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Yuan Y, Huang J, Yu J, Tan JKS, Chng KZ, Lee J, Kim S. Application of machine learning algorithms for accurate determination of bilirubin level on in vitro engineered tissue phantom images. Sci Rep 2024; 14:5952. [PMID: 38467676 PMCID: PMC10928098 DOI: 10.1038/s41598-024-56319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/05/2024] [Indexed: 03/13/2024] Open
Abstract
Neonatal Jaundice is a common occurrence in neonates. High excess bilirubin would lead to hyperbilirubinemia, leading to irreversible adverse damage such as kernicterus. Therefore, it is necessary and important to monitor neonates' bilirubin levels in real-time for immediate intervention. However, current screening protocols have their inherent limitations, necessitating more convenient measurements. In this proof-of-concept study, we evaluated the feasibility of using machine learning for the screening of hyperbilirubinemia in neonates from smartphone-acquired photographs. Different machine learning models were compared and evaluated to gain a better understanding of feature selection and model performance in bilirubin determination. An in vitro study was conducted with a bilirubin-containing tissue phantom to identify potential biological and environmental confounding factors. The findings of this study present a systematic characterization of the confounding effect of various factors through separate parametric tests. These tests uncover potential techniques in image pre-processing, highlighting important biological features (light scattering property and skin thickness) and external features (ISO, lighting conditions and white balance), which together contribute to robust model approaches for accurately determining bilirubin concentrations. By obtaining an accuracy of 0.848 in classification and 0.812 in regression, these findings indicate strong potential in aiding in the design of clinical studies using patient-derived images.
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Affiliation(s)
- Yijia Yuan
- Advanced Innovation in Micro/Nanoengineering (AIM) Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore, 119276, Singapore
- N.1 Institute for Health, National University of Singapore, Singapore, 119276, Singapore
| | - Jiayao Huang
- Advanced Innovation in Micro/Nanoengineering (AIM) Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore, 119276, Singapore
| | - Jiachen Yu
- Advanced Innovation in Micro/Nanoengineering (AIM) Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore, 119276, Singapore
- College of Biomedical Engineering and Instrument, Zhejiang University, Hangzhou, 310027, China
| | - Justin Kok Soon Tan
- Advanced Innovation in Micro/Nanoengineering (AIM) Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore, 119276, Singapore
- N.1 Institute for Health, National University of Singapore, Singapore, 119276, Singapore
| | | | - Jiun Lee
- Department of Neonatology, National University Health System, Singapore, 119228, Singapore
- Department of Paediatrics, National University of Singapore, Singapore, 119228, Singapore
| | - Sangho Kim
- Advanced Innovation in Micro/Nanoengineering (AIM) Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore, 119276, Singapore.
- N.1 Institute for Health, National University of Singapore, Singapore, 119276, Singapore.
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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: 3] [Impact Index Per Article: 3.0] [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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Okwundu CI, Uthman OA, Suresh G, Smith J, Wiysonge CS, Bhutani VK. Transcutaneous bilirubinometry versus total serum bilirubin measurement for newborns. Hippokratia 2017. [DOI: 10.1002/14651858.cd012660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Charles I Okwundu
- Stellenbosch University; Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences; Francie van Zijl Drive Tygerberg Cape Town South Africa 7505
| | - Olalekan A Uthman
- Division of Health Sciences, Warwick Medical School, The University of Warwick; Warwick Centre for Applied Health Research and Delivery (WCAHRD); Coventry UK CV4 7AL
| | - Gautham Suresh
- Baylor College of Medicine; Section of Neonatology, Department of Pediatrics; Houston Texas USA
| | - Johan Smith
- Stellenbosch University, Faculty of Health Sciences; Department of Paediatrics and Child Health; Stellenbosch South Africa
| | - Charles S Wiysonge
- South African Medical Research Council; Cochrane South Africa; Francie van Zijl Drive, Parow Valley Cape Town Western Cape South Africa 7505
| | - Vinod K Bhutani
- Stanford School of Medicine, Lucile Packard Children’s Hospital; Division of Neonatal and Developmental Medicine, Department of Pediatrics; Palo Alto California USA
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Nagar G, Vandermeer B, Campbell S, Kumar M. Reliability of transcutaneous bilirubin devices in preterm infants: a systematic review. Pediatrics 2013; 132:871-81. [PMID: 24127472 DOI: 10.1542/peds.2013-1713] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Transcutaneous bilirubin (TcB) devices are widely used for the estimation of serum bilirubin levels in term and near-term infants. Our objective was to review the diagnostic accuracy of TcB devices in preterm infants. METHODS Medline, Embase, Cochrane library, Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched (from database inception date until December 2012). Additional citations were identified by using the bibliographies of selected articles and from conference proceedings. The studies were included if they compared TcB with total serum bilirubin in preterm infants before phototherapy and presented data as correlation coefficients or as Bland-Altman difference plots. Data were extracted by 1 reviewer and checked for accuracy by the second reviewer. An assessment tool (quality assessment of diagnostic accuracy studies) was used for risk of bias assessments. RESULTS Twenty-two studies met the inclusion criteria; 21 studies reported results as correlation coefficients, with pooled estimates of r = 0.83 for each site of measurement. Pooled estimates in infants <32 weeks' gestation were similar to the overall preterm population (r = 0.89 [95% confidence interval: 0.82-0.93]). For the 2 commonly used TcB devices (ie, JM103 and BiliCheck), the results were comparable at the forehead site, although the JM103 device exhibited better correlation at the sternum. Analysis of the Bland-Altman plots (13 studies) revealed negligible bias in measurement at the forehead or sternum site by using either the JM-103 or BiliCheck device; however, the JM-103 device exhibited better precision than the BiliCheck (SD for TcB - total serum bilirubin differences: 24.3 and 31.98 µmol/L, respectively). CONCLUSIONS The TcB devices reliably estimated bilirubin levels in preterm infants and could be used in clinical practice to reduce blood sampling.
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Affiliation(s)
- Gaurav Nagar
- MSc (Clinical Epidemiology), Department of Pediatrics, Edmonton Clinical Health Academy, Room 3-528, 11405 87 Ave NW, Edmonton, AB, Canada T6G 1C9.
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Pecoraro V, Germagnoli L, Banfi G. Point-of-care testing: where is the evidence? A systematic survey. ACTA ACUST UNITED AC 2013; 52:313-24. [PMID: 24038608 DOI: 10.1515/cclm-2013-0386] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 07/26/2013] [Indexed: 11/15/2022]
Abstract
Abstract
Point-of-care testing (POCT) has had rapid technological development and their use is widespread in clinical laboratories to assure reduction of turn-around-time and rapid patient management in some clinical settings where it is important to make quick decisions. Until now the papers published about the POCT have focused on the reliability of the technology used and their analytical accuracy. We aim to perform a systematic survey of the evidence of POCT efficacy focused on clinical outcomes, selecting POCT denoted special analytes characterized by possible high clinical impact. We searched in Medline and Embase. Two independent reviewers assessed the eligibility, extracted study details and assessed the methodological quality of studies. We analyzed 84 studies for five POCT instruments: neonatal bilirubin, procalcitonin, intra-operative parathyroid hormone, troponin and blood gas analysis. Studies were at high risk of bias. Most of the papers (50%) were studies of correlation between the results obtained by using POCT instruments and those obtained by using laboratory instruments. These data showed a satisfactory correlation between methods when similar analytical reactions were used. Only 13% of the studies evaluated the impact of POCT on clinical practice. POCT decreases the time elapsed for making decisions on patient management but the clinical outcomes have never been adequately evaluated. Our work shows that, although POCT has the potential to provide beneficial patient outcome, further studies may be required, especially for defining its real utility on clinical decision making.
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Affiliation(s)
- Valentina Pecoraro
- Clinical Epidemiologic Unit, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | | | - Giuseppe Banfi
- Clinical Epidemiologic Unit, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
- Department of Biomedical Science for Health, University of Milan, Milan, Italy
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Abstract
OBJECTIVE The use of transcutaneous bilirubin (TcB) measurements has been studied extensively in the newborn population, but there have been few studies in outpatient populations and none from the offices of practicing pediatricians. STUDY DESIGN We performed TcB measurements on a mixed-race population of 120 jaundiced infants, ≥ 35 weeks of gestation, in two hospital-based outpatient clinics, a regional public health nurse follow-up program and two pediatric office practices. Three individual TcB readings were obtained from the mid-sternum, and the average and maximum values were recorded. RESULT There was good correlation between the TcB and total serum bilirubin (TSB) measurements (r=0.78, P=0.0). 59% of TSB's were ≥15 mg dl(-1) and, although the number of false-negative readings increased when the TSB values exceeded 15 mg dl(-1), it was nevertheless possible to use TcB measurements to accurately predict the risk of TSB levels ≥ 15 mg dl(-1). CONCLUSION In outpatient settings, a TcB measurement with the JM-103 provides a reliable screening method for the identification of hyperbilirubinemia even when the TSB level exceeds 15 mg dl(-1). Using the maximum of three independent measurements reduces the number of false negatives, but increases the number of false positives. The use of TcB measurements in an outpatient practice should be a valuable tool for the practitioner.
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Qualter YM, Allen NM, Corcoran JD, O'Donovan DJ. Transcutaneous bilirubin – comparing the accuracy of BiliChek®and JM 103®in a regional postnatal unit. J Matern Fetal Neonatal Med 2010; 24:267-70. [DOI: 10.3109/14767058.2010.484471] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Holland L, Blick K. Implementing and validating transcutaneous bilirubinometry for neonates. Am J Clin Pathol 2009; 132:555-61. [PMID: 19762533 DOI: 10.1309/ajcpn9bmfw8cotwp] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Noninvasive, transcutaneous bilirubin (TcB) measurement is an attractive option for neonates, but opinions about its usefulness vary among studies. We collected paired measurements of TcB and serum bilirubin (SB) in 343 term neonates using the BiliCheck meter (SpectRx, Norcross, GA) and 3 different SB methods. Correlations between SB and TcB were similar for all laboratory methods and TcB measurement sites. However, TcB bias varied depending on the comparison SB method and TcB measurement site. TcB bias also varied with race when measurements were done on the forehead but not when they were done on the sternum. Several factors must be considered before implementing TcB measurement: (1) Each laboratory instrument has its own unique relationship to TcB. (2) The chosen measurement site affects the relationship. (3) Race can affect TcB bias when the measurement is taken on the forehead. Properly used, TcB measurement, especially when taken from the sternum, can be a useful screening method for neonatal jaundice.
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Affiliation(s)
- Lorne Holland
- Department of Pathology, University of Colorado, Aurora
| | - Kenneth Blick
- University of Oklahoma Health Science Center, Oklahoma City
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Schmidt ET, Wheeler CA, Jackson GL, Engle WD. Evaluation of transcutaneous bilirubinometry in preterm neonates. J Perinatol 2009; 29:564-9. [PMID: 19322191 DOI: 10.1038/jp.2009.38] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the accuracy and precision of transcutaneous bilirubin (TcB) measurements in preterm neonates. STUDY DESIGN Neonates were stratified into three groups on the basis of gestational age: 24 to 28 weeks (Group 1, n=30), 29 to 31 weeks (Group 2, n=29) and 32 to 34 weeks (Group 3, n=31). TcB was measured using the Draeger Air Shields JM-103, and when possible, measurements were made by two observers. TcB and total serum bilirubin (TSB) measurements were compared, and interobserver precision for TcB measurements was assessed. RESULT Correlations between TcB and TSB ranged from 0.79 to 0.92. Most of the differences between TcB and TSB were +/-2 mg per 100 ml, and there was no trend for the difference to increase with increasing bilirubin values. Sensitivity, specificity and negative predictive values ranged from 0.67 to 1.0, 0.29 to 0.81 and 0.60 to 1.0, respectively. Intraclass correlations were 0.87 to 0.92. CONCLUSION TcB correlates significantly with TSB in preterm neonates, and interobserver precision is significant. Routine measurement of TcB in preterm neonates may provide enhanced clinical monitoring for hyperbilirubinemia.
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Affiliation(s)
- E T Schmidt
- Neonatal Intensive Care Unit, Parkland Health and Hospital System, Dallas, TX, USA
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El-Beshbishi SN, Shattuck KE, Mohammad AA, Petersen JR. Hyperbilirubinemia and Transcutaneous Bilirubinometry. Clin Chem 2009; 55:1280-7. [DOI: 10.1373/clinchem.2008.121889] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground: Neonatal jaundice or hyperbilirubinemia is a common occurrence in newborns. Although most cases of neonatal jaundice have a benign course, severe hyperbilirubinemia can lead to kernicterus, which is preventable if the hyperbilirubinemia is identified early and treated appropriately.Content: This review discusses neonatal jaundice and the use of transcutaneous bilirubin (TcB) measurements for identification of neonates at risk of severe hyperbilirubinemia. Such a practice requires appropriate serial testing and result interpretation according to risk level from a nomogram that provides bilirubin concentrations specific for the age of the neonate in hours. In this context, we have evaluated the potential impact on clinical outcome and limitations of TcB methods in current use.Summary: TcB measurement is a viable option in screening neonates to determine if they are at risk for clinically significant hyperbilirubinemia. Total serum bilirubin should be measured by a clinical laboratory if a newborn is shown to be at higher risk for clinically significant hyperbilirubinemia. In addition, external quality assessment to identify biases and operator training issues should be part of any TcB monitoring program.
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Affiliation(s)
| | | | - Amin A Mohammad
- Department of Pathology, University of Texas Medical Branch, Galveston, TX
| | - John R Petersen
- Department of Pathology, University of Texas Medical Branch, Galveston, TX
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Carceller-Blanchard A, Cousineau J, Delvin EE. Point of care testing: transcutaneous bilirubinometry in neonates. Clin Biochem 2008; 42:143-9. [PMID: 18929553 DOI: 10.1016/j.clinbiochem.2008.09.106] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 09/19/2008] [Accepted: 09/19/2008] [Indexed: 10/21/2022]
Abstract
Physicians taking care of infants in the first days of life are often faced with neonatal jaundice, especially in an era where post-partum discharge occurs earlier and assessment of newborn bilirubinemia status is required prior to discharge. The Canadian Pediatric Society and the American Academy of Pediatrics have developed and published guidelines for the diagnosis and management of hyperbilirubinemia in newborns. Point of care testing refers to any test performed outside of laboratory by clinical personnel and close to the site of patient care. Based on a summary of multiple reports during the last twenty years, we realize that devices which provide a non-invasive transcutaneous bilirubin (TcB) measurement have proven to be very useful as screening tools and provide a valid estimate of the total serum bilirubin level (TSB). Published data suggest that these devices provide measurements within 30-50 micromol/L of the TSB levels and can replace laboratory measurement particularly when TSB levels are less than 260 micromol/L. At the present time, in the literature, evidence is insufficient to abandon neonatal serum bilirubin testing and replace it with TcB. Any measurement, TSB or TcB, has potential for error. However, we have evidence that TcB, can help avoiding potential errors associated with even visual assessment of jaundice and may be useful as screening device to detect significant jaundice and decrease a large number of unnecessary skin punctures. The current manuscript is based on a careful comprehensive literature review concerning neonatal hyperbilirubinemia. We consider that this manuscript will help clinicians and laboratory professionals in the management of neonatal jaundice.
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Affiliation(s)
- A Carceller-Blanchard
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.
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Mercanti I, Michel F, Thomachot L, Loundou DA, Nicaise C, Vialet R, Di Marco JN, Lagier P, Martin C. [Transcutaneous bilirubin measurement in preterm infants]. Arch Pediatr 2007; 14:875-80. [PMID: 17451916 DOI: 10.1016/j.arcped.2007.02.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Accepted: 02/15/2007] [Indexed: 11/28/2022]
Abstract
UNLABELLED Transcutaneous bilirubinometry is an effective screening tool for neonatal jaundice in full-term babies. But its accuracy is not shown yet in preterm infants. METHODOLOGY We carried out a prospective study in a neonatal intensive care unit. The study included 47 preterm infants. From birth, a transcutaneous bilirubin measurement (BTc) using the BiliCheck was made on the forehead of each newborn every 8 h. Blood sampling for determination of total serum bilirubin (BS) was combined with BTc: 1) if value of BTc was higher than limits values for phototherapy; 2) on the second day of life and 3) 4 hours after cessation of phototherapy. RESULTS Mean gestational age was 30 week and mean birth weight was 1419 g. We studied 151 pairs of BTc and BS. Mean values obtained by BTc and BS were respectively 160.6+/-50 mumol/L and 190.6+/-61.4 mumol/L. A significant correlation between BTc and BS was found. But the limits of agreement were very wide. The negative predictive value (NPV) of BTc was above 90% in each group of gestational age. DISCUSSION The need for phototherapy cannot be determined by BTc in preterm infants. But the BTc is reliable when its value is under the limits for phototherapy. CONCLUSION With a very high incidence of neonatal jaundice (87%) in our cohort, a value of BTc under the limits for phototherapy has a good NPV in preterm infants.
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Affiliation(s)
- I Mercanti
- Unité de réanimation pédiatrique, néonatale et centre de brûlés, DAR Nord, CHU de Nord, chemin des bourrelly, 13915 Marseille cedex 20, France
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Engle WD, Jackson GL, Stehel EK, Sendelbach DM, Manning MD. Evaluation of a transcutaneous jaundice meter following hospital discharge in term and near-term neonates. J Perinatol 2005; 25:486-90. [PMID: 15908989 DOI: 10.1038/sj.jp.7211333] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate performance of the Minolta JM-103 Jaundice Meter (JM) as a predictor of total serum bilirubin (TSB) in outpatient neonates during the first week postnatal, and to estimate the number of TSB determinations that might be avoided in clinical use. STUDY DESIGN In neonates evaluated posthospital discharge, JM and TSB results were compared using linear regression and a Bland-Altman plot, and predictive indices were calculated for various JM cutoff values. Utilizing the 2004 American Academy of Pediatrics (AAP) guidelines, the ability of JM to predict risk zone status was determined. RESULTS Overall correlation between JM and TSB was 0.77 (p<0.001; n=121). When TSB was >17 mg/dl, a cutoff value for JM of 13 mg/dl had a sensitivity of 1.0, and 50% of TSB determinations would be avoided. CONCLUSIONS JM may facilitate outpatient management of hyperbilirubinemia by reducing the number of TSB determinations required; however, it does not provide a reliable substitute for laboratory measurement of TSB.
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Affiliation(s)
- William D Engle
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas 75390-9063, USA
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Petersen JR, Okorodudu AO, Mohammad AA, Fernando A, Shattuck KE. Association of transcutaneous bilirubin testing in hospital with decreased readmission rate for hyperbilirubinemia. Clin Chem 2005; 51:540-4. [PMID: 15738516 DOI: 10.1373/clinchem.2004.037804] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Newborns are being discharged from hospitals within 1-2 days of birth, before hyperbilirubinemia usually becomes clinically evident. We investigated the use of transcutaneous bilirubin (TcB) before discharge to determine whether it affects the use of laboratory bilirubin testing or decreases the number of neonates readmitted for hyperbilirubinemia within 7 days of initial discharge. METHODS We retrospectively searched a clinical laboratory and hospital database to determine the number of births, newborn readmission rates for hyperbilirubinemia, length of stay, and the number of bilirubin measurements in the clinical laboratory ordered for all babies in the newborn unit at the University of Texas Medical Branch from August 2002 to March 2003 (before TcB testing) and from May 2003 to December 2003 (after TcB). RESULTS Between August 2002 and December 2003, 8974 newborns (both vaginal and cesarean births) were admitted to the newborn nursery. Babies who did not fit the diagnosis-related group criteria of "normal newborn" were removed, leaving 6933 babies who were included in the study. April was considered a transition month and was not included in the study, leaving 6603 newborns to be included. Of these, 446 (6.8%) required phototherapy for treatment of hyperbilirubinemia before initial discharge. For the 8 months before and 8 months after initiation of TcB testing, the number of laboratory bilirubin measurements ordered per newborn did not change, nor did the mean (SD) length of stay for normal newborns [2.15 (1.1) days vs 2.12 (1.1) days; P = 0.53], nor days of treatment with phototherapy before discharge [2.9 (1.3) days vs 2.9 (1.3) days; P = 0.67]. By contrast, the number of readmissions per 1000 newborns per month for clinically significant hyperbilirubinemia decreased significantly (Wilcoxon rank-sums two-sample test, P = 0.044), from 4.5 (2.4) to 1.8 (1.7) after TcB testing was initiated. CONCLUSION Access to TcB testing is associated with a reduction in the hospital readmission rate for hyperbilirubinemia within 7 days of the initial discharge.
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Affiliation(s)
- John R Petersen
- Departments of Pathology, University of Texas Medical Branch, Galveston, TX 77555-0551, USA.
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