Transcutaneous bilirubinometry reduces the need for blood sampling in neonates with visible jaundice.
OBJECTIVE
We determined usefulness of transcutaneous bilirubinometry to decrease the need for blood sampling to assay serum total bilirubin (STB) in the management of jaundiced healthy Indian neonates.


METHODS
Newborns, > or =35 weeks' gestation, with clinical evidence of jaundice were enrolled in an institutional approved randomized clinical trial. The severity of hyperbilirubinaemia was determined by two non-invasive methods: i) protocol-based visual assessment of bilirubin (VaB) and ii) transcutaneous bilirubin (TcB) determination (BiliCheck). By a random allocation, either method was used to decide the need for blood sampling, which was defined to be present if assessed STB by allocated method exceeded 80% of hour-specific threshold values for phototherapy (2004 AAP Guidelines).


RESULTS
A total of 617 neonates were randomized to either TcB (n = 314) or VaB (n = 303) groups with comparable gestation, birth weight and postnatal age. Need for blood sampling to assay STB was 34% lower (95% CI: 10% to 51%) in the TcB group compared with VaB group (17.5% vs 26.4% assessments; risk difference: -8.9%, 95% CI: -2.4% to -15.4%; p = 0.008).


CONCLUSIONS
Routine use of transcutaneous bilirubinometry compared with systematic visual assessment of bilirubin significantly reduced the need for blood sampling to assay STB in jaundiced term and late-preterm neonates. (ClinicalTrials.gov number, NCT00653874).
Mishra
S
S
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. drmishrasatish@gmail.com
Chawla
D
D
Agarwal
R
R
Deorari
A K
AK
Paul
V K
VK
Bhutani
V K
VK
D001663:Bilirubin / Q000097:blood*; D001800:Blood Specimen Collection; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis*; D007567:Jaundice, Neonatal / Q000175:diagnosis*; D008297:Male; D015997:Neonatal Screening / Q000295:instrumentation / Q000379:methods*; D011897:Random Allocation; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D001663:Bilirubin