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. 2020 Dec 5;20(1):548.
doi: 10.1186/s12887-020-02450-w.

The forehead is a better site than the sternum to check transcutaneous bilirubin during phototherapy in sick infants

Jaesung Jeon  1 , Gina Lim  2 , Ki Won Oh  1 , Na Mi Lee  3 , Hye Won Park  4 , Mi Lim Chung  5
Affiliations

The forehead is a better site than the sternum to check transcutaneous bilirubin during phototherapy in sick infants

Jaesung Jeon et al. BMC Pediatr. .

Abstract

Background: To confirm the accuracy of transcutaneous bilirubin (TcB) in the neonatal intensive care unit both with and without phototherapy, and compare forehead and sternum as the TcB assessment site.

Methods: We simultaneously assessed the total serum bilirubin (TSB) and TcB at the forehead and sternum, using a JM-103 bilirubinometer. We analyzed the correlation between the TSB and TcB assessed at the forehead and sternum, with measurements classified as 'without phototherapy' (before phototherapy and > 24 hours after phototherapy discontinuation) and 'with phototherapy' (after 24 hours of phototherapy).

Results: There were 1,084 paired forehead and sternum TcB measurements, with the corresponding TSB measurement, from 384 infants. Their mean gestational age of 35.4 ± 3.2 weeks (62% were preterm) and a mean birth weight of 2434 ± 768 grams, and TSB was 6.61 ± 3.56 mg/dL. Without phototherapy, TcB values at the forehead and sternum were correlated well to the TSB value (r = 0.925 and 0.915, respectively). With phototherapy, TcB values at the forehead and sternum were significantly correlated with the TSB value, but TcB at the forehead (r = 0.751) was a better match to the TSB than was TcB at the sternum (r = 0.668). Additionally, Bland-Altman plots showed a greater degree of underestimation of the TSB by TcB at the sternum with phototherapy.

Conclusions: TcB was more accurate in infants not receiving phototherapy. During phototherapy, it is better to assess TcB at the forehead rather than at the sternum.

Keywords: jaundice; neonatal intensive care unit; phototherapy; transcutaneous bilirubin.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Correlation between TSB and TcB. a Correlation between TSB and TcB values without phototherapy. b Correlation between TSB and TcB values with phototherapy (○ and solid line: TcB at the forehead, ■ and dashed line: TcB at the sternum). The x-axis shows the TSB value and the y-axis shows the TcB value. TcB, transcutaneous bilirubin; TSB, total serum bilirubin
Fig. 2
Fig. 2
Bland-Altman plots of TSB and TcB. Bland-Altman plots of without phototherapy (a), and with phototherapy (b). The x-axis shows the mean TSB and TcB (mg/dL) values, and the y-axis shows the difference between TSB and TcB (mg/dL) values. The red colour represents forehead values and blue colour represents sternum values. The solid horizontal line represents the mean difference; the dashed lines represent the 95% confidence interval. TcB, transcutaneous bilirubin; TSB, total serum bilirubin
See this image and copyright information in PMC

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