Simultaneous measurement of total transcutaneous bilirubin on forehead and chest as a predictive model for total serum bilirubin in premature and term newborns

María Esther Martínez Mercado, Luis Fernando Torres Bernal, Javier Góngora Ortega, María del Rosario Sánchez Ortiz, José Antonio Guerrero Díaz de León


Background: detection of hyperbilirubinemia in neonates has become a challenge for healthcare systems. The objective of this study was to determine the usefulness of simultaneous measurements of total transcutaneous bilirubin on forehead (TTBf) and total transcutaneous bilirubin on chest (TTBs) as a predictive model for total serum bilirubin (TSB) in premature and term neonates.

Material and methods: a transverse and analytical study in neonates with gestational age between 30 and 42 weeks, from January 21 through April 30, 2013, at a public gynecology, obstetrics, and neonatology hospital. Pearson correlation was determined between TSB/TTBf and TSB/TTBs. Linear regression analyses were conducted for one and for several independent variables.

Results: for 89 simultaneous determinations the correlation between TSB/TTBf was 0.8411 and for TSB/TTBs 0.7942 (p < 2.2 E-16 for both cases). With the simple regression analysis between TSB and TTBf the equation was: TSB = 2.1187 + 0.7035 × TTBf (p < 2.2 E-16, R2 = 70.75%, R2 adjusted = 70.41%); for TSB and TTBs the equation was: TSB = 2.0405 + 0.6349 × TTBs (p < 2.2 E-16, R2 = 63.07%, R2 adjusted = 62.65%). With multiple regression analysis for TSB vs. TTBf, TTBs the equation was: TSB = 1.620 + 0.503 × TTBf + 0.224 × TTBs (p < 2.2 E-16, R2 = 72.87%, R2 adjusted = 72.24%).

Conclusions: it was proven that the model that included TTBf and TTBs allowed us to obtain a better prediction of TSB than models with a single measurement of TTB in hospitalized premature and term neonates.

Palabras clave

transcutaneous bilirubin, bilirubinometer, neonatal hyperbilirubinemia, kernicterus.

Texto completo:

PDF (English)


Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;114:297-316.

Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Matchko JF. Hyperbilirubinemia in the newborn infant 35 weeks gestation: an update with clarifications. Pediatrics 2009;124:1193-98.

Jimenez B, Miguel MA, Acosta JM, Fernandez MP. Detección no invasiva de hyperbilirubinemia: evaluación clínica y bilirubina transcutanea con bilirubina serica. Rev Sanid Milit Mex 2010;64:54-60.

Rubaltelli FF, Gourley GR, Loskamp N, Modi N, Roth-Kleiner M, Sender A, Vert P. Transcutaneous Bilirubin Measurement: A Multicenter Evaluation of a New Device. Pediatrics 2001;107:1264-71.

Bhutani BK, Gourly GR, Adler S, Kreamer B, Dalin Ch, Johnson LH. Noninvasive Measurement of Total Serum Bilirubin in a Multiracial Predischarge Newborn Population to Assess the Risk of Severe Hyperbilirubinemia. Pediatrics 2000;106;e17.

Romagnoli C, Tiberi E, Barone G, De Curtis M, Regoli D, Paolillo P, et al. Validation of transcutaneous bilirubinnomogram in identifying neonates not at risk of hyperbilirubinaemia: A prospective, observational, multicenter study. Early Hum Dev 2012;88:51-5.

Jangaard KA, Curtis H, Goldbloom RB, Hon D. Estimation of bilirubin using BiliChekTM, a transcutaneous bilirubin measurement device: Effects of gestational age and use of phototherapy. Paediatr Child Health 2006;11:79-83.

Fouzas S, Mantagou L, Skylogianni E, Mantagos S, Varvarigou A. Transcutaneous Bilirubin Levels for the First 120 Postnatal Hours in Healthy Neonates. Pediatrics 2010;125; e52.

Holland L, Blick K. Implementing and Validating Transcutaneous Bilirubinometry for Neonates. Am J Clin Pathol 2009;132:555-61.

Poland RL, Hartenberger C, McHenry H, Hsi A. Comparison of Skin for Sites for Estimating Serum Total Bilirubin in In-Patients and Out-Patients: Chest is Superior to Brow. J Perinatol 2004;24:541-3.

Ho E, Lee S, Chow C, Chung J. Bilicheck transcutaneous bilirubinometer: a screening tool for neonatal jaundice in the Chinese population. Hong Kong Med J 2006;12:99-102.

Stillova L, Matasova K, Mikitova T, Stilla J, Kolarovszka H, Zibolen M. Evaluation of Transcutaneous Bilirubinometry in Preterm Infants of Gestational Age 32-34 Weeks. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2007;151:267-71.

Rodriguez-Weber MA, Lopez-Candiani C, Valencia-Salazar G, Millote-Galindo G. Eficacia de un analizador de bilirubina no invasivo en neonatos. Bol Med Hosp Infant Mex 1999;56:539-42.

Draper NR, Smith H. Applied Regression Analysis. 3th edition. USA. Wiley Series in Probability and Statistics, 1998, pp. 327-68.

Engle WD, Jackson GL, Dendelbach D, Manning D, Frawley WH. Assessment of a Transcutaneous Device in the Evaluation of Neonatal Hyperbilirubinemia in a Primarily Hispanic Population. Pediatrics 2002;110:61-7.


Enlaces refback

  • No hay ningún enlace refback.