Improvement of Conventional Transcutaneous Bilirubinometry Results in Term Newborn Infants

ABSTRACT

This prospective study was performed to determine a way to improve conventional transcutaneous bilirubinometry results in healthy term newborn infants. In 118 infants during phototherapy (group A), and in 118 infants without phototherapy (group B), bilirubin determinations were done in duplicate using the Minolta AirShields Jaundice Meter type 101 (transcutaneous bilirubin index [TcB]), and the diazometric method on the Hitachi 717 Automated Analyzer (total reacting serum bilirubin [SeB]). In 112 infants (group C), bilirubin determinations were done in triplicate, using simple direct-reading photometry on the Moltronic Bilirubinometer (direct serum bilirubin [BiB]). A close correlation between TcB and SeB values was observed in group A (r = 0.69; p < 0.001) and in group B (r = 0.59; p < 0.001). The 95% confidence intervals of TcB readings corresponding to SeB were ± 80.7 μmol/L in group A and ± 76.9 μmol/L in group B, respectively. In group C, using a correctly calibrated BiB with adult sera containing bilirubin concentration in the range 271 to 344 μmol/L, the 95% confidence intervals of parallel TcB and BiB readings corresponding to SeB were ± 28 μmol/L. Parallel determinations of the TcB and the BiB in healthy term newborn infants give results almost identical to those of bilirubin determination by the laboratory method.

KEYWORDS

Transcutaneous bilirubinometry - conventional - term newborn infant

REFERENCES

• 1 Maisels M J, Gifford K, Antle C E, Leib G R. Jaundice in the healthy newborn infant: a new approach to an old problem.  Pediatrics. 1988;  53 132-137
• 2 Newman T B, Maisels M J. Evaluation and treatment of jaundice in the term newborn: a kinder, gentler approach.  Pediatrics. 1992;  89 809-818
• 3 Levi A J, Gatmaintan Z, Arais I M. Deficiency of hepatic organic anion-binding protein, impaired organic anion uptake by liver and psysiologic jaundice in newborn monkeys.  N Eng J Med. 1970;  283 1136-1139
• 4 Valaes T. Bilirubin toxicity: the problem was solved a generation ago.  Pediatrics. 1992;  89 819-820
• 5 American Academy of Pediatrics . Practice parameter: management of hyperbilirubinemia in the healthy term newborn.  Pediatrics . 1994;  94 558-565
• 6 Yamanouchi I, Yamanouchi Y, Igarashi I. Transcutaneous bilirubinometry: preliminary studies of noninvasive transcutaneous bilirubin meter in the Okayama national Hospital.  Pediatrics. 1980;  65 195-202
• 7 Knudsen A. The cephalocaudal progression of jaundice in newborns in relation to the transfer of bilirubin from plasma to skin.  Early Hum Dev. 1990;  22 23-28
• 8 Heygi T, Hiatt M, Indyk L. Transcutaneous bilirubinometry. I. Correlations in term infants.  J Pediatr. 1981;  98 454-457
• 9 Goldman S L, Penalver A, Peneranda R. Jaundice meter: evaluation of new guidelines.  J Pediatr. 1982;  101 253-256
• 10 Tan K L. Transcutaneous bilirubinometry in Chinese and Malay Infants.  Acta Paediatr Scand. 1982;  71 593-596
• 11 Yamauchi Y, Yamanouchi I. Transcutaneous bilirubinometry. Bilirubin kinetics of the skin and serum during and after phototherapy.  Biol Neonate. 1989;  56 263-269
• 12 Cohen A N, Ostrow J D. New Concepts in phototherapy: Photoisomerization of bilirubin IX α and potential toxic effects of light.  Pediatrics. 1980;  65 740-747
• 13 Granati B, Felice M, Fortunato A, Giancola G, Rubaltelli F F. Sites of action of light during phototherapy.  Biol Neonate. 1983;  43 1-8
• 14 Yamauchi Y, Yamanouchi I. Transcutaneous bilirubinometry. Effect of irradiation on the skin bilirubin index.  Biol neonate. 1988;  54 314-319
• 15 Rutledge J C, Ou C-N. Bilirubin and the laboratory. Advances in the 1980s, considerations for the 1990s.  Pediatr Clin North Am. 1989;  36 189-198
• 16 Brügmann G. Calibration of direct reading photometers for the determination of neonatal bilirubin.  J Clin Chem Clin Biochem. 1990;  28 83-89
• 17 Schlebusch H, Axer K, Schneider Ch, Liappis N, Röhle G. Comparison of five routine methods with the candidate reference method for the determination of bilirubin in neonatal serum.  J Clin Chem Clin Biochem. 1990;  28 203-210
• 18 Schlebusch H, Röhle G, Schneider Ch, Liappis N, Geilenkeuser W-J, Genz R. Improvement of the accuracy of bilirubinometer results.  Lab Med. 1991;  15 10-15
• 19 Blijenberg B G, Brügmann G, Geilenkeuser W-J et al.. Calibrators and control Samples for bilirubinometers.  J Clin Chem Clin Biochem. 1993;  31 367-374
• 20 Rubaltelli F, Gourley G, Laskamp N et al.. Transcutaneous bilirubin measurement: a multicenter evaluation of a new device.  Pediatrics. 2001;  107 1264-1271
• 21 Robertson A, Kazmierczak S, Vos P. Improved transcutaneous bilirubinometry: comparison of ScectRxBiliCheck and Minolta Jaundice meter JM-102 for estimating serum bilirubin in a normal newborn population.  J Perinatol. 2002;  22 12-14
• 22 Wong C M, Van Dijk P JE, Laing I A. A comparison of transcutaneous bilirubinometers: SpectRx BiliCheck versus Minolta AirShields.  Arch Dis Child Fetal Neonatal Ed. 2002;  87 F137-F140
• 23 Maisels M J, Lee C. Transcutaneous bilirubin measurements: variation in meter response.  Pediatrics. 1983;  71 457-459
• 24 Tan K L, Dong F. Transcutaneous bilirubinometry during and after phototherapy.  Acta Paediatr. 2003;  92 327-331
• 25 O'Brien P C, Shampo M A. Statistics for clinicians. 7. Regression.  Mayo Clin Proc. 1981;  56 452-454
• 26 Kapitulnik J, Horner-Mibashan R, Blondheim S H, Kaufmann N A, Russel A. Increase in bilirubin-binding affinity of serum with age of infant.  J Pediatr. 1975;  86 442-445
• 27 Lindner N, Regev A, Gazit G, Carplus M, Mandelberg A, Tamir I, Reichman B. Noninvasive determination of neonatal hyperbilirubinemia: standardization for variation in skin color.  Am J Perinatol. 1994;  11 223-225
• 28 Knudsen A. The influence of the reserve albumin concentration and pH on the cephalocaudal progression of jaundice in newborns.  Early Hum Dev. 1991;  25 37-41
• 29 Knudsen A. The influence of the basal yellow colour of the skin at birth on later jaundice meter readings in mature newborn infants.  Acta Paediatr Scand. 1992;  81 494-497
• 30 Fok T-F, Lau S-P, Hui C-W, Fung K-P, Wan C-W. Transcutaneous bilirubinometer: its use in Chinese term infants and the effect of haematocrit and phototherapy on the TCB index.  Aust Paediatr J. 1986;  22 107-109
• 31 Kramer L I. Advancement of dermal icterus in the jaundiced newborn.  Am J Dis Child. 1969;  118 454-458
• 32 Myara A, Sender A, Valette V et al.. Early changes in cutaneous bilirubin and serum bilirubin isomers during intensive phototherapy of jaundiced neonates with blue and green light.  Biol Neonate. 1997;  71 75-82
• 33 Christensen T, Kinn G. Bilirubin bound to cells does not form photoisomers.  Acta Paediatr. 1993;  82 22-25
• 34 Dominiguez Ortega F, Ormazabal Ramos J C, Martin Zarza M. Tanscutaneous bilirubinometry: correlation of the reading site obtained with spectrophotometry and diazo reaction technique.  An Esp Pediatr. 1993;  39 438-440
• 35 Clark R P, Stothers J K. Neonatal skin temperature distribution using infra-red colour thermography.  J Physiol. 1980;  302 323
• 36 Karlsson H, Hänel S-E, Nilsson K, Olegard R. Measurement of skin temperature and heat flow from skin in term newborn babies.  Acta Paediatr. 1995;  84 605-612