Erlandsson Speychal Felicia, Pettersson Miriam, Eriksson Mats, Odlind Andreas, Ohlin Andreas
Department of Pediatrics, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.
PLoS One. 2025 Mar 25;20(3):e0320067. doi: 10.1371/journal.pone.0320067. eCollection 2025.
Home phototherapy is recommended as an alternative to hospital-based therapy for neonatal jaundice in otherwise healthy full-term infants. With a reliable device for transcutaneous bilirubin (TcB) measurement, bilirubin values could be monitored at home during treatment. This study aimed to examine the accuracy of TcB measurement of bilirubin levels before, during, and after home phototherapy. Patients requiring phototherapy were assigned to home (intervention) or hospital-based phototherapy (control). Transcutaneous bilirubin measurement was made at the sternum (uncovered skin) and at sacrum (covered by the diaper during treatment). Simultaneously, total serum bilirubin (TSB) level was collected through a blood sample. The agreement between TcB and TSB before, during, and after phototherapy was assessed using Bland-Altman plots. Altogether 141 patients and 856 paired bilirubin values were included. The results show that TcB measurements underestimate TSB levels. Before phototherapy, the mean difference between TcB and TSB was 75 ± 36 μmol/L at the sternum and 135 ± 39 μmol/L at sacrum, with no difference between study groups. During phototherapy, the mean difference at the sternum was larger in the control group, 105 ± 73 μmol/L, than in the intervention group, 50 ± 41 μmol/L; at sacrum, the mean difference was 125 ± 44 μmol/L, comparable in both study groups. After phototherapy, the TcB-TSB agreement improved, with a mean difference of 29 ± 33 μmol/L (sternum) and 87 ± 35 μmol/L (sacrum), and no difference between study groups. In conclusion this study shows that full-term infants who qualified for phototherapy show poor agreement between TcB measurement and TSB, suggesting that TcB measurements cannot replace measurement of TSB level before, during, or after home phototherapy.
对于健康足月新生儿黄疸，家庭光疗被推荐为医院治疗的替代方案。借助可靠的经皮胆红素（TcB）测量设备，可在家庭治疗期间监测胆红素值。本研究旨在检验家庭光疗前、治疗期间及治疗后TcB测量胆红素水平的准确性。需要光疗的患者被分配至家庭（干预组）或医院光疗（对照组）。在胸骨（未覆盖皮肤）和骶骨（治疗期间被尿布覆盖）处进行经皮胆红素测量。同时，通过血样采集总血清胆红素（TSB）水平。使用Bland-Altman图评估光疗前、治疗期间及治疗后TcB与TSB之间的一致性。共纳入141例患者及856对胆红素值。结果显示，TcB测量低估了TSB水平。光疗前，胸骨处TcB与TSB的平均差值为75±36μmol/L，骶骨处为135±39μmol/L，研究组之间无差异。光疗期间，对照组胸骨处的平均差值更大，为105±73μmol/L，干预组为50±41μmol/L；骶骨处平均差值为125±44μmol/L，两组相当。光疗后，TcB-TSB一致性有所改善，胸骨处平均差值为29±33μmol/L，骶骨处为87±35μmol/L，研究组之间无差异。总之，本研究表明符合光疗条件的足月婴儿，TcB测量与TSB之间一致性较差，提示在家庭光疗前、治疗期间及治疗后，TcB测量无法替代TSB水平的测量。
