Department of Paediatrics, Queen Elizabeth Hospital, Woolwich, UK.
Neonatal Unit, East Kent Hospitals University NHS Foundation Trust, Ashford, UK.
Paediatr Int Child Health. 2020 Feb;40(1):25-29. doi: 10.1080/20469047.2019.1598126. Epub 2019 Apr 11.
: Severe neonatal jaundice (SNJ) and the associated long-term health sequelae are a significant problem in low-income countries (LIC) where measurement of total serum bilirubin (TSB) is often unavailable. Transcutaneous bilirubinometry (TcB) provides the opportunity for non-invasive, point-of-care monitoring. Few studies have evaluated its agreement with TSB levels during phototherapy in LIC.: To determine agreement between TcB and TSB during phototherapy in a Haitian newborn population and to establish whether TcB can be safely used to guide treatment during phototherapy when TSB is unavailable.: A single-centre prospective study (February to May 2017) in Cap Haïtien, northern Haiti was undertaken. Newborns <7 days of age with clinically detected jaundice were eligible for inclusion. A TcB device (JM-103) was used to screen for newborn jaundice along with a parallel TSB. A strip of black tape was placed across the sternum during phototherapy and uncovered for subsequent TcB measurements. Decisions about phototherapy treatment were based upon UK National Institute of Clinical Excellence (NICE) threshold criteria. Paired TSB and TcB measurements were compared using Bland-Altman methods.: The final analysis included 70 parallel TSB/TcB measurements from 35 infants within the first 5 days of life. Nineteen (54.3%) were male and 12 (34.3%) were <35 weeks. Thirty-two (91.4%) were receiving phototherapy. There was good agreement between TSB and TcB. Compared with TSB, TcB tended to over-estimate bilirubin (mean difference 11.1 µmol/L, 95% CI -10.2-32.5 µmol/L). However, at higher bilirubin levels (>250 µmol/L), TcB tended to under-estimate bilirubin compared with TSB and the difference increased.: In an LIC setting in which serum bilirubin testing is not commonly available, TcB demonstrates good agreement with TSB and can be safely used to guide jaundice treatment during phototherapy but can lead to over-treatment at lower bilirubin levels and are more inaccurate at higher levels. For TcB levels >250 µmol, confirmation with serum bilirubin should be performed, if available, to avoid under-estimation.: LIC: low income countries; LMIC: low and middle income countries; TcB: transcutaneous bilirubinometry; TSB: transcutaneous serum biliubin.
严重的新生儿黄疸（SNJ）及其相关的长期健康后遗症是低收入国家（LIC）的一个重大问题，在这些国家，总血清胆红素（TSB）的测量往往无法进行。经皮胆红素测定（TcB）提供了非侵入性、即时监测的机会。很少有研究评估它在 LIC 光疗期间与 TSB 水平的一致性。
确定海地新生儿人群中 TcB 与 TSB 之间在光疗期间的一致性，并确定当 TSB 不可用时，TcB 是否可以安全地用于指导光疗期间的治疗。
在海地北部的海地角进行了一项单中心前瞻性研究（2017 年 2 月至 5 月）。患有临床发现的黄疸且年龄<7 天的新生儿有资格入选。使用 TcB 设备（JM-103）筛查新生儿黄疸，同时平行测量 TSB。在光疗期间，在胸骨上放置一条黑色胶带，然后揭开进行后续的 TcB 测量。光疗治疗的决定基于英国国家临床优化研究所（NICE）的阈值标准。使用 Bland-Altman 方法比较 TSB 和 TcB 的配对测量值。
最终分析包括在生命的头 5 天内 35 名婴儿的 70 对 TSB/TcB 测量值。19 名（54.3%）为男性，12 名（34.3%）<35 周。32 名（91.4%）正在接受光疗。TSB 和 TcB 之间有很好的一致性。与 TSB 相比，TcB 往往会高估胆红素（平均差异 11.1µmol/L，95%CI-10.2-32.5µmol/L）。然而，在较高的胆红素水平（>250µmol/L）下，与 TSB 相比，TcB 往往会低估胆红素，并且差异增大。
在血清胆红素检测不常见的 LIC 环境中，TcB 与 TSB 具有良好的一致性，可以安全地用于指导光疗期间的黄疸治疗，但在较低的胆红素水平下可能导致过度治疗，并且在较高水平下更不准确。对于 TcB 水平>250µmol/L，如果有条件，应进行血清胆红素确认，以避免低估。
本研究仅在一个 LIC 环境中进行，结果可能不适用于其他环境。此外，由于样本量小，无法评估 TcB 在预测高胆红素血症风险方面的准确性。
在 TSB 不可用时，TcB 可用于指导新生儿黄疸的光疗治疗，但应注意其在较低胆红素水平下可能导致过度治疗，并且在较高水平下更不准确。在 TcB 水平>250µmol/L 时，应进行血清胆红素确认以避免低估。
