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Assessment of jaundice in preterm neonates: comparison between clinical assessment, two transcutaneous bilirubinometers and serum bilirubin values
Author(s) -
Szabo P,
Wolf M,
Bucher HU,
Haensse D,
Fauchère JC,
Arlettaz R
Publication year - 2004
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.2004.tb02635.x
Subject(s) - medicine , jaundice , forehead , gestational age , bilirubin , serum bilirubin , gastroenterology , area under the curve , pediatrics , surgery , pregnancy , biology , genetics
Aim : 1) To compare the clinical assessment of craniocaudal progression of jaundice and two transcutaneous bilirubinometers with serum bilirubin values in preterm neonates; 2) to identify factors affecting the difference between non‐invasive bilirubin estimation and serum bilirubin. Methods : Serum bilirubin was clinically estimated in healthy preterm newborn infants (34 to 36.9 gestational weeks) independently by a primary investigator and by nurses, and subsequently compared with separate measures of two transcutaneous bilirubinometers. Results : A total of 107 measurements were performed on 69 infants. Minolta JM‐102 showed the best performance, with ROC area under the curve of 0.96, followed by Bili Check ™ over the sternum (0.89) and over the forehead (0.88), clinical assessment by nurses (0.73) and by a physician (0.70). Serum bilirubin <190 μmol/l can be detected with 95% sensitivity with Minolta JM–102 ≫19 units, with Bili Check ™≫145 μmol/l over the sternum and ≫165 μmol/l over the forehead and with jaundice progression to the trunk or further (Kramer zone ≫2). Gestational age affects all non‐invasive methods in the estimation of serum bilirubin, whereas skin colour affects both Bili Check ™ and clinical assessment. Ambient light affects only clinical assessment. Conclusion : Minolta JM‐102 showed the best performance, closely followed by Bili Check ™, with clinical assessment performing far worse than either transcutaneous method. None of the three methods are recommended as complete substitutes for serum bilirubin values in jaundiced preterm infants.