Using BiliCheck for preterm neonates in a sub-intensive unit: diagnostic usefulness and suitability.
BACKGROUND
BiliCheck (BC), a new transcutaneous bilirubinometer is thought to be lacking in the disadvantages of old devices and could be potentially useful for diagnosing jaundice in preterm babies. Although its accuracy is well known in healthy term babies, there is a lack of knowledge about its usefulness in preterm infants.


OBJECTIVE
To investigate BC usefulness in preterm babies and its suitability in a sub-intensive neonatal unit.


METHODS
In 340 preterm infants between 30 and 36 weeks of gestational age, transcutaneous and serum bilirubin measurement were performed. Hematocrit, pH, postnatal age, gestational age, and sex were also studied to clarify their influence on BC accuracy. For a subset of 100 neonates transcutaneous measurement, blood collection and serum analysis were timed and costs were considered.


RESULTS
Correlation coefficient is 0.795 (p<0.001) and this is not affected by factors previously supposed to be important. Overall sensitivity was 100% and specificity were comprised between 40% and 72%. BC has a tendency to overestimate serum bilirubin, at high values. Considering the whole time for serum bilirubin measurement, transcutaneous bilirubinometry is a faster (p<0.0001), but more expensive technique with a cost of about 5 euro/measurement. Nevertheless, using BC as a screening-device we could safely avoid 58-79% of blood samples, since its positive predictive values is about 21-42%. This would allow to a cost reduction of 1555-2120 euro/year.


CONCLUSIONS
BC has a good reliability in preterm infants although not as good as in healthy term babies. BC is a time-sparing tool and can improve the management of neonatal jaundice in preterm infants; however, its tendency to overestimate suggests its use only for screening purposes.
De Luca
Daniele
D
Division of Neonatology, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy. dm.deluca@fastwebnet.it <dm.deluca@fastwebnet.it>
Zecca
Enrico
E
de Turris
Pierluigi
P
Barbato
Giada
G
Marras
Marco
M
Romagnoli
Costantino
C
D001663:Bilirubin / Q000032:analysis* / Q000097:blood; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis*; D007363:Intensive Care Units, Neonatal; D007565:Jaundice / Q000175:diagnosis*; D008111:Liver Function Tests / Q000379:methods*; D008297:Male
D001663:Bilirubin