title: Diagnosis Accuracy of Transcutaneous Bilirubinometry in Very Preterm Newborns.
abstract: Transcutaneous bilirubin (TcB) is a validated test for systematic screening of neonatal hyperbilirubinemia and monitoring term and near-term infants under phototherapy.
  
  
  
  To evaluate TcB diagnostic accuracy for very preterm neonates.
  
  
  
  Total serum bilirubin (TSB) and TcB measurements were performed prospectively in a multicenter sample of newborns <30 weeks of gestational age (GA). TcB sensitivity, specificity, predictive values, and likelihood ratios for the detection of neonates requiring phototherapy were calculated over the first 15 days of life, with or without phototherapy, with the expectation of achieving a detection rate of hyperbilirubinemia of over 95%. The potential influence of neonatal characteristics on the discordance between TcB and TSB in very preterm newborns was analyzed using multivariate multilevel logistic regression analyses.
  
  
  
  Altogether, 481 measurements were analyzed in 167 preterm patients. Mean GA was 27.6 ± 1.6 weeks. The rates of newborns requiring phototherapy were 52% in the first 3 days, 16% from the 4th to the 7th day, and 2% during the second week. Diagnostic performance was similar among babies with or without phototherapy. TcB sensitivity decreased over time from 100% (93.9-100.0) to 50% (1.3-98.7). Specificity showed an inverse evolution from 14.8% (7.0-26.2) to 80.7% (72.2-89.2). The best performance was that of negative predictive values which varied from 95.5 to 100.0. False negatives were rare throughout the study (0.8% of measurements). In a multivariate analysis, the only factor significantly influencing discordance between TcB and TSB was postnatal age. We did not find any impact of GA and skin color.
  
  
  
  Among very preterm babies, TcB measurements might be useful for screening for neonatal jaundice in the first 2 weeks of life. In case of a TcB value below the phototherapy threshold, invasive TSB quantification could be unnecessary, with potential avoidance of blood drawing.
authors.affiliation: Clinique Universitaire de Pédiatrie, CHU de Grenoble Alpes, Grenoble, France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Rubio
authors.forename: Chloé
authors.initials: C
authors.lastname: Epiard
authors.forename: Maya
authors.initials: M
authors.lastname: Gebus
authors.forename: Michel
authors.initials: M
authors.lastname: Deiber
authors.forename: Sylvain
authors.initials: S
authors.lastname: Samperiz
authors.forename: Céline
authors.initials: C
authors.lastname: Genty
authors.forename: Anne
authors.initials: A
authors.lastname: Ego
authors.forename: Thierry
authors.initials: T
authors.lastname: Debillon
mesh_terms: D001663:Bilirubin / Q000097:blood*; D005260:Female; D005602:France; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000175:diagnosis*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D015997:Neonatal Screening / Q000379:methods*; D010789:Phototherapy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D001663:Bilirubin