While many cases of jaundice are benign, newborns must be continuously monitored to identify those who might develop severe hyperbilirunemia and, in rare cases, acute bilirubin encephalopathy or kernicterus (risk of permanent brain damage).
In the management of jaundice, the ability to screen easily and treat effectively is crucial to newborn health. It requires an approach that is:
- Simple to use
- Both efficient and effective
Screening protocols and phototherapy can help provide the best care for each infant.
Below are resource materials about jaundice management.
Understanding a common condition
Most babies affected
of healthy newborns develop jaundice.1 In preterm infants, almost every baby is affected.1 Source: Keren et al. Arch Dis Child Fetal and Neonatal Ed. 2009;94: F317-F322 and Bhutani et al. J Pediatr 2013:162;477-482
Sample Bilirubin Trend for Newborn
Most babies are discharged from the hospital much earlier than 4 days which is why it is important to recognize bilirubin levels could peak as late as the 4th day. Hyperbilirubinemia is the most common reason for readmission in the first month of life.
Total Serum Bilirubin (TSB) vs.
Transcutaneous Bilirubin (TcB)
TSB testing is the standard for bilirubin measurement which is measured directly from a blood sample and must be obtained with a heel stick procedure. TcB screening non-invasively measures bilirubin levels in the skin to provide an estimate of the TSB level. If TcB measurements reach a certain level*, a TSB test is required.*Protocols and guidelines are defined by neonatal societies,
hospitals or clinics.
Jaundice is commonly treated with phototherapy. The blue light helps reduce high levels of serum bilirubin. According to the clinician’s decision, a blood transfusion is used when the bilirubin level is at a high level.*/***Defined level according to protocols or guidelines set within a specific hospital or clinic **Bilirubin can accumulate in the gray matter of the central nervous system, thus causing a brain dysfunction called Kernicterus.
TcB in the Community
TcB is now being used beyond the hospital in a community setting. Midwifery clinics from around the world have incorporated jaundice screening devices into their practice.
Reports from Children's hospitals & midwifery clinics
Middelton Pediatrics, Orlando Florida:
“Our patients’ parents seem to be pleased with the idea of an alternative to a heel stick when a heel stick might not be necessary.”
Guilford Child Health, Greensboro, North Carolina:
“It has been immensely valuable to be able to have immediate results instead of having to wait several hours.”
ABMU health board, Swansea:
“Our two audits using the transcutaneous5 bilirubinometer showed a good acceptance of the bilirubinometer, a reduction in blood test requirement of five fold and a reduction in use of phototherapy in the postnatal wards.”5Transcutaneous: Not going underneath the skin
Midwifery Practice aan het Spaarne - Haarlem, The Netherlands:
“I plotted the results of the jaundice meter, versus the serum bilirubin levels for our low risk, mainly caucasian population. The result was a correlation that we are really satisfied with.”
Midwife clinic, Sweden:
“We like to measure the sternum4, it’s easy to access and the child can stay in the mother’s arms.”4 Sternum: the breast bone
- Reliability of Transcutaneous Bilirubin Devices in Preterm Infants: A Systematic Review
Transcutaneous bilirubin (TcB) devices are widely used for the estimation of serum bilirubin levels in term and near-term infants. Our objective was to review the diagnostic accuracy of TcB devices in preterm infants.
- Management of Hyperbilirubinemia in the Newborn Infant >35 Weeks of Gestation
In July 2004, the Subcommittee on Hyperbilirubinemia of the American Academy of Pediatrics (AAP) published its clinical practice guideline on the management of hyperbilirubinemia in the newborn infant 35 weeks of gestation, and a similar guideline was published in 2007 by the Canadian Paediatric Society.
- Transcutaneous Bilirubin Levels in the First 96 Hours - Maisels
To obtain transcutaneous bilirubin (TcB) measurements, at 6-hour intervals, in the first 96 hours after birth in a normal newborn population (gestational age: > or =35 weeks).
- Evaluation of a New Transcutaneous Bilirubinometer_Maisels et al
The objective of this study was to evaluate the Minolta/Hill-Rom Air-Shields Transcutaneous Jaundice Meter model JM-103. We studied a convenience sample of 849 newborns > or =35 weeks of gestation in 3 hospitals.
- Transcutaneous Bilirubinometers and Ethnicity
We read with interest De Luca et al’s comparison of the Medick BiliMed and Respironics BiliChek transcutaneous bilirubinometers. We agree that BiliChek provides a reliable measure of skin bilirubin and it performed well in our ethnically diverse population.