Transcutaneous Bilirubinometers Inaccurate in Black
African Neonates | By Will Boggs MD | August 31, 2016
NEW YORK (Reuters Health) Transcutaneous bilirubinometers significantly overestimate serum bilirubin and may result in overtreatment in black African neonates, researchers from Nigeria report.
The magnitude of total plasma/serum bilirubin (TSB) overestimation was most intriguing: transcutaneous bilirubin (TcB) is likely to overestimate serum bilirubin by at least 3 mg/dL in one out of every three black neonates; and the overestimation may reach 8 mg/dL in some neonates, Dr. Bolajoko O. Olusanya from Center for Healthy Start Initiative, Ikoyi, Lagos, Nigeria told Reuters Health by email.
TcB tends to underestimate TSB in neonates with light or medium skin color and to overestimate TSB in neonates with dark skin color, but there is limited evidence on the divergence between TcB and TSB in settings with predominantly darkskinned infants or limited access to timely and reliable TSB measurements.
Dr. Olusanyas team investigated the prevalence and correlates of significant TcB overestimation in a black African population to facilitate optimal decisions for appropriate clinical intervention.
Among 1553 healthy infants with 2107 paired TcBTSB measurements, TcB ranged from 2.1 to 19.9 mg/dL and TSB ranged from 0.3 to 19.5 mg/dL, according to the August 30th Pediatrics online report.
TcB overestimated TSB by at least 2 mg/dL in 64.5%, by at least 3 mg/dL in 42.7%, and by at least 4 mg/dL in 25.7% of all measurements.
Of the 1774 (84.2%) overestimated TSB values 1 mg/dL, only 3.1% of cases required phototherapy.
Underestimation of TSB was uncommon only 1.1% of all measurements underestimated TSB by 2 mg/dL or more.
TcB is not a substitute for TSB in this racial group, Dr. Olusanya said. As much as possible, TSB measurements should serve as basis for initiating treatment for jaundiced neonates. Where timely TSB measurement cannot be assured, physician judgment on the overall clinical conditions of the neonates is critical in initiating treatment based solely on TcB results.
Until further improvements on available TcB devices are realized, populationbased TcB nomograms in this racial group should be considered for identifying infants at high risk of significant hyperbilirubinemia, she said. Efforts to develop more reliable lowcost pointofcare devices should be accelerated, particularly for low and middleincome countries that presently bear a disproportionate burden of avoidable bilirubininduced neonatal morbidities.
Dr. Michael Kaplan from The Hebrew University of Jerusalem, who has published extensively on hyperbilirubinemia and glucose6phosphate dehydrogenase (G6PD) deficiency, told Reuters Health, Serum bilirubin measurements are frequently hard to come by in Nigeria. So are transcutaneous devices, in fact, and in the present study were specially provided.
Transcutaneous bilirubin readings frequently overestimate the serum bilirubin measurement in this population, and TcB readings in the phototherapy zone should be confirmed with a serum test in order to avoid unnecessary hospitalization and treatment, he agreed.
Reuters Health Information © 2016
Cite this article: Transcutaneous Bilirubinometers Inaccurate in Black African Neonates. Medscape. Aug 30, 2016.