Transcutaneous bilirubinometry
Transcutaneous bilirubinometry
| |||||
( TCB ) is a non-invasive , painless , | |||||
point-of-care method of estimating | |||||
SBR . The technique was first | |||||
described in 1978 by Peevy and colleagues | |||||
using the spectral reflectance of neonatal skin . 55 Typically , a handheld device known as a bilirubinometer | |||||
is used to direct light | |||||
into the newborn ’ s skin . The wavelength | |||||
intensity of the reflected | |||||
light is analysed by the meter to | |||||
provide an SBR level estimate by | |||||
means of a mathematical algorithm | |||||
that accounts for haemoglobin and skin pigments . 56 The device provides an immediate result , is typically | |||||
easy to use , and requires | |||||
minimal clinician training . The | |||||
location for TCB measurements has | |||||
commonly been either the sternum | |||||
or forehead . There is evidence | |||||
however , that TCB levels are often | |||||
higher on the sternum ( presumably | |||||
secondary to reduced light expo- |
Figure 3 . Bilirubin metabolism . |
sure ) and therefore , the sternum should routinely be used for measurement |
of TCB . 56 |
US National Institute of Diabetes and Digestive and Kidney Diseases / bit . ly / 3IZDhRx |
Bilirubinometers and TCB correlation with SBR have been extensively evaluated . In healthy newborns , correlation coefficients reportedly range from 0.70 to 0.97 . 57-68 Jones and colleagues studied the use of the newest TCB meter , the Drägar Jaundice Meter JM-105 in North Carolina to determine SBR correlation in comparison with the Philips Bili- Chek device among 176 near-term infants . 69 TCB measurements were taken on the forehead and sternum with both devices , and a SBR blood sample was obtained within 30 minutes of TCB measurement . Optimal TCB / SBR correlation was with sternal TCB samples taken with the JM-105 . Per previous studies |
, significant reliability variation | |||||
was found among racial groups : | |||||
SBR was significantly overestimated | |||||
in Hispanic / Latino and African | |||||
babies and underestimated | |||||
in those of Caucasian ethnicity . 70 TCB / SBR correlation decreased |
Figure 4 . Normal biliary tree . |
with higher SBR levels , with a tendency to over and underpredict |
equally , unlike previous studies |
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PAGE 28 |
Visual inspection is |
estimation of hyperbilirubinae- |
in healthy newborn infants of 35 |
days 2-5 . A total of 3532 observa- |
that have raised concerns that TCB |
in general , the primary , and in many developing countries , the only screening method for assessment of neonatal hyperbilirubinaemia . 10 The reliability of visual |
mia has been extensively evaluated . 51-54 Riskin and colleagues prospectively studied the reliability of clinical assessment screening for neonatal hyperbilirubinaemia |