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Journal of Rawalpindi Medical College (JRMC); 2013;17(1):81-83
Original Article
Validity of Transcutaneous Bilirubinometer in
Neonates as Compared to Laboratory Serum Bilirubin
Estimation
Tariq Saeed, Muhammad Zahoor ul Haq, Mohsin Butt, Tariq Mahmood Raja, Rubina Zulfiqar
Department of Paediatrics, Holy Family Hospital and Rawalpindi Medical College
Abstract
inexpensive screening. The bilirubin level, may be
measured either in the serum or noninvasively via
transcutaneous bilirubinometry. 5,6
Frequent blood sampling, for serum bilirubin
estimation, may cause anemia especially in premature
newborns. Blood sampling is a painful procedure and
can increase the risk of infection and scar formation.
Using other methods of bilirubin estimation is
important for the prevention of these devastating
complications.
A study suggests that 20-50%
reduction in samples collected for bilirubin analysis
could be achieved after implementation of
transcutaneous
bilirubin
measurements.
Transcutaneous bilirubinometry is a safe and effective
technique for screening of hyperbilirubinemia in
neonates.7-11 It is easy to use and non-invasive method
to estimate the level of bilirubin. Transcutaneous
bilirubin measurements correlate with serum bilirubin
estimation in neonates that permit non invasive and
rapid measurements. The accuracy of transcutaneous
bilirubinometry for bilirubin estimation and its role in
the prevention of frequent blood sampling in term
infants have been established.
Bilirubin values
obtained by transcutaneous bilirubinometer were not
significantly different from laboratory values thus
proving the fact that transcutaneous bilirubinometer is
a useful device to measure bilirubin. 12-14 Since the last
two decades, an electronic device by the name of Air
Shield Jaundice Meter has been manufactured, as a
joint effort by the researchers at Okajama medical
centre Japan and the Minolta Camera Ltd. Moreover,
in last two years, SpectR(x) of USA has also marketed
another transcutaneous bilirubin measuring device by
the name of Bilicheck. The performance of Bilicheck is
highly influenced by the measurement site. The
forehead is the most frequent site of transcutaneous
bilirubin measurement in clinical practice.15,16
Background : To
determine the validity of
transcutaneous bilirubinometer, keeping laboratory
serum bilirubin level as gold standard and to
compare bilirubin levels by both methods after
treatment i.e. phototherapy and exchange transfusion
in the evaluation of neonatal jaundice.
Methods: In this cross sectional study serum
samples of 122 neonates, up to 01 week of age, of
either sex, having visible clinical jaundice were sent
to pathology laboratory for total bilirubin estimation.
At the same time, total bilirubin level was checked
and recorded by a BiliCheck Jaundice Meter.
Results: Before start of treatment serum bilirubin
values ranged from 150-300mol with mean of
220mol while transcutaneous bilirubin values
ranged from 155-320mol with mean of 229mol. The
bilirubin value obtained by transcutaneous
bilirubinometer does not differ significantly from
laboratory serum bilirubin measurement before
treatment.
Conclusion:
Bilicheck
Transcutaneous
Bilirubinometer, as a screening device, offers an
accurate, rapid, economic and noninvasive means of
assessing plasma bilirubin concentrations in
neonates.
Key Words : Bilirubin, Bilirubinometer, Jaundice.
Introduction
Jaundice (icterus) is the most common condition
that requires medical attention in neonates. In most
neonates, unconjugated hyperbilirubinemia reflects a
normal transitional phenomenon.In some neonates,
serum unconjugated bilirubin levels may excessively
rise,which is neurotoxic and may lead to hearing loss,
gaze abnormality, athetoid cerebral palsy and mental
retardation.1-4 Typically, the concentration of bilirubin
in the plasma must exceed 1.5 mg/dL, three times the
usual value of approximately 0.5mg/dl, for the
coloration to be easily visible. Early recognition of
hyperbilirubinemia is of cardinal significance and
requires evaluation in the form of noninvasive and
Patients and Methods
This study was carried out from June, 2008 to Nov,
2008 in the Neonatal Intensive Care Unit of Holy
Family Hospital Rawalpindi. Total 122 neonates up to
01 week of age, having visible clinical jaundice
81
Journal of Rawalpindi Medical College (JRMC); 2013;17(1):81-83
reporting to neonatology unit of Holy Family Hospital
Rawalpindi were subjected to the clinical study.
Before
start
of
treatment,
transcutaneous
measurements were taken by application of Bilicheck
to the forehead of infants. Three such readings were
taken and the average value recorded. Blood samples
were obtained from a peripheral vein under strict
aseptic conditions within 10 minutes of transcutaneous
bilirubin measurements. Transcutaneous bilirubin and
Serum bilirubin levels were retaken during treatment
with Phototherapy or exchange transfusion to
compare both levels. Serum bilirubin was estimated by
an automated
spectrophotometer. Total Serum
Bilirubin was analyzed using Merckotest kit
(Germany)
,
based
on
DPD
(dichlorophenyldiazonium) method, at a wavelength
of 546nm. The neonates were then given treatment,
either with Phototherapy or Exchange transfusion and
their serum & transcutaneous bilirubin levels were reestimated
bilirubin estimation before start of treatment, revealed
bilirubin value between 150mol - 300mol with mean
of 220mol, having standard deviation of 37.48.
Similarly, the transcutaneous bilirubin (By Bilicheck)
values before starting treatment ranged between 155320mol with mean of 229mol, having standard
deviation of 41.595 (Table 1). Test statistics showed a
good coefficient of correlation between bilirubin
values obtained by bilicheck and those received from
laboratory with p- value 0.00 (Table 2). Majority (73%)
of neonates were given the phototherapy while 27%
needed exchange transfusion (Table 3).
After treatment, the serum bilirubin values ranged
from 50-160mol, with mean of 88.93mol having
standard deviation of 23.516. The transcutaneous
bilirubin values ranged from 55- 190mol, with mean
of 105.94mol having standard deviation of 25.619
(Table 4). After treatment bilirubin levels estimated
transcutaneously and in the serum are statistically
significant with P value 0.00 (Table 5). Bilirubin value
obtained by transcutaneous bilirubinometer do not
differ significantly from laboratory serum bilirubin
measurement before treatment. However, serum
bilirubin levels are still required, when treatment with
phototherapy or exchange transfusion is being
considered.
Results
122 neonates were included in the study over a
period extending from June 2008 - November 2008.
Their ages ranged from 1-7 days, with mean of 3.5
days. Regarding sex, 66 male and 56 female neonates
were included. Their weights ranged from 2.5 - 3.5 kg,
with 74% lying between 2.5-3.0 kg.
Table 4: Bilirubin levels (mol) after treatment
Table 1:
Bilirubin levels (mol) before
start of treatment (n = 122)
Serum Bilirubin from
Laboratory
Mean
SD
Minimum
Maximum
220.86
37.481
150
300
Mean
SD
Minimum
Maximum
Transcutaneous
Bilirubin (by
Bilicheck)
229.75
41.595
155
320
Transcutaneous (by
Bilicheck)
105.94
25.619
55
190
Table 5: Test statistics after treatment
Serum bilirubin
Chi-square
a
df
Asymp.sig.
Table 2: Test statistics before treatment
Serum
Transcutaneous
bilirubin
bilirubin
Chi-square a
40.557
29.279
df
3
3
Asymp.Sig.
.00
.00
p < 0.05 is statistically significant
97.984
2
.00
Transcutaneous
bilirubin
41.918
2
.00
P < 0.05 is statistically significant
Discussion
Neonatal jaundice contributes to a major share of
admissions in the neonatal intensive care units.
Transcutaneous bilirubinometers are widely used in
the developed countries of the world and are subjected
to continuous research in regard to their comparison
with serum bilirubin estimation. Present study showed
a good Coefficient of Correlation (p=0.00) between the
bilirubin values obtained by Bilicheck and those
Table 3: Neonatal Jaundice- Treatment (n=122)
Treatment Options
Phototherapy
Exchange Transfusion
(n = 122)
Serum Bilirubin
from Lab
88.93
23.516
50
160
No(%)
89(73)
33(27)
The 122 serum samples sent to laboratory for
82
Journal of Rawalpindi Medical College (JRMC); 2013;17(1):81-83
received from Laboratory. Laeeq A et al (1993)
performed simultaneous estimation of serum and
transcutaneous bilirubin measurements on 105 full
term jaundiced newborns. Their results revealed a
good correlation between transcutaneous and serum
bilirubin values. 17 If screening by transcutabeous
bilirubin indicates that a neonate is at increased risk
for clinically significant hyperbilirubinemia, serum
bilirubin should be measured.18
Bilicheck can be
safely used for the evaluation of bilirubin levels in
newborn infants under phototherapy. However, it
cannot be used directly to make decisions about
exchange transfusion or phototherapy in neonates.19,20
In the present study, the bilirubin values obtained
by transcutaneous bilirubinometer do not differ
significantly from laboratory serum bilirubin
measurement before treatment. However, serum
bilirubin levels were still required, when treatment
with phototherapy or exchange transfusion was being
considered. TcB measurement provides a good
estimate of the bilirubin level, as with any laboratory
measurement. It is important to consider the relevant
risk factors for jaundice when making decisions about
follow-up or intervention.21-23
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Conclusion
16.
1.Using predetermined TcB cut-off values with
reasonable sensitivity and specificity, transcutaneous
bilirubinometer is a useful screening tool to identify
infants with TSB ≥ 300 µmol/L, requiring blood
sampling, hospital admission and treatment.
2. While contemplating exchange transfusion and
phototherapy spectrophotometric bilirubin estimation
will be required
17.
18.
19.
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