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Dai J, Parry DM, Krahn J
Transcutaneous bilirubinometry: its role in the
assessment of neonatal jaundice
Clin Biochem 30 (1): 1-9, Feb 1997
CANADA
OBJECTIVE: To review the literature on transcutaneous
bilirubinometry so that its exact role in the prevention of
kernicterus or bilirubin encephalopathy could be determined.
DESIGN AND METHODS: Literature searches were done in Medline and
Current Contents.
RESULTS: It is estimated that about 50% of newborns have an
episode of jaundice in the first few days of life. Six percent of
newborns may develop hyperbilirubinemia (> 220 mumol/L), which
can potentially cause bilirubin encephalopathy or kernicterus, a
severe neonatal disease. In the past, serum bilirubin (SB) has
been the preferred method of detecting hyperbilirubinemia in
newborns. The ordering of SB in neonates is based on visual
evaluation by either physicians or nursing staff. Skin puncture
collection of blood exposes the neonate to trauma and risk of
infection. A noninvasive device for predicting serum bilirubin
levels in newborns diminishes the need to do skin punctures. One
such device that has been very extensively studied is the Minolta
AirShields Jaundice Meter. It is a portable light-weight
instrument that uses reflectance measurements on the skin to
determine the amount of yellow color present in the skin, namely
transcutaneous bilirubin (TcB). Although the TcB measurements
correlate well with serum bilirubin (SB) levels, they cannot
accurately predict serum bilirubin because of error related to a
variety of factors.
CONCLUSIONS: TcB cannot be used directly to make decisions about
transfusions or phototherapy in neonates. It is a good tool for
screening neonates to determine when a laboratory measurement of
serum bilirubin is needed. Such a practice requires careful
selection of the decision level so that false-negative TcB values
do not prevent appropriate serum bilirubin tests from being done.