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Hulzebos CV, Camara JE, van Berkel M, Delatour V, Lo SF, Mailloux A, Schmidt MC, Thomas M, Mackay LG, Greaves RF. Bilirubin measurements in neonates: uniform neonatal treatment can only be achieved by improved standardization. Clin Chem Lab Med 2024; 0:cclm-2024-0620. [PMID: 39066506 DOI: 10.1515/cclm-2024-0620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024]
Abstract
Measurement of total bilirubin (TBil) concentration in serum is the gold standard approach for diagnosing neonatal unconjugated hyperbilirubinemia. It is of utmost importance that the measured TBil concentration is sufficiently accurate to prevent under treatment, unnecessary escalation of care, or overtreatment. However, it is widely recognized that TBil measurements urgently require improvement in neonatal clinical chemistry. External quality assessment (EQA) programs for TBil assess for differences between laboratories and provide supporting evidence of significant differences between various methods, manufacturers and measurement platforms. At the same time, many countries have adopted or only slightly adapted the neonatal hyperbilirubinemia management guidelines from the USA or UK, often without addressing differences in the methodology of TBil measurements. In this report, we provide an overview of the components of bilirubin that are measured by laboratory platforms, the availability of current reference measurement procedures and reference materials, and the role of EQA surveys in this context. Furthermore, the current status of agreement in neonatal bilirubin against clinical decision thresholds is reviewed. We advocate for enhancements in accuracy and comparability of neonatal TBil measurements, propose a path forward to accomplish this, and reflect on the position of the International Federation for Clinical Chemistry and Laboratory Medicine (IFCC) Working Group Neonatal Bilirubin (WG-NB) in this matter.
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Affiliation(s)
- Christian V Hulzebos
- Department of Paediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Johanna E Camara
- Chemical Sciences Division, National Institute of Standards and Technology (NIST), Gaithersburg, MD, USA
| | - Miranda van Berkel
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Vincent Delatour
- Laboratoire National de Métrologie et d'Essais (LNE), Paris, France
| | - Stanley F Lo
- Department of Pathology and Laboratory Medicine, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Agnès Mailloux
- Centre National de Référence en Hémobiologie Périnatale, Unit of Biologie, Pole Biology, Hopital Saint Antoine (Public Assistance Hospitals of Paris (AP-HP)), Paris, France
| | | | - Mercy Thomas
- The Royal Children's Hospital, Parkville, VIC, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | | | - Ronda F Greaves
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
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Dufey F. Robust Regression Techniques for Multiple Method Comparison and Transformation. Biom J 2024; 66:e202400027. [PMID: 39001710 DOI: 10.1002/bimj.202400027] [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: 01/24/2024] [Revised: 05/23/2024] [Accepted: 06/11/2024] [Indexed: 07/15/2024]
Abstract
A generalization of Passing-Bablok regression is proposed for comparing multiple measurement methods simultaneously. Possible applications include assay migration studies or interlaboratory trials. When comparing only two methods, the method boils down to the usual Passing-Bablok estimator. It is close in spirit to reduced major axis regression, which is, however, not robust. To obtain a robust estimator, the major axis is replaced by the (hyper-)spherical median axis. This technique has been applied to compare SARS-CoV-2 serological tests, bilirubin in neonates, and an in vitro diagnostic test using different instruments, sample preparations, and reagent lots. In addition, plots similar to the well-known Bland-Altman plots have been developed to represent the variance structure.
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Affiliation(s)
- Florian Dufey
- Roche Diagnostics GmbH, Assay Development & System Integration (DSRIBF), Penzberg, Germany
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Oostendorp M, Ten Hove CH, van Berkel M, Roovers L. A Significant Increase in the Incidence of Neonatal Hyperbilirubinemia and Phototherapy Treatment Due to a Routine Change in Laboratory Equipment. Arch Pathol Lab Med 2024; 148:e40-e47. [PMID: 37596896 DOI: 10.5858/arpa.2022-0478-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 08/21/2023]
Abstract
CONTEXT.— Total serum bilirubin (TSB) analysis is pivotal for diagnosing neonatal hyperbilirubinemia. Because of a routine change in laboratory equipment, our TSB assay changed from a diazo to a vanadate oxidase method. Upon implementation, TSB results were substantially higher in newborns than expected based on the validation. OBJECTIVE.— To investigate the application of TSB and intermethod differences in neonates and their impact on phototherapy treatment. DESIGN.— The diazo and vanadate methods were compared directly using neonatal and adult samples. Anonymized external quality control data were analyzed to explore interlaboratory differences among 8 commercial TSB assays. Clinical patient data were extracted from the medical records to investigate the number of newborns receiving phototherapy. RESULTS.— The mean bias of the vanadate versus the diazo TSB method was +17.4% and +3.7% in neonatal and adult samples, respectively. External quality control data showed that the bias of commercial TSB methods compared with the reference method varied from -3.6% to +20.2%. Within-method variation ranged from 5.2% to 16.0%. After implementation of the vanadate TSB method, the number of neonates treated with phototherapy increased approximately threefold. CONCLUSIONS.— Currently available TSB assays lack harmonization for the diagnosis of neonatal hyperbilirubinemia. Between-methods differences are substantially higher in neonatal compared with adult samples, highlighting the importance of including neonatal samples during assay validation. Close collaboration between laboratory specialists and clinicians is essential to prevent overtreatment or undertreatment upon the implementation of novel analyzers or assays. Also, harmonization of TSB assays, with an emphasis on neonatal application, is warranted.
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Affiliation(s)
- Marlies Oostendorp
- From the Departments of Clinical Chemistry and Hematology (Oostendorp), Rijnstate Hospital, Arnhem, the Netherlands
- the Department of Clinical Chemistry, Dicoon BV, Arnhem, the Netherlands (Oostendorp)
| | | | - Miranda van Berkel
- the Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands (van Berkel)
| | - Lian Roovers
- Clinical Research (Roovers), Rijnstate Hospital, Arnhem, the Netherlands
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Kittanakom S, Shea J, Leung F, Ly V, Panchadcharadevan S, Kathuria S, Margolis I, Barakauskas V, Kavsak PA. Impact of switching total bilirubin assays on the classification of neonates at high risk for hyperbilirubinemia. Clin Chem Lab Med 2023; 61:e175-e178. [PMID: 36872634 DOI: 10.1515/cclm-2023-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/16/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Saranya Kittanakom
- William Osler Health System, Brampton, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Jennifer Shea
- Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Felix Leung
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Pathology and Laboratory Medicine, Sinai Health System, Toronto, ON, Canada
| | - Vinh Ly
- William Osler Health System, Brampton, ON, Canada
| | | | | | | | - Vilte Barakauskas
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital, Vancouver, BC, Canada
| | - Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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