The forehead is a better site than the sternum to check transcutaneous bilirubin during phototherapy in sick infants
- PDF / 1,048,893 Bytes
- 5 Pages / 595.276 x 790.866 pts Page_size
- 50 Downloads / 155 Views
RESEARCH ARTICLE
Open Access
The forehead is a better site than the sternum to check transcutaneous bilirubin during phototherapy in sick infants Jaesung Jeon1, Gina Lim1*, Ki Won Oh1, Na Mi Lee2, Hye Won Park3 and Mi Lim Chung4
Abstract Background: To confirm the accuracy of transcutaneous bilirubin (TcB) in the neonatal intensive care unit both with and without phototherapy, and compare forehead and sternum as the TcB assessment site. Methods: We simultaneously assessed the total serum bilirubin (TSB) and TcB at the forehead and sternum, using a JM-103 bilirubinometer. We analyzed the correlation between the TSB and TcB assessed at the forehead and sternum, with measurements classified as ‘without phototherapy’ (before phototherapy and > 24 hours after phototherapy discontinuation) and ‘with phototherapy’ (after 24 hours of phototherapy). Results: There were 1,084 paired forehead and sternum TcB measurements, with the corresponding TSB measurement, from 384 infants. Their mean gestational age of 35.4 ± 3.2 weeks (62% were preterm) and a mean birth weight of 2434 ± 768 grams, and TSB was 6.61 ± 3.56 mg/dL. Without phototherapy, TcB values at the forehead and sternum were correlated well to the TSB value (r = 0.925 and 0.915, respectively). With phototherapy, TcB values at the forehead and sternum were significantly correlated with the TSB value, but TcB at the forehead (r = 0.751) was a better match to the TSB than was TcB at the sternum (r = 0.668). Additionally, Bland-Altman plots showed a greater degree of underestimation of the TSB by TcB at the sternum with phototherapy. Conclusions: TcB was more accurate in infants not receiving phototherapy. During phototherapy, it is better to assess TcB at the forehead rather than at the sternum. Keywords: jaundice, neonatal intensive care unit, phototherapy, transcutaneous bilirubin
Background The American Academy of Pediatrics (AAP) recommends screening for jaundice and its risk factors before newborns leave the hospital. In healthy newborns, transcutaneous bilirubin (TcB) assessment has been widely used for screening, as it does not require blood sampling and provides a quick result. By contrast, total serum bilirubin (TSB) assessment requires blood sampling, which is an invasive and painful procedure. However, the * Correspondence: [email protected] 1 Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, 44033 Ulsan, South Korea Full list of author information is available at the end of the article
accuracy of TcB in infants receiving phototherapy is lower due to skin bleaching [1–4]. Furthermore, there is doubt regarding its accuracy under phototherapy because phototherapy converts bilirubin through the skin. Although several recent studies regarding TcB assessment after the application of phototherapy have reported its good reliability, other studies have reported a low reliability. This difference in results could be due to differences in assessment sites, target patients, presence o
Data Loading...
