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Comparison of Transcutaneous Bilirubin with Serum Bilirubin in a Tertiary Care Newborn Unit- A Cross-Sectional Study |
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| Correspondence
Address : Satnam Kaur, Department of Pediatrics, Vardhman Mahavir Medical College, New Delhi, India. E-mail: sk_doc@yahoo.co.in |
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Introduction: Transcutaneous Bilirubin (TcB) is a non invasive, point of care test for assessing bilirubin level. There has been renewed interest in use of this method with availability of newer generation transcutaneous bilirubinometer (Bilichek and JM-103). Indian studies evaluating TcB with newer generation bilirubinometer have limitations of small sample size, inclusion of mainly term neonates and focusing only on correlation between the two methods (ignoring agreement between the two). Aim: To compare TcB measurement with Total Serum Bilirubin (TSB) in neonates (term as well preterm) with clinically significant jaundice. Materials and Methods: This cross-sectional study enrolled 400 healthy neonates (<34 weeks-50, 34-37 weeks-152, >37 weeks-198) who were judged to have clinically significant jaundice and required TSB estimation. TcB was measured at forehead using TcB meter (DRAGER, JM-103) within 30 minutes of obtaining sample for TSB. TcB -TSB difference was computed. Pearson’s correlation coefficient and Bland Altman analysis were used to assess the strength of association and agreement, respectively between the two values. Results: Mean (±SD) TcB-TSB difference was 0.68±2.12 mg/dL (range -5.6 to 6.9 mg/dL). Corresponding difference in preterm and term babies was 1.20±1.92 mg/dL (range -4.1 to 5) and 0.15±2.19 mg/dL (range -5.6 to 6.9 mg/dL) respectively. Correlation between TcB and TSB was good across various gestational ages (r value 0.75 overall and 0.71, 0.74 and 0.74 in 30-34 weeks, 34-37 weeks and >37 weeks gestational age, respectively) and between TSB values of 10-18 mg/dL (r-value 0.79). However, correlation was poor when TSB was less than 10 mg/dL and moderate at TSB level above 18 mg/dL (r value 0.36 and 0.65, respectively). Clinically relevant discrepancy of ≥±3 mg/dL between TcB and TSB was present in 17% of study subjects. The 95% limits of agreement between TcB-TSB and mean of TcB and TSB by Bland Altman analysis were estimated to be -3.48 to 4.84 suggesting poor agreement between two methods. Conclusion: TcB correlates well with TSB in TSB range of 10-18 mg/dL but agreement between two methods is not good and underestimation by TcB at higher values of TSB is a concern. So, TcB is not a substitute for TSB and should never be used in isolation. |
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