Iranian Journal of Neonatology

Iranian Journal of Neonatology

Relationship among Bilirubin Levels Measured Using Three Methods of Transcutaneous, Serum, and Kramer’s Scale in Term Neonates

Document Type : Original Article

Authors
Sara Esmaelzadeh -Saeieh 1
Mehrnaz Asgaripoor 2
Kourosh Kabir 3
Alireza Jashni Motlagh 3
1 Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
2 Alborz University of Medical Sciences, Karaj, Iran
3 School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
10.22038/ijn.2022.62304.2191
Abstract
Background: The measurement of total serum bilirubin is a stressful diagnostic method; therefore, it is necessary to measure bilirubin levels using non-invasive ways. The present study aimed to assess the relationship between bilirubin levels measured using three methods of transcutaneous, serum, and Kramer’s scale in term neonates with jaundice.
Methods: This descriptive-analytical study was conducted on 180 full-term neonates admitted to Imam Ali Hospital in Alborz province, Iran. Bilirubin level was measured by three methods of serum, transcutaneous (using MBJ20, B&M Technology Co., China), and Kramer’s scale (based on the appearance) before phototherapy. Thereafter, the relationship between serum bilirubin levels using transcutaneous and Kramer’s scale was determined by the Pearson and Spearman correlation coefficients.
Results: The correlation coefficient between serum bilirubin and transcutaneous bilirubin (TCB) was obtained at 0.915 before phototherapy. Furthermore, the correlation coefficients between serum bilirubin and TCB were calculated at 0.881 and 0.77 in the covered and uncovered areas after phototherapy, respectively. The correlation coefficient between TCB in the covered and uncovered areas was 0.81. The mean difference between serum bilirubin and TCB was 0.42±1.25 before phototherapy. Moreover, the mean difference values between serum bilirubin and TCB were reported as 1.36±1.37 and 83.1±63.4 in the covered and uncovered areas after phototherapy, respectively.
Conclusion: As evidenced by the obtained results, there was a significant correlation between TCB and serum bilirubin before the initiation of phototherapy. Therefore, it is recommended to use TCB instead of repeated blood sampling to follow and monitor neonates.
 
 
Keywords
Serum bilirubin
Term neonate
Transcutaneous bilirubin
  1. Brits H, Adendorff J, Huisamen D, Beukes D, Botha K, Herbst H, Joubert G. The prevalence of neonatal jaundice and risk factors in healthy term neonates at National District Hospital in Bloemfontein. Afr J Prm Health Care Fam Med. 2018;10(1):e1-e6.
  2. Najib KS, Saki F, Hemmati F, Inaloo S. Incidence, risk factors and causes of severe neonatal hyperbilirubinemia in the South of iran (fars province). Iran Red Crescent Med J. 2013;15(3):260-3.
  3. Olusanya BO, Osibanjo FB, Slusher TM. Risk factors for severe neonatal hyperbilirubinemia in low and middle-income countries: a systematic review and meta-analysis. PloS One. 2015;10(2):e0117229.
  4. Orimadegun AE, Ojebiyi AO. Primary health workers’ knowledge and practices relating to neonatal jaundice in Ibadan, Nigeria. Afr J Prim Health Care Fam Med. 2017;9(1):e1-e7.
  5. Mahram M, Oveisi S, Jaberi N. Trans-cutaneous bilirubinometery versus serum bilirubin in neonatal jaundice. Acta Med Iran. 2015;53(12):764-9.
  6. Samanta S, Tan M, Kissack C, Nayak S, Chittick R, Yoxall CW. The value of Bilicheck as a screening tool for neonatal jaundice in term and near-term babies. Acta Paediatr. 2004;93(11):1486-90.
  7. Sajjadian N, Shajari H, Saalehi Z, Esphahani F, Taheri PA. Transcutaneous bilirubin measurement in preterm neonates. Acta Med Iran. 2012:765-70.
  8. Cucuy M, Juster-Reicher A, Flidel O, Shinwell E. Correlation between transcutaneous and serum bilirubin in preterm infants before, during, and after phototherapy. J Matern -Fetal Neonatal Med. 2018;31(10):1323-6.
  9. Mansouri M, Mahmoodnejad A, Taghizadeh Sarvestani R, Gharibi F. A comparison between transcutaneous bilirubin (TCB) and total serum bilirubin (TSB) measurements in term neonates. Int J Pediatr. 2015;3(3.1):633-41.
  10. Ebbesen F, Hansen TW, Maisels MJ. Update on phototherapy in jaundiced neonates. Curr Pediatr Rev. 2017;13(3):176-80.
  11. Khoshdel A, Khalili Boroujeni T, Nourbakhsh SM, Kasiri K. Correlation of transcutaneous and serum bilirubin levels in infants with neonatal jaundice hospitalized in Hajar Hospital in Shahrekord. Pajoohande. 2013;18(4):189-194.
  12. Yang ST, Liu FC, Chen HL. Comparison of transcutaneous and serum bilirubin before, under, and after phototherapy in term and late-preterm infants. Kaohsiung J Med Sci. 2019;35(11):715-24.
  13. Radfar M, Hashemieh M, Shirvani F, Madani R. Transcutaneous bilirubinometry in preterm and term newborn infants before and during phototherapy. Arch Iran Med. 2016;19(5):323-8.
  14. Raba AA, O'Sullivan A, Miletin J. Transcutaneous bilirubinometry during and after phototherapy in preterm infants: a prospective observational study. BMJ Paediatr Open. 2020;4(1):e000681.
  15. Arman D, Topcuoğlu S, Gürsoy T, Ovalı F, Karatekin G. The accuracy of transcutaneous bilirubinometry in preterm infants. J Pediatr. 2020;40(2):212-8.
  16. Yu ZB, Han SP, Chen C. Bilirubin nomograms for identification of neonatal hyperbilirubinemia in healthy term and late-preterm infants: a systematic review and meta-analysis. World J Clin Pediatr. 2014;10(3):211-8.
  17. Juster-Reicher A, Flidel-Rimon O, Rozin I, Shinwell ES. Correlation of transcutaneous bilirubinometry (TCB) and total serum bilirubin (TsB) levels after phototherapy. J Matern-Fetal Neonatal Med. 2015;28(11):1329-31.
  18. Murli L, Thukral A, Sankar MJ, Vishnubhatla S, Deorari AK, Paul VK, Sakariah A, Agarwal R. Reliability of transcutaneous bilirubinometry from shielded skin in neonates receiving phototherapy: a prospective cohort study. J Perinatol. 2017;
    37(2):182-7.
  19. De Luca D, Dell'Orto V. Patched skin bilirubin assay to monitor neonates born extremely preterm undergoing phototherapy. J Pediatr. ;188:122-7.
  20. Aprillia Z, Gayatri D, Waluyanti FT. Sensitivity, specificity, and accuracy of kramer examination of neonatal jaundice: Comparison with total bilirubin serum. Compr Child Adolesc Nurs. 2017;
    40(sup1):88-94.
  21. Varughese PM. Kramer's scale or transcutaneous bilirubinometry: the ideal choice of a pediatrician? can we trust our eyes.
Iranian Journal of Neonatology
Volume 13, Issue 2
Spring 2022
Pages 32-38