Measuring transcutaneous bilirubin: a comparative analysis of three devices on a multiracial population

Abstract

Background: Hyperbilirubinemia can lead to potentially irreversible bilirubin-induced neurotoxicity. Transcutaneous bilirubin (TcB) determination has become a valuable aid in non invasive screening of neonatal jaundice.The aim of this study is to compare the performance of three most widespread transcutaneous bilirubinometers on a multiracial population of term and late pre-term neonates.

Methods: Bilirubin concentration was determined using traditional photometric determination and transcutaneously with Bilicheck, BiliMed and JM-103, in random order.Total serum bilirubin (TSB) was determined over a wide concentration range (15,8-0,7 mg/dl) with a mean of 9,5 mg/dl. Related TcB values using Bilicheck (TcB-BC), BiliMed (TcB-BM), and JM-103 (TcB-JM) are reported in Table 1.

Results: A multiracial population of 289 neonates was enrolled with a gestational age ranging from 35 to 41 weeks; birth weight ranging from 1800 to 4350 grams; hours of life ranging from 4 to 424. In the total study population correlation analysis using Pearson coefficients showed good results for Bilicheck (r = 0.86) and JM-103 (r = 0.85) but poor for BiliMed (r = 0,70). Similar results were found for the non-Caucasian neonates subgroup. Bilicheck and JM-103 had a greater area under the curve than BiliMed when TSB =14 mg/dl was chosen as a threshold value both for the total study population and the non-Caucasian subgroup.

Conclusions: Bilicheck and JM-103, but not BiliMed, are equally reliable screening tools for hyperbilirubinemia in our multiracial neonatal population.

Figure 1

A. Pearson’s correlation coefficients for the whole population.B. Pearson’s correlation coefficients for African population.

Figure 2

A and 2B. Bland Altman plot for the whole population and for African neonates respectively. These graphs show the mean difference between TSB and TcB for each transcutaneous bilirubinometer ± 1.96 SD that are index of imprecision of the instruments.

Figure 3

ROC curves when TSB > 14 mg/dl was the outcome of choice for the three transcutaneous bilirubinometer (A: whole population; B: African neonates). AUC and difference between areas are reported for whole population.