Transcutaneous bilirubin after phototherapy in term and preterm infants

To compare transcutaneous bilirubin (TcB) readings with total serum bilirubin (TSB) after phototherapy, estimating the range of TcB where confirmation through blood sampling can be avoided. Preterm and term neonates receiving in-hospital phototherapy underwent TcB measurements (device JM-103, TcB) a...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2014-11, Vol.134 (5), p.e1324-e1329
Main Authors: Grabenhenrich, Jana, Grabenhenrich, Linus, Bührer, Christoph, Berns, Monika
Format: Article
Language:English
Subjects:
Adult
Babies
Bilirubin
Bilirubin - blood
Blood
Dosage and administration
Female
Health aspects
Humans
Infant, Newborn
Infant, Premature - blood
Infants (Premature)
Jaundice, Neonatal - blood
Jaundice, Neonatal - diagnosis
Jaundice, Neonatal - therapy
Male
Medical treatment
Pediatrics
Phototherapy
Phototherapy - methods
Pregnancy
Premature birth
Premature infants
Prospective Studies
Young Adult
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Summary:To compare transcutaneous bilirubin (TcB) readings with total serum bilirubin (TSB) after phototherapy, estimating the range of TcB where confirmation through blood sampling can be avoided. Preterm and term neonates receiving in-hospital phototherapy underwent TcB measurements (device JM-103, TcB) alongside routine TSB before and after treatment. We calculated time-dependent safety margins for transcutaneous readings to correctly assign 99% of infants not to receive phototherapy. Between August 2011 and December 2012, 86 newborn infants (47 preterm, 39 term) underwent a total of 189 parallel measurements. Mean difference (TcB - TSB) before treatment was -0.6 mg/dL (SD, 1.9 mg/dL). Within the first 8 hours after phototherapy, TcB levels were -2.4 mg/dL (SD, 2.1 mg/dL) below TSB. Thereafter the difference gradually returned to pretreatment values (-1.8 mg/dL in 8-16 hours, -1.1 mg/dL in 16-24 hours, and -0.8 mg/dL after 24 hours), while variations remained stable over time (SD, 1.4-1.8 mg/dL). In the first 8 hours after treatment, TcB levels of -7.3 mg/dL below the individual phototherapy threshold allowed safe rejection of confirmatory blood sampling. After 8 hours, that safety margin was reduced to approximately -5.0 mg/dL. TcB measurements remain a valuable tool after phototherapy when time-dependent underestimation of TcB is being accounted for.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2014-1677