Correlation of the transcutaneous bilirubin and serum bilirubin levels measured before and after phototherapy in newborns: a prospective observational study

Aim: The purpose of the present study was to show the reliability of the transcutaneous bilirubin (TcB) measurement as an alternative method to total serum bilirubin (TSB) when starting treatment with phototherapy (PT), which is one of the most important treatment methods of hyperbilirubinemia as a very common practice in the neonatal period and eliminates the disadvantages of blood collection. Materyal and Method: Two measurements were made to evaluate whether there was a correlation between the total serum bilirubin and transcutaneous bilirubin level measurement for follow-up in newborns who were hospitalized and prospectively followed up in the Newborn Intensive Care Unit of Karabuk University Medical Faculty Training and Research Hospital between April 13 and June 30, 2022 (Level III Neonatal Center) who were scheduled for starting phototherapy. The primary result was the correlation between TcB and TSB at the first 24 hours and after, at the initiation of FT, termination of FT, and 12 hours after PT was discontinued. Results: The TSB and TcB values of the newborns were measured at the beginning of PT, at the end of PT, and 12 hours after PT was ended. The first measurement values were 11.60±5.16 and 10.72±4.02, respectively; the second measurement values were 7.45±2.34 and 6.35±2.83, respectively; and the third measurement values were 8.03±2.45 and 7.35±2.63 mg/dL, respectively. A strong positive correlation was found among all measurement values. Also, when the newborns who received FT for the first 24 hours were evaluated by subgrouping, the high correlation between TcB and TSB levels continued. Conclusion: The present study showed that there is a significant relationship between TcB taken from the covered skin and TSB at the start, end, and 12 hours after PT. Also, when the newborns who received PT for the first 24 hours were evaluated in a subgroup, it was found that TCB measurement predicted the TSB level at a high level before and after PT. Based on these findings, it was concluded that TcB measurement, including in the first 24 hours, is reliable in the follow-up of newborns receiving PT for the treatment of hyperbilirubinemia. However, we think that larger prospective controlled studies are required in this respect.

Keywords:

Newborn bilirubin, phototherapy,

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Woodgate P, Jardine LA. Neonatal jaundice. BMJ Clin Evid 2011; 2011: 0319.
Johnson L, Bhutani VK. The clinical syndrome of bilirubin-induced neurologic dysfunction. Semin Perinatol 2011; 35: 101-13
Cashore WJ. The neurotoxicity of bilirubin. Clin Perinatol 1990; 17: 437–47.
Hassan Shabuj M, Hossain J, Dey S. Accuracy of transcutaneous bilirubinometry in the preterm infants: a comprehensive meta-analysis. J Matern Fetal Neonatal Med 2019; 32: 734-41.
Ahmed M, Mostafa S, Fisher G, Reynolds TM. Comparison between transcutaneous bilirubinometry and total serum bilirubin measurements in preterm infants <35 weeks gestation. Ann Clin Biochem 2010: 47: 72-7.
Özkan H, Ören H, Duman N, Duman M, Dermal bilirubin kinetics during phototherapy in term neonates. Acta Paediatr 2003; 92: 577-81.
Beck M, Kau N, Schlebusch H. Transcutaneous bilirubin measurement in newborn infants: evaluation of a new spectrophotometric method. Arch Dis Child Fetal Neonatal Ed 2003; 88: F350-1.
Nagar G, Vandermeer B, Campbell S, Kumar M. Effect of phototherapy on the reliability of transcutaneous bilirubin devices in term and near-term infants: a systematic review and meta-analysis. Neonatology 2016; 109: 203-12.
Newman J. Re: Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants (35 or more weeks’ gestation) - Summary. Paediatr Child Health 2007; 12: 401-18.
Amos RC, Jacob H, Leith W. Jaundice in newborn babies under 28 days: NICE guideline 2016 (CG98). Arch Dis Child Educ Pract Ed 2017; 102: 207-9.
Tan KL, Dong F. Transcutaneous bilirubinometry during and after phototherapy. Acta Paediatr 2003; 92: 327–31.
Rylance S, Yan J, Molyneux E. Can transcutaneous bilirubinometry safely guide phototherapy treatment of neonatal jaundice in Malawi? Paediatr Int Child Health 2014; 34: 101-7.
Çoban A, Kaynak Türkmen M, Gürsoy T. Turkish Neonatal Society guideline to the approach, follow-up, and treatment of neonatal jaundice. Turk Pediatri Ars 2018; 53: 172-9.
American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114: 297-316.
George D. (2011). SPSS for windows step by step: A simple study guide and reference, 17.0 update, 10/e (4th ed.). Pearson Education India.
Murli L, Thukral A, Sankar MJ, et al. Reliability of transcutaneous bilirubinometry from shielded skin in neonates receiving phototherapy: a prospective cohort study. J Perinatol 2017; 37: 182-7.
Bhutani VK, Johnson LH, Gourley G. Measuring bilirubin through the skin?. Pediatrics 2003; 111: 919-20.
Johnson SM, Vasu V, Marseille C, et al. Validation of transcutaneous bilirubinometry during phototherapy for detection and monitoring of neonatal jaundice in a low-income setting. Paediatr Int Child Health 2020; 40: 25-9.
Radfar M, Hashemieh M, Shirvani F, Madani R. Transcutaneous Bilirubinometry in Preterm and Term Newborn Infants before and during Phototherapy. Arch Iran Med 2016; 19: 323-8.
20.Hassan Shabuj M, Hossain J, Dey S. Accuracy of transcutaneous bilirubinometry in the preterm infants: a comprehensive meta-analysis. J Matern Fetal Neonatal Med 2019: 32: 734-41.
Vasava S, Dagli P. Transcutaneous bilirubinometry: Influence of gestational age and measurement site. Sri Lanka J Child Health 2018; 47: 27-32.
Amneenah A. Comparison of diagnostic accuracy of transcutaneous bilirubinometry during phototherapy by using skin patch. Int J Health Sci 2022; 6: 7276-88.