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Dai J, Krahn J, Parry DM
Clinical impact of transcutaneous bilirubinometry as
an adjunctive screen for hyperbilirubinemia
Clin Biochem 29 (6): 581-586, Dec 1996
CANADA
OBJECTIVE: To determine what the clinical impact would be of
implementing a jaundice meter for use in a busy neonatal service
as an adjunctive screening tool for hyperbilirubinemia.
DESIGN AND METHODS: Test utilization data was collected for a
6-month period to determine how neonatal bilirubin was utilized
in this hospital. The jaundice meter was evaluated in a study
population of healthy term infants. The performance
characteristics of the meter and the test utilization data were
used to predict the clinical impact a meter could have on
screening for hyperbilirubinemia.
RESULTS: Utilization data indicated that about 60% of all single
bilirubin neonatal testing (i.e., bilirubin only ordered) was
done by normal nurseries. A jaundice meter cutoff decision
reading of 17 was shown to have a sensitivity of 100% and a
specificity of 68% for hyperbilirubinemia (> 260 mumol/L) in a
study population of healthy term infants. From this data, it was
estimated that use of a jaundice meter could eliminate 43% of the
single (i.e., not combined with other tests) bilirubin tests done
on healthy term neonates with no prior exposure to phototherapy.
This constitutes an overall 20% reduction in bilirubin testing in
normal nurseries when testing done on babies exposed to
phototherapy and combined bilirubin testing are taken into
consideration. Additionally, it was shown that there would be an
improvement of 9% in the prediction of hyperbilirubinemia without
loss of 100% sensitivity.
CONCLUSION: Use of a jaundice meter in normal nurseries as an
adjunctive screening tool enhances patient care by reducing the
overall blood procurement rate in normal nurseries by 20% and
increasing screening efficiency for significant
hyperbilirubinemia by 5%.