Ann Pediatr Res | Volume 3, Issue 1 | Research Article | Open Access

Agreement between Transcutaneous Bilirubin and Serum Bilirubin Measurements Before, During and After Phototherapy in Term and Preterm Neonates a Prospective Cohort Study in an Asian Multi-Ethnic Population

Kei Him Samson Cheung1, Mary Grace Tan2, Stephanie MC Fook-Chong3,4 and Cheo Lian Yeo2,5*

1Department of Paediatrics, Kandang Kerbau Hospital, Singapore
2Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
3Health Services Research Unit, Singapore General Hospital; Singapore
4Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
5Department of Paediatrics, Duke-NUS Medical School, Singapore

*Correspondance to: Cheo Lian Yeo 

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Abstract

Background: Neonatal jaundice occurs commonly in neonates. Serum bilirubin, the gold standard method of assessing the severity of jaundice is a painful, time consuming and costly procedure. Transcutaneous Bilirubin (TcB) has been touted as an alternative method of detecting neonatal jaundice.Objectives: To determine the agreement between transcutaneous bilirubin and serum bilirubin measurements before, during and after phototherapy in term and preterm neonates and to evaluate factors that may influence the correlation between TcB and TSB.
Methods: A total of 1541 paired bilirubin readings were obtained from 566 neonates managed for jaundice in the Department of Neonatal and Developmental Medicine at the Singapore General Hospital over a 4 month period. Neonates requiring an assay of bilirubin were prospectively enrolled and bilirubin was measured using TSB and TcB methods. Bland-Altman plots of difference in TcB and TSB versus the average of TcB and TSB were used to assess the degree of clinical agreement between TcB and TSB measurements. Limits of agreement of ± 35 µmol/L were considered to be clinically acceptable.Results: Bland Altman analysis revealed good clinical agreement between TcB and TSB measurements before and after phototherapy in both term and preterm neonates. The intra-class correlation coefficient for TcB at the sternum, forehead and inter-scapular was good at 0.937 before and 0.960 after phototherapy. The difference in TcB and TSB in neonates of Malay and Indian ethnicity are statistically higher compared to the Chinese (p=0.001).Conclusion: Agreement between TcB and TSB measurements is good before and after phototherapy, hence TcB is recommended in screening for jaundice and trending of jaundice after phototherapy.

Keywords:

Newborn or neonates; Term and preterm; Bilirubinometry or transcutaneous bilirubin; Serum bilirubin, Phototherapy

Citation:

Cheung KHS, Tan MG, Fook-Chong SMC, Yeo CL. Agreement between Transcutaneous Bilirubin and Serum Bilirubin Measurements Before, During and After Phototherapy in Term and Preterm Neonates a Prospective Cohort Study in an Asian Multi-Ethnic Population. Ann Pediatr Res. 2019; 3(1): 1018.

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