Article

Aplicación del bilirrubinómetro no invasivo en recién nacidos

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Abstract

Introducción: Las pautas para prevención y tratamiento de hiperbilirrubinemia neonatal recomiendan medición de bilirrubina sérica total (BST) o bilirrubina transcutánea (BTc) para determinar el grado de ictericia antes del alta del recién nacido (RN); ésta última no invasiva, proporciona información instantánea y de calidad superior a la evaluación clínica. A pesar de ello aún no ha sido aplicada en forma sistemática en los hospitales de Paraguay. Objetivo: evaluar la aplicación en nuestro medio de la medición de bilirrubinemia transcutánea antes del alta correlancionando con la bilirrubina sérica. Materiales y Métodos: Estudio observacional, descriptivo con componente analítico, de corte transversal. Fueron incluidos RN con edad gestacional ≥ a 35 semanas, con peso ≥ a 2000 gramos, luego de las 24 hs de vida hasta los 8 días; bajo consentimiento informado de los padres, durante un año. Los datos fueron consignados en una planilla de Microsoft Excel y procesado por el software IBM SPSS Statistics ®. Resultados: De 271 RN que ingresaron al estudio, en la primera medición con el Bilirrubinómetro transcutáneo, cumplían con criterios para toma de bilirrubina sérica 90 (33,2%) de ellos. En los restantes 181 RN (66,8%), los datos emparejados no estaban disponibles debido a que siguiendo las recomendaciones de las guías actuales no fue necesario medir la bilirrubina sérica. El valor del coeficiente de correlación para la primera medición fue r = 0.574. Para la segunda medición las medidas emparejadas estaban disponibles para 131 RN. En este caso se encontró correlación positiva entre ambos métodos de 0,590. Conclusión: La bilirrubina transcutánea puede utilizarse en forma rápida, segura y válida, como un test de screening para la detección de hiperbilirrubinemia y podría evitar una proporción importante de toma de muestras sanguíneas, mejorando la seguridad del paciente.

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Neonatal jaundice is the most frequently encountered diagnostic and therapeutic problem in the newborn. In the jaundiced infant, it is thought that the binding capacity of plasma albumin is exceeded, which allows free bilirubin to diffuse into and accumulate within extravascular tissues, such as the central nervous system. Affected newborns may develop kernicterus. The standard method of serum bilirubin measurement requires blood specimen taken by heel prick or venepunetue which involves pain of the newborn and is time consuming. A non invasive, transcutaneous measurement of bilirubin concentration is developed to be an alternative method as a reliable for the screening method to detect hyperbilirubinemia To compare the estimates of serum bilirubin using a recently introduced device called a BiliCheck and its transcutaneous bilirubinometer index with the standard direct spectrophotometric measurement of serum bilirubin. Prospective descriptive study. Estimates of serum bilirubin, as measured using the BiliCheck, were compared with serum bilirubin concentration measured by direct spectrophotometry in neonates at Songklanagarind Hospital. Transcutaneous bilirubinometer readings were taken on the forehead. Eighty-two newborns were enrolled in the present study. The means and standard deviations of serum bilirubin concentration and transcutaneous bilirubinometer index were 11.96 +/- 2.98 and 11.61 +/- 2.93 mg/dl, respectively. There was no statistically significant difference (p = 0.44, paired t-test). The correlation coefficient between total serum bilirubin and BiliCheck index was 0.95 with the linear regression equation of Y= 0.99x + 0.4. Serum bilirubin can be accurately measured by the transcutaneous bilirubinometer index in full term newborn infants prior to any intervention modalities.
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Hyperbilirubinaemia is one of the most frequent causes of hospital readmission during the first week of life. Its detection is still a big challenge, mainly due to the early discharge from the hospital that can be associated with a delay of the diagnosis. The identification of those newborns at risk of developing significant hyperbilirubinaemia is one of the main priorities in the public health care system. An approach to the management of newborn jaundice is presented in this article, following the recommendations based on the medical evidence and on the opinion of the Standards Committee of the Spanish Society of Neonatology.
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Objective: In order to reduce invasive testing in newborns prior to discharge, we tested the direction of the correlation between transcutaneous bilirubin (TcB) and total serum bilirubin (TSB), the likelihood of missing high TSBs with a raised threshold for confirmatory testing, and also calculated potential cost savings from fewer laboratory testing. Methods: We performed a cross-sectional analysis of single paired TcB and TSB results measured at 36 ± 2 h of life in neonates ≥37 weeks admitted only to the Level 1 nursery. TcB was measured using the BiliChek® meter. Results: Of the 552 infants, 512 (92.8%) had TSB levels below TcB values. Correlation between TcB and TSB was 0.69. If TSB confirmation was to be performed at 11.7 mg/dL (medium risk threshold for phototherapy), the negative predictive value was 99.4%, with a potential cost savings of $6555.00 ($1500.00 per 100 patients). Of the 495 infants with TcB <11.7 mg/dL, only 3 had TSB levels higher than 11.7 mg/dL, and none met phototherapy threshold for low risk infants. Conclusions: TcB screening at our institution has a high negative predictive value, and can be used as a stand-alone test until values are close to phototherapy threshold, thus reducing invasive testing and cost.
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Objective: To test whether the combined use of total plasma/serum bilirubin (TSB) levels and clinical risk factors more accurately identifies infants who receive phototherapy than does the use of either method alone. Study design: We recruited healthy infants of ≥35 weeks' gestation at 6 centers that practiced universal predischarge TSB screening. Transcutaneous bilirubin (TcB) was measured at 24 hours, with TSB at 24-60 hours and at 3- to 5- and 7- to 14-day follow-up visits. Clinical risk factors were identified systematically. Results: Of 1157 infants, 1060 (92%) completed follow-up, and 982 (85%) had complete datasets for analysis. Infant characteristics included 25% were nonwhite and 55% were Hispanic/Latino; >90% were breastfed. During the first week, jaundice was documented in 84% of subjects. Predischarge TSB identified the 41 (4.2%) and 34 (3.5%) infants who received phototherapy before and after discharge, respectively. Prediction of postdischarge phototherapy was similar for combined clinical risk factors (earlier gestational age [GA], bruising, positive direct antiglobulin test, Asian race, exclusive breastfeeding, blood type incompatibility, jaundice extent) and age-adjusted TSB (area under the curve [AUC] = .86 vs .87), but combined screening was better (AUC = .95). TcB/TSB combined with GA alone was equally predictive (AUC = .95; 95% CI .93-.97). Conclusions: Jaundice is present in 4 of 5 (84%) healthy newborns. Predischarge TcB/TSB (adjusted for postnatal age) combined with specific clinical factors (especially GA) best predicts subsequent phototherapy use. Universal implementation of this strategy in the US should improve outcomes of healthy newborns discharged early.
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A new noninvasive bilirubinometer (Tc BM), which measures transcutaneous bilirubin level of the newborn, was developed as a joint effort by the present authors and the Minolta Camera Company, Ltd. A series of linear relationships were found to exist between total serum bilirubin concentration and yellowish skin color intensity in both term and low-birth-weight infants of Japanese ancestry. The instrument was examined for precision, accuracy, and technique-dependence. From these resulting relationships, it can be concluded that the transcutaneous bilirubin measurement is precise and accurate, and will become an alternative to the routine procedures used to measure serum bilirubin concentration in the near future. Although the values obtained during phototherapy or postexchange stage do not correlate well with serum bilirubin measurement, transcutaneous bilirubin will be accepted by the general nursery staffs because of its potential screening value.
Article
Unlabelled: Transcutaneous bilirubin (TcB) was measured with a new bilirubinometer, BiliCheck, in 261 jaundiced infants in the neonatal intensive care unit (NICU) [gestational age (GA) 25-43 wk] (group 1) and in 227 healthy jaundiced term and near-term infants (GA 35-43 wk) (group 2). Imprecision of a single determination of TcB measured on the forehead [TcB(h)], expressed as 1 standard deviation, was 15-18 micromol l(-1). No statistically significant difference between intraoperator and interoperator imprecision was found. There was a good correlation between TcB(h) and total serum bilirubin (TSB) in both groups of infants, although TcB(h) was on average lower than TSB. In the NICU infants, TcB(h), other things being equal, was lower in males than in females, and decreased with increasing postnatal age, for the same TSB level. In the infants in both groups who had a GA > or = 35 wk, sick infants had a higher TcB(h) than healthy infants for the same TSB level. The differences were statistically significant, but small and of minor clinical significance. Blood haemoglobin concentration, GA and ethnic origin were not found to influence TcB(h), i.e. BiliCheck corrects sufficiently for these factors. In all 488 infants, TcB was measured at four different body sites. Measurements on the forehead and sternum [TcB(s)] correlated well with TSB, while measurements on the knee and foot correlated less well. In the NICU infants TcB(h) predicted TSB statistically significantly better than TcB(s), while in the healthy term and near-term infants TcB(h) and TcB(s) predicted TSB equally well. Therefore, the preferable body site for measurement of TcB under routine conditions is the forehead. By retrospective analysis of the data, a screening model is presented whereby TcB(h) can be used to screen infants who require phototherapy. We found that using screening limits for TcB(h), which are 70% of the currently used phototherapy limits for TSB, 80% of blood samples in healthy term and near-term infants, and 42% of NICU infants with GA > or = 32 wk, could be avoided. Conclusion: BiliCheck is suitable for screening both NICU and healthy newborn infants with jaundice, with regard to the need for phototherapy. The authors recommend using a TcB(h) limit which is 70% of the currently recommended TSB limits for phototherapy, to decide whether TSB needs to be measured.
Article
This chapter will focus on techniques that have been developed to measure transcutaneous bilirubin (TcB). The first electronic TcB device proved to be useful when used as a screening method for identifying newborns who needed a serum bilirubin determination. Newer TcB devices can be used not only as screening tools but also as reliable substitutes for serum bilirubin measurements. The Chromatics Colormate III is still based on the colour of the skin, estimating serum bilirubin from skin-reflectance (skin colour) whereas the BiliCheck measures transcutaneous bilirubin by utilizing the entire spectrum of visible light (380 to 760 nm) reflected by the skin.
Correlación entre bilirrubina sérica, capilar y transcutánea en recién nacidos del hospital materno infantil German Urquid
  • B Villarroel
  • M Terceros