title: Transcutaneous bilirubinometry reduces the need for blood sampling in neonates with visible jaundice.
abstract: 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).
authors.affiliation: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. drmishrasatish@gmail.com
authors.forename: S
authors.initials: S
authors.lastname: Mishra
authors.forename: D
authors.initials: D
authors.lastname: Chawla
authors.forename: R
authors.initials: R
authors.lastname: Agarwal
authors.forename: A K
authors.initials: AK
authors.lastname: Deorari
authors.forename: V K
authors.initials: VK
authors.lastname: Paul
authors.forename: V K
authors.initials: VK
authors.lastname: Bhutani
mesh_terms: 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
chemical_list: D001663:Bilirubin