title: Skin bilirubin measurement during phototherapy in preterm and term newborn infants.
abstract: BACKGROUND
  The few existing studies evaluating the reliability of transcutaneous bilirubin monitoring during phototherapy gave controversial results.
  
  
  OBJECTIVE
  To evaluate the accuracy of transcutaneous bilirubin measurement in a large population of newborn infants, during phototherapy.
  
  
  METHODS
  Total serum bilirubin and transcutaneous bilirubin on patched and unpatched skin areas were simultaneously measured in newborn infants undergoing phototherapy. Transcutaneous measurements were performed with a multiwavelength transcutaneous bilirubinometer (Respironics BiliCheck). The Passing-Bablok regression and the Bland-Altman plot were used to estimate the relationship between serum and transcutaneous bilirubin.
  
  
  RESULTS
  We studied 364 newborn infants with a mean (SD) gestational age of 34.6 (3) weeks and a mean birth weight of 2371 (805) grams. Total serum bilirubin, patched transcutaneous bilirubin and unpatched transcutaneous bilirubin were similar before phototherapy. After 52 (33) hours of phototherapy, the difference between serum bilirubin and patched transcutaneous bilirubin was 0.2 (3.1) mg/dL (not significant) while the difference between serum bilirubin and unpatched transcutaneous bilirubin was 3.2 (3.0) mg/dL (p<0.001). Statistical analysis showed a good agreement between serum bilirubin and patched transcutaneous bilirubin, while unpatched transcutaneous bilirubin underestimates serum levels. The difference between patched and unpatched values was significantly lower in preterm than in term infants (2.8 mg/dL vs. 3.6 mg/dL; p<0.001).
  
  
  CONCLUSIONS
  BiliCheck can be safely used for the evaluation of bilirubin levels in newborn infants under phototherapy. Its reliability on patched skin of the forehead is high enough to consistently reduce blood draws and to ascertain when to discontinue phototherapy. Because of the individual variance, any clinical decision has to be taken on the basis of the transcutaneous bilirubin trend more than on a single value.
authors.affiliation: Department of Pediatrics, Division of Neonatology, University Hospital A. Gemelli, Rome, Italy. enrizecca@rm.unicatt.it
authors.forename: Enrico
authors.initials: E
authors.lastname: Zecca
authors.forename: Giovanni
authors.initials: G
authors.lastname: Barone
authors.forename: Daniele
authors.initials: D
authors.lastname: De Luca
authors.forename: Rosa
authors.initials: R
authors.lastname: Marra
authors.forename: Eloisa
authors.initials: E
authors.lastname: Tiberi
authors.forename: Costantino
authors.initials: C
authors.lastname: Romagnoli
mesh_terms: D001663:Bilirubin / Q000097:blood / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood / Q000378:metabolism / Q000628:therapy; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood / Q000378:metabolism*; D007235:Infant, Premature, Diseases / Q000097:blood / Q000378:metabolism / Q000628:therapy; D008297:Male; D010789:Phototherapy; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012867:Skin / Q000378:metabolism*
chemical_list: D001663:Bilirubin