Local experience of transcutaneous bilirubinometry : an accurate alternative to serum sampling?

Abstract

Background: Babies are frequently referred to the Paediatric Emergency Department from the Breastfeeding Clinic and Community Discharge Liaison service with jaundice as indicated by high transcutaneous bilirubin (TCB) readings measured using transcutaneous bilirubinometry. Serum bilirubin (SEB) testing is then performed in the Emergency Department and the need for admission for phototherapy decided based upon on SEB. If there is strict correlation between these modes of bilirubin measurement, there would be no need to verify TCB with SEB levels in cases where bilirubin is clearly above cut – off, thus reducing hospital waiting time, costs and time to starting treatment. ---

Objectives: To establish whether TCB is a reliable screening test for neonatal jaundice necessitating phototherapy based on the relationship between TCB and SEB in patients in Malta. ---

Method: Neonates referred from the Breastfeeding Clinic to the Paediatric Emergency Department with raised TCB over five months (June-October 2017) were included. Data was obtained from the Breastfeeding Clinic, local delivery suite and iSOFT Clinical Database, and interpreted using in-built data analysis tools and custom-made data analysis spreadsheets on Microsoft Excel®. ---

Results: There was a significant difference between the two groups, mean TCB being significantly greater than SEB (t=2.32, p=0.04). However, TCB occasionally also under-read bilirubin levels. ---

Conclusions: These findings differ from results of similar studies conducted in other centres. Given the significant difference between TCB and SEB, it is recommended that, locally, baseline SEB levels continue to be repeated in the Emergency Department prior to establishing the need for phototherapy in neonatal jaundice.