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Review
. 2023 May 9;5(5):CD012660.
doi: 10.1002/14651858.CD012660.pub2.

Transcutaneous bilirubinometry versus total serum bilirubin measurement for newborns

Charles I Okwundu  1 , Abiola Olowoyeye  2 , Olalekan A Uthman  3 , Johan Smith  4 , Charles S Wiysonge  5 , Vinod K Bhutani  6 , Michelle Fiander  7 , Kanekal S Gautham  8
Affiliations
Review

Transcutaneous bilirubinometry versus total serum bilirubin measurement for newborns

Charles I Okwundu et al. Cochrane Database Syst Rev. .

Abstract

Background: Jaundice is a very common condition in newborns, affecting up to 60% of term newborns and 80% of preterm newborns in the first week of life. Jaundice is caused by increased bilirubin in the blood from the breakdown of red blood cells. The gold standard for measuring bilirubin levels is obtaining a blood sample and processing it in a laboratory. However, noninvasive transcutaneous bilirubin (TcB) measurement devices are widely available and used in many settings to estimate total serum bilirubin (TSB) levels.

Objectives: To determine the diagnostic accuracy of transcutaneous bilirubin measurement for detecting hyperbilirubinaemia in newborns.

Search methods: We searched CENTRAL, MEDLINE, Embase, CINAHL and trial registries up to 18 August 2022. We also checked the reference lists of all included studies and relevant systematic reviews for other potentially eligible studies.

Selection criteria: We included cross-sectional and prospective cohort studies that evaluated the accuracy of any TcB device compared to TSB measurement in term or preterm newborn infants (0 to 28 days postnatal age). All included studies provided sufficient data and information to create a 2 × 2 table for the calculation of measures of diagnostic accuracy, including sensitivities and specificities. We excluded studies that only reported correlation coefficients.

Data collection and analysis: Two review authors independently applied the eligibility criteria to all citations from the search and extracted data from the included studies using a standard data extraction form. We summarised the available results narratively and, where possible, we combined study data in a meta-analysis.

Main results: We included 23 studies, involving 5058 participants. All studies had low risk of bias as measured by the QUADAS 2 tool. The studies were conducted in different countries and settings, included newborns of different gestational and postnatal ages, compared various TcB devices (including the JM 101, JM 102, JM 103, BiliChek, Bilitest and JH20-1C) and used different cutoff values for a positive result. In most studies, the TcB measurement was taken from the forehead, sternum, or both. The sensitivity of various TcB cutoff values to detect significant hyperbilirubinaemia ranged from 74% to 100%, and specificity ranged from 18% to 89%.

Authors' conclusions: The high sensitivity of TcB to detect hyperbilirubinaemia suggests that TcB devices are reliable screening tests for ruling out hyperbilirubinaemia in newborn infants. Positive test results would require confirmation through serum bilirubin measurement.

PubMed Disclaimer

Conflict of interest statement

AO: none known CO: none known OU: none known KG has declared he has no conflict of interest; but he is an Editor with Cochrane Neonatal Group. He was not be involved in the editorial process of this manuscript. JS: none known CW: none know VB: none known MF is an Information Specialist and Managing Editor with the Cochrane Neonatal Group. She was not involved in the editorial process of this manuscript.

Figures

1
1
Flow diagram
2
2
Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies.
3
3
Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study.
4
4
Forest plot of Analysis 1 (JM 101).
5
5
Summary ROC Plot of Analysis 1 (JM 101).
6
6
Summary ROC plot of Analysis 4: BiliChek (cutoff > 250 μmol/L).
7
7
Summary ROC plot of Analysis 5: BiliChek (cutoff > 200 μmol/L)
1
1. Test
JM 101
2
2. Test
JM 102
3
3. Test
BiliChek (cutoff > 250 μmol/L)
4
4. Test
BiliChek (cutoff > 200 μmol/L)
5
5. Test
JH20‐1C
6
6. Test
BiliChek HR; diazo
7
7. Test
BiliChek HR; vitros
8
8. Test
JM 103 (TcB > 204 μmol/L)
9
9. Test
JM 103 (TcB > 230 μmol/L)
10
10. Test
JM 103 (sternum TcB P95)
11
11. Test
JM 103 (sternum TcB P75)
12
12. Test
JM 103 (forehead TcB P95)
13
13. Test
JM 103 (forehead TcB P75)
14
14. Test
BiliChek (need for phototherapy)
15
15. Test
Bilitest (TSB > 15 mg/dL)
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD012660

References

References to studies included in this review

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Greco 2017 {published data only}
    1. Greco C, Iskander IF, Akmal DM, El Houchi SZ, Khairy DA, Bedogni G, et al. Comparison between Bilistick System and transcutaneous bilirubin in assessing total bilirubin serum concentration in jaundiced newborns. Journal of Perinatology 2017;37(9):1028-31. [PMID: ] - PubMed
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Harish 1998 {published data only}
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Hemmati 2021 {published data only}
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Hill 2016 {published data only}
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Ho 2006 {published data only}
    1. Ho EY, Lee SY, Chow CB, Chung JW. BiliCheck transcutaneous bilirubinometer: a screening tool for neonatal jaundice in the Chinese population [Xianggang yi xue za zhi]. Hong Kong Medical Journal 2006;12(2):99-102. [PMID: ] - PubMed
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    1. Ho HT, Ng TK, Tsui KC, Lo YC. Evaluation of a new transcutaneous bilirubinometer in Chinese newborns. Archives of Disease in Childhood. Fetal and Neonatal Edition 2006;91(6):F434-8. [DOI: 10.1136/adc.2005.090217] [PMID: ] - DOI - PMC - PubMed
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Hulzebos 2019 {published data only}
    1. Hulzebos CV, Vader-van ID, Bos AF, Dijk PH. Should transcutaneous bilirubin be measured in preterm infants receiving phototherapy? The relationship between transcutaneous and total serum bilirubin in preterm infants with and without phototherapy. PLOS One 2019;14(6):e0218131. - PMC - PubMed
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Jalalodini 2019 {published data only}
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Jangaard 2006 {published data only}
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Jegathesan 2021 {published data only}
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Jeon 2020 {published data only}
    1. Jeon J, Lim G, Oh KW, Lee NM, Park HW, Chung ML. The forehead is a better site than the sternum to check transcutaneous bilirubin during phototherapy in sick infants. BMC Pediatrics 2020;20:1-5. - PMC - PubMed
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Jones 2017 {published data only}
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Juster‐Reicher 2014 {published data only}
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Kazmierczak 2004 {published data only}
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Khajehei 2021 {published data only}
    1. Khajehei M, Chua SC, Gidaszewski B, Swain J. Comparing JM-105 and MBJ-20 transcutaneous bilirubinometers according to the area tested in ethnically diverse late-preterm and term neonates. Journal of Perinatal & Neonatal Nursing 2021;35(3):E30-7. [PMID: ] - PubMed
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Rohsiswatmo 2018 {published data only}
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References to other published versions of this review

Okwundu 2017
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