Transcutaneous bilirubinometry is a reliably conservative method of assessing neonatal jaundice.
OBJECTIVE
In order to reduce invasive testing in newborns prior to discharge, we tested the direction of the correlation between transcutaneous bilirubin (TcB) and total serum bilirubin (TSB), the likelihood of missing high TSBs with a raised threshold for confirmatory testing, and also calculated potential cost savings from fewer laboratory testing.


METHODS
We performed a cross-sectional analysis of single paired TcB and TSB results measured at 36 ± 2 h of life in neonates ≥37 weeks admitted only to the Level 1 nursery. TcB was measured using the BiliChek® meter.


RESULTS
Of the 552 infants, 512 (92.8%) had TSB levels below TcB values. Correlation between TcB and TSB was 0.69. If TSB confirmation was to be performed at 11.7 mg/dL (medium risk threshold for phototherapy), the negative predictive value was 99.4%, with a potential cost savings of $6555.00 ($1500.00 per 100 patients). Of the 495 infants with TcB <11.7 mg/dL, only 3 had TSB levels higher than 11.7 mg/dL, and none met phototherapy threshold for low risk infants.


CONCLUSIONS
TcB screening at our institution has a high negative predictive value, and can be used as a stand-alone test until values are close to phototherapy threshold, thus reducing invasive testing and cost.
a Department of Pediatrics , Medical University of South Carolina , Charleston , SC , USA.
Ganga L
GL
Srinivas
a Department of Pediatrics , Medical University of South Carolina , Charleston , SC , USA.
Christina Dibattista
CD
Cuff
a Department of Pediatrics , Medical University of South Carolina , Charleston , SC , USA.
Myla D
MD
Ebeling
a Department of Pediatrics , Medical University of South Carolina , Charleston , SC , USA.
James T
JT
Mcelligott
D001663:Bilirubin / Q000097:blood*; D001774:Blood Chemical Analysis / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000097:blood* / Q000628:therapy; D010789:Phototherapy; D012867:Skin
D001663:Bilirubin
BiliChek® meter; correlation; hyperbilirubinemia; newborn