title: Transcutaneous bilirubinometry is not influenced by term or skin color in neonates.
abstract: BACKGROUND
  The utility of transcutaneous bilirubin measurements (TcB) in screening for hyperbilirubinemia in preterm infants (<34 weeks) and in non-white infants remains a matter of debate.
  
  
  OBJECTIVE
  To evaluate accuracy of TcB in preterm and term infants of different ethnic backgrounds, using a second generation bilirubinometer.
  
  
  METHODS
  The Draeger JM-103® device was used to measure TcB. Eighty five measurements of TcB and total serum bilirubin (TSB) were retrospectively compared. Neonates were stratified into groups according to gestational age: <34 weeks (group 1, n=44) and >34 weeks (group 2, n=41), and according to ethnic origin: Caucasians (group A, n=49) and non-Caucasians (group B, n=36). Statistical analysis, using Pearson's correlation coefficient (r) and Bland-Altman analysis were performed to evaluate correlation and agreement between TSB and TcB values. Multiple linear regression was used to control for confounders for TSB values.
  
  
  RESULTS
  Correlation between TSB and TcB was high. Pearson's correlation coefficients were over 0.9 in all groups (0.910, 0.908, 0.916 and 0.934, p<0.0001 in groups 1, 2, A, and B respectively). Bland-Altman plots showed acceptable and close limits of agreements (56.8/-57.7, 54.2/-67.2, 57.7/-55.8, and 51.3/-69.9μmol/L in groups 1, 2, A and B respectively) with a trend for TcB to overestimate TSB in groups 2 and B. Birth term and skin color were not identified as confounding factors for predicting TSB in multiple linear regression.
  
  
  CONCLUSIONS
  TcB measurements using the Draeger JM-103® device correlate significantly with TSB, regardless of term and skin color. Transcutaneous bilirubinometry seems to be a safe and cost-effective screening method for severe hyperbilirubinemia in newborns of different terms and ethnic origins.
authors.affiliation: Neonatal and Pediatric Intensive Care Unit, Hôpital de Bicetre, APHP, Le Kremlin Bicêtre, France. Electronic address: mickael.afanetti@gmail.com.
authors.forename: Mickael
authors.initials: M
authors.lastname: Afanetti
authors.affiliation: Neonatal and Pediatric Intensive Care Unit, Hôpital de Bicetre, APHP, Le Kremlin Bicêtre, France.
authors.forename: Sergio
authors.initials: S
authors.lastname: Eleni Dit Trolli
authors.affiliation: Neonatal and Pediatric Intensive Care Unit, Hôpital de Bicetre, APHP, Le Kremlin Bicêtre, France.
authors.forename: Nadya
authors.initials: N
authors.lastname: Yousef
authors.affiliation: Neonatal and Pediatric Intensive Care Unit, Hôpital de Bicetre, APHP, Le Kremlin Bicêtre, France.
authors.forename: Ikram
authors.initials: I
authors.lastname: Jrad
authors.affiliation: Neonatal and Pediatric Intensive Care Unit, Hôpital de Bicetre, APHP, Le Kremlin Bicêtre, France.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Mokhtari
mesh_terms: D001663:Bilirubin / Q000032:analysis*; D002624:Chemistry, Clinical / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000175:diagnosis*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood; D016014:Linear Models; D008297:Male; D015997:Neonatal Screening / Q000295:instrumentation / Q000379:methods; D012680:Sensitivity and Specificity; D012880:Skin Pigmentation / Q000502:physiology*; D044465:White People
chemical_list: D001663:Bilirubin
keywords: Bland–Altman difference plots; Correlation coefficient; Jaundice; Preterm and term infants; Skin color; Transcutaneous bilirubin evaluation