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Reliability of transcutaneous bilirubin determination based on skin color determined by a neonatal skin color scale of our own

European Journal of Pediatrics volume 180, pages 607–616 (2021)Cite this article

Abstract

Measurement of transcutaneous bilirubin (TcB) is widely used to estimate serum bilirubin (SB). However, its reliability depending on skin tone is still controversial. Ethnic classification does not correlate well with skin tone. We aimed to determine the reliability of transcutaneous bilirubin in a multiethnic population based on skin color according to our neonatal skin color scale. We conducted a prospective, observational study comparing SB and TcB among different skin colors. With the blood sample routinely obtained at 48–72 h for the screening of inborn errors of metabolism, we determined SB and TcB with a jaundice meter. We obtained data from 1359 newborns (color 1 337, color 2 750, color 3 249, color 4 23) and analyzed 1549 dyads SB/TcB. Correlation between TcB and serum bilirubin was very good (R2 = 0.908–0.956), globally and by color group, with slight differences between darker and lighter skin colors. Bland-Altman plots showed different mean bias depending on skin color. Conclusions: Our study not only supports the reliability of TcB to assess SB regardless of skin color, but also supports the fact that TcB tends to overestimate SB in a higher degree in dark-skinned neonates. This may help reduce the number of blood samples for newborns.

What is Known:
• Jaundice meters are extensively used to diagnose neonatal hyperbilirubinemia, although controversies exist on their reliability depending on skin color.
• Only a few studies have analyzed their accuracy in multiethnic populations, but none has used a validated neonatal skin color scale.
What is New:
• We verified correlation between serum and transcutaneous bilirubin in a multiethnic population depending on skin color after classifying our neonates into color groups with our own validated neonatal skin color scale.

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Abbreviations

SB:

Serum bilirubin

TcB:

Transcutaneous bilirubin

GA:

Gestational age

BW:

Birth weight

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Acknowledgments

We would like to thank Jennifer Bricker-Bolton for proofreading this manuscript and helping with the English language.

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Affiliations

  1. Department of Neonatology, Service of Pediatrics, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain

    Silvia Maya-Enero, Júlia Candel-Pau, Jordi Garcia-Garcia & María Ángeles López-Vílchez

  2. AMIB (Assessoria Metodològica i Bioestadística) (Methodological and Biostatistical Consultancy), IMIM (Institut Hospital del Mar d’Investigacions Mèdiques) (Hospital del Mar Institute for Medical Research), Doctor Aiguader 88, 08003, Barcelona, Spain

    Xavier Duran-Jordà

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  1. Silvia Maya-Enero
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Contributions

Dr. Silvia Maya-Enero helped design the study, collected data, coordinated and supervised data collection, helped analyze the results of the study, drafted the initial manuscript, and approved the final manuscript as submitted.

Dr. Júlia Candel-Pau conceptualized and designed the study, designed the data collecting instruments, designed and created the new neonatal color scale, carried out the training of the staff in the use of the new scale, collected data, coordinated and supervised data collection, helped analyze the results of the study, helped draft the initial manuscript, and approved the final manuscript as submitted.

Dr. Jordi Garcia-Garcia helped in the initial study design, helped create the new neonatal color scale and collect data, reviewed and revised the manuscript, and approved the final manuscript as submitted.

Dr. Xavier Duran-Jordà performed all the statistical analyses, helped the rest of the authors to interpret them and provided the tables and figures. He revised the manuscript, and approved the final manuscript as submitted.

Dr. María Ángeles López-Vílchez helped conceptualize and design the study, helped create the new neonatal color scale, collected data, reviewed and revised the manuscript, and approved the final manuscript as submitted.

Corresponding author

Correspondence to Silvia Maya-Enero.

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The authors declare that they have no conflict of interest.

Ethical approval

Our hospital Ethics Committee approved this study.

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Informed consent was obtained from all individual participants included in the study.

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Maya-Enero, S., Candel-Pau, J., Garcia-Garcia, J. et al. Reliability of transcutaneous bilirubin determination based on skin color determined by a neonatal skin color scale of our own. Eur J Pediatr 180, 607–616 (2021). https://doi.org/10.1007/s00431-020-03885-0

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  • DOI: https://doi.org/10.1007/s00431-020-03885-0

Keywords

  • Neonatal
  • Serum bilirubin
  • Hyperbilirubinemia
  • Transcutaneous bilirubin
  • Jaundice
  • Jaundice meters
  • Dräger Jaundice Meter JM-105
  • Skin color