Diagnostics for Newborn Jaundice- Jaundice Meters (bilirubinometers)
The Importance of Jaundice Meters (Bilirubinometers) in Diagnosis of Newborn Jaundice
Neonatal jaundice is caused by the accumulation of bilirubin in the bloodstream and affects more than half of newborns. Left untreated, jaundice can lead to permanent neurological damage and mortality, making early diagnosis extremely important. However, if it is identified early, jaundice can be easily treated using blue-light phototherapy. World Health Organization guidelines for managing hyperbilirubinemia using serum bilirubin concentration vary based on age and prematurity and can be found here.(1)
Early identification of infants at risk of severe hyperbilirubinemia is an essential component of newborn care; all newborns should be examined within 24 hours of birth and in the following two days. Parents and healthcare workers should be encouraged to look for jaundice by blanching the skin (on the nose in particular), looking at the gums and examining the eyes. Visual estimation, especially in dark-skinned babies has limitations, and it also challenging to assess the severity.
Types of Jaundice Diagnostics
In newborns, a blood sample is often collected by pricking the heel of the infant and collecting a few drops of blood in a small tube (heelstick). This is called the Total Serum Bilirubin (TSB) concentration and while it is the gold standard reference for determining newborn jaundice measurement, it is invasive, requires laboratory-based colorimetric assays, and is therefore rarely feasible in primary care or low-resource settings.
Non-invasive technology is available in some healthcare facilities that will measure bilirubin by using an instrument placed on the skin, this is called transcutaneous bilirubinometry (TcB). Transcutaneous bilirubinometry (TcB) devices, or jaundice meters are based on the principle of multi wavelength spectral reflectance from the bilirubin staining in the skin and provide an opportunity for non-invasive, point-of-care monitoring to inform treatment decisions. (3) (see Phototherapy Buyers Guide)
Non-invasive visual assessment tools such as icterometers and improved methods of digital color processing to screen for hyperbilirubinemia are also promising for point-of-care screening for determining treatment or referral.
Key Considerations for Jaundice Meters
- Screening versus diagnosing to make treatment decisions. The clinical accuracy of TcB and TSB levels are important to determine appropriate levels of phototherapy, in addition to other factors such as age and prematurity. Understanding how the device will be used, what reference or confirmatory diagnostics are available, are important to select the appropriate device for the clinical setting, and to ensure that phototherapy and clinical monitoring will be feasible by trained providers.
- Monitoring efficacy of treatment. Assessing a newborn’s response to phototherapy is important to determine dosing, duration, and changes in bilirubin levels. Quantified results, therefore, should be used to assess treatment efficacy
- Training. Understanding what to do with the results provided by either the TSB, TcB, or visual estimation should be informed by what treatment options are available under clinical supervision. Effective phototherapy, or in more extreme cases, exchange transfusion, relies on accuracy of bilirubin levels to determine if a baby should receive conventional or intensive phototherapy, and if there are other conditions that require care to be integrated with jaundice treatment.
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References and Acknowledgments
(1) World Health Organization. Recommendations for Management of Common Childhood Conditions: Evidence for Technical Update of Pocket Book Recommendations: Newborn Conditions, Dysentery, Pneumonia, Oxygen Use and Delivery, Common Causes of Fever, Severe Acute Malnutrition and Supportive Care. WHO; Geneva: 2012.
(2) Olusanya, Bolajoko O et al. “Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings.” BMC pediatrics vol. 15 39. 12 Apr. 2015, doi:10.1186/s12887-015-0358-z
(3) Bosschaart N, Kok JH, Newsum AM, et al. Limitations and opportunities of transcutaneous bilirubin measurements. Pediatrics. 2012;129(4):689-694. doi:10.1542/peds.2011-2586