubin in clinically jaundiced newborns according to our local guidelines, in order to safely decide the appropriate care plan.
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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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da Conceição CM, Dornaus MFPDS, Portella MA, Deutsch AD, Rebello CM. Influence of assessment site in measuring transcutaneous bilirubin. EINSTEIN-SAO PAULO 2014; 12:11-5. [PMID: 24728239 PMCID: PMC4898232 DOI: 10.1590/s1679-45082014ao2711] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 12/02/2013] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To investigate the influence of the site of measurement of transcutaneous bilirubin (forehead or sternum) in reproducibility of results as compared to plasma bilirubin. METHODS A cohort study including 58 term newborns with no hemolytic disease. Transcutaneous measurements were performed on the forehead (halfway between the headline and the glabella, from the left toward the right side, making consecutive determinations, one-centimeter apart) and the sternum (five measurements, from the suprasternal notch to the xiphoid process with consecutive determinations, one-centimeter apart) using Bilicheck® (SpectRx Inc, Norcross, Georgia, USA). The correlation and agreement between both methods and plasma bilirubin were calculated. RESULTS There was a strong linear correlation between both determinations of serum bilirubin at the forehead and sternum (r=0.704; p<0.01 and r=0.653; p<0.01, respectively). There was correspondence of the mean values of transcutaneous bilirubin measured on the sternum (9.9 ± 2.2mg/dL) compared to plasma levels (10.2 ± 1.7 mg/dL), but both differ from the values measured on the forehead (8.6 ± 2 .0mg/dL), p<0.05. CONCLUSION In newborn term infants with no hemolytic disease, measuring of transcutaneous bilirubin on the sternum had higher accuracy as compared to serum bilirubin measurement on the forehead.
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Akahira-Azuma M, Yonemoto N, Ganzorig B, Mori R, Hosokawa S, Matsushita T, Bavuusuren B, Shonkhuuz E. Validation of a transcutaneous bilirubin meter in Mongolian neonates: comparison with total serum bilirubin. BMC Pediatr 2013; 13:151. [PMID: 24074043 PMCID: PMC3850747 DOI: 10.1186/1471-2431-13-151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/25/2013] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Moe Akahira-Azuma
- Department of Pediatrics, National Center for Global Health and Medicine, Tokyo, Japan.
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Romagnoli C, Catenazzi P, Barone G, Giordano L, Riccardi R, Zuppa AA, Zecca E. BiliCheck vs JM-103 in identifying neonates not at risk of hyperbilirubinaemia. Ital J Pediatr 2013; 39:46. [PMID: 23880298 PMCID: PMC3734036 DOI: 10.1186/1824-7288-39-46] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 07/16/2013] [Indexed: 11/25/2022] Open
Abstract
Background Transcutaneous bilirubinometry is widely used to predict hyperbilirubinemia by using several devices. The aim of this study was to compare the predictive ability of BiliCheck vs JM-103 in identifying neonates not at risk of significant hyperbilirubinemia, putting the data obtained with the two instruments on our transcutaneous bilirubin nomogram built with the BiliCheck. Methods Transcutaneous bilirubin (TcB) measurement was performed when jaundice appeared in newborn babies and/or just before discharge from the hospital. It was performed at the forehead with the two instruments within 5 minutes by two experienced neonatologists, each one blind to the value obtained by the other. Blood samples were drawn to obtain total serum bilirubin (TSB) levels soon after TcB measurements. Results A total of 627 paired-sample measurements were obtained from 298 newborn babies. Out of the total population studied, 16 newborn babies (5.4%) showed significant hyperbilirubinemia defined as TSB value >17 mg/dL, or as need for phototherapy treatment according to the AAP guidelines. TcB measurements showed false negative results in the first 60 hours of life using both devices. After the 60th hour of life, TcB measurements using both devices successfully predicted newborn babies not at risk of significant hyperbilirubinemia, being the JM-103 more reliable than BC because of fewer false positive results. Conclusions Our study shows that both BC and JM-103 can exclude subsequent significant hyperbilirubinemia when the measurements are performed after the 60th hour of life. Nevertheless, the transcutaneous pre-discharge screening should be considered only as the first step, and it has to be followed by a follow-up through the first days after discharge.
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Mussavi M, Niknafs P, Bijari B. Determining the correlation and accuracy of three methods of measuring neonatal bilirubin concentration. IRANIAN JOURNAL OF PEDIATRICS 2013; 23:333-9. [PMID: 23795258 PMCID: PMC3684480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 03/16/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There are different methods for measuring bilirubin concentration; however, it is quite important for practitioners to know which method should be used in certain clinical situations. The present prospective study aimed to compare three different methods for measuring neonatal bilirubin concentrations. METHODS All full term neonates who were either brought into emergency departments or admitted to the neonatal wards in Kerman city in 2011 were recruited (n = 428). The correlation coefficients were estimated for the routine ways of bilirubin concentrations including "Capillary", "Cutaneous" and "Laboratory" methods. FINDINGS Of 428 recruited neonates, 178 were female. Mean age ±SD was 178±71 hours. The correlation coefficient for "David Icterometer" vs "JM103" was 0.91, while the corresponding coefficient for "David Icterometer" vs "Capillary" was 0.96. It was also equivalent to 0.85 for correlation between "JM103" and "Capillary" methods. The David Icterometer measured an average of 2.36 mg/dl levels of bilirubin concentration compared to the JM103 method. The Capillary method showed a lower bilirubin level than the venous concentration (0.91 mg/dl on average). Compared with the "Capillary", the "JM103" measured a slightly higher level of bilirubin with an average 0.57 mg/dl. CONCLUSION Due to low difference (less than 1 mg/dl) between "JM103" and the "Capillary methods" for measurement of neonatal bilirubin concentration, these two methods could alternatively be used instead of usual laboratory method.
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Affiliation(s)
- Mirhadi Mussavi
- Department of Pediatrics, Ilam University of Medical Sciences, Ilam, Iran
| | - Pedram Niknafs
- Department of Pediatrics, Kerman University of Medical Sciences, Kerman, Iran,Corresponding Author:Address: Pediatrics Department, Kerman University of Medical Sciences, Kerman, Iran. E-mail:
| | - Bahareh Bijari
- Department of Pediatrics, Kerman University of Medical Sciences, Kerman, Iran
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Coda Zabetta CD, Iskander IF, Greco C, Bellarosa C, Demarini S, Tiribelli C, Wennberg RP. Bilistick: a low-cost point-of-care system to measure total plasma bilirubin. Neonatology 2013; 103:177-81. [PMID: 23295342 DOI: 10.1159/000345425] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 10/25/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Severe neonatal hyperbilirubinemia, with consequent encephalopathy, remains a common cause of morbidity and death in many regions of the world. Poor access to clinical laboratory resources and screening programs to measure plasma bilirubin levels is a major contributor to delayed treatment in developing countries, and the cost of existing point-of-care screening instruments precludes their dissemination. OBJECTIVES We are evaluating the accuracy of a low-cost, minimally invasive point-of-care system (Bilistick) requiring a 25-µl blood sample that could be used in low-resource environments to evaluate patients with neonatal jaundice. METHODS We compared plasma bilirubin levels in divided blood samples by clinical laboratories and by Bilistick at two medical centers serving term and near-term newborns from ethnically different populations. RESULTS 118 neonates with bilirubin levels ranging from 24.8 to 501.0 µmol/l were analyzed. The mean bilirubin concentration (±SD) was 215.6 ± 85.5 µmol/l for Bilistick and 226.1 ± 86.4 µmol/l by laboratory determination. Pearson's correlation coefficient between all paired results was 0.961, and the Bland-Altman analysis showed a mean difference of 10.3 µmol/l with a 95% interval of agreement of -38.0 to 58.7 µmol/l. CONCLUSION Bilistick is a minimally invasive method for measuring total bilirubin concentration over a wide range of values and should provide an affordable and accurate system for pre-discharge and follow-up screening of jaundiced infants, particularly in low-resource environments.
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Affiliation(s)
- C D Coda Zabetta
- Liver Research Centre, Italian Liver Foundation, Trieste, Italy.
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