title: Implementation of a neonatal transcutaneous bilirubin screening programme in rural India.
abstract: Universal pre-discharge assessment of risk for neonatal hyperbilirubinaemia is recommended by the American Academy of Pediatrics. A common algorithm is universal transcutaneous bilirubin (TcB) screening, followed by confirmatory total serum bilirubin (TSB) testing for results which cause concern. There is a paucity of data on the feasibility of TcB screening in low-income settings.
  
  
  
  To evaluate the acceptability and feasibility of implementing universal TcB screening at a resource-limited hospital in rural India, and to determine if it was associated with increased recognition of high-risk hyperbilirubinaemia.
  
  
  
  In December 2012 at Vivekananda Memorial Hospital, Karnataka, India, universal TcB screening at 24-48 hours of life was implemented, with TSB estimated if TcB was >75th percentile for age. The proportion of families that provided consent and the proportion of infants who underwent TcB and TSB testing were calculated. The rates of phototherapy pre- and post-implementation and the rate of high-risk hyperbilirubinaemia (TSB >95th percentile for age) post-implementation among infants ≥ 35 weeks gestation were determined.
  
  
  
  Parents of 568 of 660 (86%) eligible infants consented to participation. All of these infants were screened with TcB. The proportion who had TSB testing was similar in the pre- (6%) and post-implementation (7%) periods. The rate of phototherapy was not significantly different after implementation (2% vs 3%). Five cases of high-risk hyperbilirubinaemia were identified post-implementation.
  
  
  
  The study demonstrates the acceptability and feasibility of universal TcB screening at a resource-limited hospital in rural India. In settings in which early post-discharge follow-up cannot be assured, TcB can play a valuable role in identifying infants who need evaluation.
authors.affiliation: a Department of Paediatrics , University of California , San Francisco , USA.
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Morgan
authors.affiliation: b Departments of Paediatrics , Vivekananda Memorial Hospital , Saragur , India.
authors.forename: G S
authors.initials: GS
authors.lastname: Kumar
authors.affiliation: a Department of Paediatrics , University of California , San Francisco , USA.
authors.forename: Sunitha V
authors.initials: SV
authors.lastname: Kaiser
authors.affiliation: c Department of Pathology , Vivekananda Memorial Hospital , Saragur , India.
authors.forename: Sridevi
authors.initials: S
authors.lastname: Seetharam
authors.affiliation: a Department of Paediatrics , University of California , San Francisco , USA.
authors.forename: Theodore D
authors.initials: TD
authors.lastname: Ruel
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001663:Bilirubin / Q000097:blood*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000175:diagnosis*; D007194:India; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000379:methods*; D010290:Parents / Q000523:psychology; D010789:Phototherapy / Q000706:statistics & numerical data; D012424:Rural Population
chemical_list: D001663:Bilirubin
keywords: Hyperbilirubinaemia; MBJ20 bilirubinometer; Neonatal jaundice; Resource-limited setting; Transcutaneous bilirubin screening