Pediatrics & Therapeutics
Open Access

Abstract

A Study Comparing the Transcutaneous and Serum Bilirubin Values In term and Preterm Babies at a Tertiary Care Hospital

Paramesh Sreekumar*, Nayla Ali Mohamed Alfaw, Hanan Alanezi, Emad Shatla, Minoosh Nasef, Hajar Hasan Theyab

Introduction: The estimation of transcutaneous bilirubin is a newer, less invasive approach used to determine the pathway for effective monitoring and management of neonatal jaundice. However, its reliability in comparison with total serum bilirubin is yet to be fully established especially in preterm infants and those who undergo phototherapy. This study aims at finding the correlation between Total Serum Bilirubin (TSB) and Transcutaneous Bilirubin (TcB) in term and preterm babies, both before and during phototherapy. Methods: This study was a prospective observational study conducted in the NICU, postnatal ward and the outpatient department of a tertiary health care center in Bahrain. A total of 210 infants were included in the study and were categorized into term infants and preterm who were further subdivided into two groups (between 30 weeks to 39 weeks and 34 weeks to 40 weeks) according to their gestational age. Transcutaneous bilirubin was estimated by Drager JM-105 bilirubinometer from the forehead of the babies and were compared with total serum bilirubin collected simultaneously. The measurements were taken before and during phototherapy. The statistical correlation of transcutaneous bilirubin and total serum bilirubin was shown using Bland Altman analysis and scatter plot. Result: In term infants, the mean difference between the TSB and Tcb estimation before phototherapy was approximately 21.6 μmol/L and during phototherapy was about 17.7 μmol/L. Most of the data points fall within the 95% limits of agreement, which range from about 49.5 to 92.7 μmol/L before phototherapy and approximately 36.2 to 71.6 μmol/L while under phototherapy. According to Pearson correlation test, the magnitude of correlation was significant with r=+0.840, p<0.001, in those babies who were of term gestation whose TSB and TCB were compared before phototherapy while it was r=+0.869, p<0.001 during phototherapy. In preterm babies between 30 weeks to 39 weeks of gestation, the mean TcB-TSB difference before phototherapy was17.7 μmol/L (95% LOA-14.7 to 50.2) and during phototherapy was 21.4 μmol/L (95% LOA-19.0 to 61.9) while those between 34 weeks to 40 weeks of gestation showed a difference between TcB and TSB of 22.2 μmol/L (95% LOA-39.9 to 84.2) and 25.2 μmol/L (95% LOA-37.7 to 88.1) before and during phototherapy respectively. Conclusion: Our study shows a strong positive correlation between TcB and TSB in term and preterm babies before and during phototherapy. The results need to be interpreted with caution in preterm babies less than 34 weeks of gestation especially during phototherapy owing to the possibility of wider variations. Although Tcb is very helpful as a screening tool, the decision regarding the initiation of phototherapy and management of neonatal jaundice especially in preterm babies of lower gestational age should be based on TSB values. Further studies especially in preterm babies and during phototherapy may aid in providing further clarity in the role of transcutaneous bilirubin measurement in the management of neonatal hyperbilirubinemia

Published Date: 2024-12-20; Received Date: 2024-11-20