Transcutaneous Bilirubin Accuracy Before, During, and After Phototherapy: A Meta-Analysis.

CONTEXT: Transcutaneous bilirubinometry (TcB) is used as a valid screening to identify neonates requiring measurement of total serum bilirubin (TSB) before phototherapy. Its use during and after phototherapy is not advised yet because of unknown reliability. OBJECTIVES: To determine the agreement of TcB and TSB measurements before, during, and after phototherapy. DATA SOURCES: PubMed Medline, Cochrane Library, and references of eligible studies were searched. STUDY SELECTION: Prospective and retrospective cohort and cross-sectional studies reporting Bland-Altman statistics of paired TcB and TSB measurements in term and preterm newborns. DATA EXTRACTION: Meta-analysis was performed using the Mantel-Haenszel weighted approach. The agreement between TcB and TSB in µmol/L was described by pooled mean differences (MDs) and limits of agreement (LoA). RESULTS: Fifty-four studies were included. The pooled MD before phototherapy is 2.5 µmol/L (LoA -38.3 to 43.3). The pooled MD during phototherapy is -0.3 µmol/L (LoA -34.8 to 34.2) on covered skin and -28.6 µmol/L (LoA -105.7 to 48.5) on uncovered skin. The pooled MD after phototherapy is -34.3 µmol/L (LoA -86.7 to 18.1) on covered skin and -21.1 µmol/L (LoA -88.6 to 46.4) on uncovered skin. Subgroup analysis revealed the best agreement at the forehead. We did not find any difference in agreement between term and preterm neonates. LIMITATIONS: Language restriction. CONCLUSIONS: TcB measurements before and during phototherapy on covered skin show good agreement compared with TSB in term and preterm newborns. More studies are needed to evaluate the accuracy after phototherapy.

Transcutaneous Bilirubinometry in Jaundiced Neonates: A Randomized Controlled Trial.

BACKGROUND: For evaluation of jaundiced neonates, serum bilirubin (SB) or transcutaneous bilirubinometry (TcB) is used. Few data are available on the quantitative reduction of blood sampling by using TcB. METHODS: We conducted a randomized controlled trial in hospitalized jaundiced neonates ≥32 weeks' gestational age. In the intervention group, TcB was used and in the control group the decision to obtain a blood sample for SB was based on visual and clinical assessment. Outcome measure was the number of blood samples before phototherapy. When TcB was <50 µmol/L below the threshold for phototherapy, SB was obtained. The decision to start treatment was always based on an SB value. RESULTS: A total of 430 were randomized and included in the intention-to-treat analysis: 213 in the TcB group and 217 in the control group. In the TcB group, 104 (48.4%) had at least 1 blood sample taken for SB, versus 172 (79.3%) in the control group (difference 30.5%, 95% confidence interval 21.5-38.7, P < .001). The number of blood draws was significantly reduced by 38.5% (0.9 ± 1.1 vs 1.3 ± 1.0, difference -0.5, 95% confidence interval -0.7 to -0.3, P < .001). Peak of bilirubin value, indications for phototherapy, or exchange transfusion and hospitalization length were not different between groups. CONCLUSIONS: The use of TcB in jaundiced neonates is feasible and safe, resulting in a reduction of more than one-third in blood draws.