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Comparative Study
. 2014 Jan-Mar;12(1):11-5.
doi: 10.1590/s1679-45082014ao2711.

Influence of assessment site in measuring transcutaneous bilirubin

Cristiane Maria Conceição  1 , Maria Fernanda Pellegrino da Silva Dornaus  1 , Maria Aparecida Portella  1 , Alice D Agostini Deutsch  1 , Celso Moura Rebello  1
Affiliations
Comparative Study

Influence of assessment site in measuring transcutaneous bilirubin

Cristiane Maria Conceição et al. Einstein (Sao Paulo). 2014 Jan-Mar.

Abstract
in English, Portuguese

Objective: To investigate the influence of the site of measurement of transcutaneous bilirubin (forehead or sternum) in reproducibility of results as compared to plasma bilirubin.

Methods: A cohort study including 58 term newborns with no hemolytic disease. Transcutaneous measurements were performed on the forehead (halfway between the headline and the glabella, from the left toward the right side, making consecutive determinations, one-centimeter apart) and the sternum (five measurements, from the suprasternal notch to the xiphoid process with consecutive determinations, one-centimeter apart) using Bilicheck® (SpectRx Inc, Norcross, Georgia, USA). The correlation and agreement between both methods and plasma bilirubin were calculated.

Results: There was a strong linear correlation between both determinations of serum bilirubin at the forehead and sternum (r=0.704; p<0.01 and r=0.653; p<0.01, respectively). There was correspondence of the mean values of transcutaneous bilirubin measured on the sternum (9.9 ± 2.2mg/dL) compared to plasma levels (10.2 ± 1.7 mg/dL), but both differ from the values measured on the forehead (8.6 ± 2 .0mg/dL), p<0.05.

Conclusion: In newborn term infants with no hemolytic disease, measuring of transcutaneous bilirubin on the sternum had higher accuracy as compared to serum bilirubin measurement on the forehead.

Objetivo:: Verificar a influência do local da mensuração da bilirrubina transcutânea (fronte ou esterno) na reprodutibilidade dos resultados, quando comparada à bilirrubina plasmática.

Métodos:: Estudo tipo coorte incluindo 58 recém-nascidos a termo sem doença hemolítica. Foram realizadas determinações transcutâneas na fronte (a meia distância entre a raiz do couro cabeludo e a glabela, iniciando do lado esquerdo em direção ao direito, realizando determinações consecutivas, separadas por 1cm) e no esterno (cinco mensurações iniciando da fúrcula até o apêndice xifoide, com determinações consecutivas, separadas por 1cm), utilizando o equipamento Bilicheck® (SpectRx Inc, Norcross, Geórgia, Estados Unidos). Foram calculadas as correlações e a concordância entre ambos os métodos, e a bilirrubina plasmática.

Resultados:: Foi encontrada forte correlação linear tanto entre a determinação na fronte quanto no esterno, com nível sérico de bilirrubina (r=0,704; p<0,01 e r=0,653; p<0,01, respectivamente). Houve correspondência dos valores médios de bilirrubina transcutânea aferidos no esterno (9,9±2,2mg/dL) com os valores plasmáticos (10,2±1,7mg/dL), porém ambos diferiram dos valores medidos na fronte (8,6±2,0mg/dL), com p<0,05.

Conclusão:: Em recém-nascidos a termo sem doença hemolítica, a mensuração da bilirrubina transcutânea realizada no esterno apresenta maior acurácia em relação à mensuração na fronte, quando comparada à bilirrubina sérica.

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Conflict of interest statement

Conflict of interest: none.

Figures

Figure 1
Figure 1. Linear correlation between transcutaneous measurement on the forehead and serum total bilirubin levels
Figure 2
Figure 2. Linear correlation between transcutaneous measurement on the sternum and serum total bilirubin level
Figure 3
Figure 3. Bland-Altman charts plotted with the differences in the results between transcutaneous measurements on the sternum and (A), and transcutaneous measurements taken on the forehead and plasma bilirubin (B)
Figure 4
Figure 4. Bilirubin levels measured on the forehead, sternum and plasma. Values as mean±standard deviation (DP)
See this image and copyright information in PMC

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