title: Effect of Phototherapy on the Reliability of Transcutaneous Bilirubin Devices in Term and Near-Term Infants: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Transcutaneous bilirubin (TcB) devices are commonly used for screening of hyperbilirubinemia in term and near-term infants not exposed to phototherapy. However, the accuracy of TcB devices in infants exposed to phototherapy is unclear.
  
  
  OBJECTIVE
  To conduct a systematic review of studies comparing TcB devices with total serum bilirubin (TSB) in infants receiving phototherapy or in the postphototherapy phase.
  
  
  METHODS
  MEDLINE, EMBASE, Cochrane Library, CINAHL and Scopus databases (from inception to May 8, 2014) were searched. Additional citations were identified from the bibliography of selected articles and from the abstracts of conference proceedings. The studies were included if they compared TcB results with TSB in term and near-term infants during phototherapy or after discontinuation of phototherapy. Two reviewers independently assessed studies for inclusion, and discrepancies were resolved with consensus. Risk of bias was assessed using the QUADAS-2 tool.
  
  
  RESULTS
  Fourteen studies were identified. The pooled estimates of correlation coefficients (r) during phototherapy were: covered sites 0.71 (95% CI 0.64-0.77, 11 studies), uncovered sites 0.65 (95% CI 0.55-0.74), 8 studies), forehead 0.70 (95% CI 0.64-0.75, 12 studies) and sternum 0.64 (95% CI 0.43-0.77, 5 studies). Two studies also provided results as Bland-Altman difference plots (mean TcB-TSB differences -29.2 and 30 µmol/l, respectively). The correlation coefficient improved marginally in the postphototherapy phase (r = 0.72, 95% CI 0.64-0.78, 4 studies).
  
  
  CONCLUSIONS
  We found a moderate correlation between TcB and TSB during phototherapy with a marginal improvement in the postphototherapy phase. Further research is needed before the use of TcB devices can be recommended for these settings.
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Alta., Canada.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Nagar
authors.forename: Ben
authors.initials: B
authors.lastname: Vandermeer
authors.forename: Sandy
authors.initials: S
authors.lastname: Campbell
authors.forename: Manoj
authors.initials: M
authors.lastname: Kumar
mesh_terms: D001663:Bilirubin / Q000097:blood*; D004864:Equipment and Supplies; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000175:diagnosis; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood; D007567:Jaundice, Neonatal / Q000097:blood / Q000175:diagnosis*; D015997:Neonatal Screening / Q000295:instrumentation* / Q000379:methods; D010789:Phototherapy / Q000009:adverse effects / Q000379:methods; D047928:Premature Birth / Q000097:blood*; D015203:Reproducibility of Results; D012867:Skin; D047929:Term Birth / Q000097:blood*
chemical_list: D001663:Bilirubin