Abstract
Objective: To assess accuracy in transcutaneous bilirubinometry (TcB) measurements over an 11-year period and investigate differential performances depending on ethnic background. Aims to establish a TcB screening threshold to trigger measuring the serum bilirubin (SBR) for each group.
Methods: We conducted a retrospective review using neonatal unit data from 2013–2024. All neonates with numerical paired TcB and SBR’s were included (n=1464). The ethnicity had been recorded for 1,196 neonates; TcB and SBR results for these patients were compared using 4 broad groups: White, South Asian, Chinese and Black ethnic groups. The neonatal unit used several different bilirubinometers during this time.
Findings: Among 1,464 patients, the mean TcB and SBR were 262 and 256 μmol/L respectively (p<0.00001). There was an absolute mean difference of -6 μmol/L, with 95% confidence intervals from -8 to -4 μmol/L, confirming a systematic difference. In this QIP, we have chosen to represent the difference between SBR and TcB (SBR-TcB) with the Δ symbol, for clarity. The mean Δ was 0, -3, -13 and -33 μmol/L for the Chinese, White, South Asian and Black ethnic groups respectively. Thus, there is a systematic overestimate of TcB versus SBR for all groups except the Chinese ethnicity. The overestimate is more statistically significant in darker skin tones. There was no significant change in Δ in any group over the 11 years. For all ethnicities, the 95th centiles for mean Δ ranged from +55 to +66 μmol/L. Thus, setting a cut off for +65 μmol/L regardless of skin color would ensure that 95% of children are managed safely.
Keywords
Jaundice, Bilirubin, Bilirubinometry, Transcutaneous, Kernicterus, Ethnicity, Diversity, Technology