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