Transcutaneous bilirubinometry with the Bilicheck in very premature newborns

W A Willems, L M van den Berg, H de Wit, A Molendijk
Journal of Maternal-fetal & Neonatal Medicine 2004, 16 (4): 209-14

OBJECTIVES: To investigate the potential advantages of use of the Bilicheck in the very preterm population, with special emphasis on the effect of possible adverse skin conditions on the accuracy of the measurements. In addition we estimated the potential for safe reduction of the number of blood samples taken for serum bilirubin determinations by introduction of the Bilicheck into the neonatal intensive-care unit (NICU).

METHODS: Total serum bilirubin (TSB) and transcutaneous bilirubin (TcB) were determined in very preterm newborns (gestational age < 30 weeks). To assess the agreement between TSB and TcB values, Bland-Altman plots were analyzed. Accuracy and (intra-device) imprecision were determined by statistical analysis. A screening model was developed to estimate the potential for safe reduction of the number of blood samples taken for TSB determination.

RESULTS: Correlations between TcB and TSB values varied between 0.86 and 0.88 and all were statistically significant. Bland-Altman plots and statistical analysis showed that the agreement between TcB and TSB measurements was largest for the group with good skin conditions, as expected. The Bilicheck device had an acceptable level of intra-device imprecision (2.29 +/- 13.51 micromol/l). Applying the screening model to our entire study population, 35 of the 93 TSB measurements (38%) could have been saved.

CONCLUSIONS: The Bilicheck is a screening device with the potential to reliably indicate hyperbilirubinemia in very preterm infants. Caution is required when skin measurements are performed in the presence of peripheral edema and/or a poor peripheral circulation. Its application in the NICU environment has the potential to reduce the number of blood samples by 40%.

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