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Transcutaneous Bilirubin Measurements in Newborn Infants.

Journal of the Korean Pediatric Society 1985;28(4):314-324.
Published online April 30, 1985.
Transcutaneous Bilirubin Measurements in Newborn Infants.
Cook Huh1, Soon Bock park1, Baek Keun Lim1, Jong Soo Kim1, Duk Jin Yun2
1Department of Pediatrics, Wonju Medical College,Yonsei University
2Departmetn of Pediatrics, College of Medicine, Yonsei University
경피 빌리루빈측정기에 의한 신생아 빌리루빈 농도측정에 관한 연구
허 국1, 박순복1, 임백근1, 김종수1, 윤덕진2
1연세대학교 원주의과대학 소아과학교실
2연세대학교 의과대학 소아과학교실
Neonatal jaundice is probably the most frequently encountered diagnostic and therapeutic problem in the newborn, but its accurate assessment still requires a measurement of the serum bilirubin concentration. To date, repetitive and continuing blood sampling has been the only acceptable methodology available for monitoring the jaundiced newborn infant. This technique serves as a source of discomfort and of serious infection(Lilien LD, 1976). The transcuaneous bilirubinometer is a reflectometer which permits the noninvasive monitoring of neonatal hyperbilirubinemia. The present study evaluates the accuracy and precision of the transcutaneous bilirubinometer using a sample of 276 full term infants and 861ow birth weight and preterm infants at Won-ju Christian Hospital from July 1982 to May 1983. The results were as follows: 1)The precision of transcutaneous bilirubin measurements is a mean coefficient of variation of less than 3%. Transcutaneous bilirubin meter is sufficiently precise to provide a reliable indication of total serum bilirubin concentration levels in neonates diagnosed with clinical icterus. 2)Technique dependence in transcutaneous bilirubin measurement is the calculated coefficient of variation ranged from a low of 1.85% to a high of 3.67%. 3)Correlation between transcutaneous and serum bilirubin measurement was found a linear relationship between the two procedures which can be expressed as : r=0.753, p<0.001 ; y=0.56X+8.14. 4)Cofficiants of correlation between total serum bilirubin concentration levels and the transcutaneous bilirubin measurements of different body sites were notably high with the exceptions of the palm, sole, and heal areas. 5)Coefficiants of correlation in different birth weight groups were 0.649 at 1,000~2,000 gm, 0.569 at 2,001 〜2,500 gm, 0.793 at 2,501 〜3,000 gm, 0.755 at more 3001 gm. It was found the normal weight groups were higher coefficients of correlation. 6)Accuracy of transcutaneous bilirubinometry in different gestational age groups represented that the term infant groups were higher correlation than premature ones. 7)The coefficients of correlation were 0.693 below serum bilirubin concentration 10 mg/dl, 0.555 above 10 mg/dl. This is suggesting that the accuracy of transcutaneous bilirubino- metry may be lower at increased concentration of serum bilirubin. 8)Test has been performed to evaluate instrument accuracy in cases where hyperbilirubinemia has been treated with a regimen of phototherapy. The coefficient of correlation was low, a fact which could mean contraindication of transcutaneous bilirubin measurements in conjunction with phototherapy. 9)Limited testing has been done on those infants who have received, exchange transfusions in an effort to determine the level of instrument accuracy which can be expected in such cases. The initial results from pre- and post exchange transfusion data demonstrate an unacceptable level of correlation with total serum bilirubin concentration levels and intraindicates the use of transcutaneous bilirubin measurements in such cases. It is suggested that transcutaneous biruibinometry, utilizing the right upper chest or sternal sites, forehead, in an effective method of screening for yperbilirubinemia is healthy term infants. Although the values obtained from low birth weight, preterm infants, during phototherapy, or post exchange stage do not correlate well with serum bilirubin, the transcutaneous bilirubinometry is a noninvasive, non traumatizing method with great potevalues as a screening device.
Key Words: Transcutaneous bilirubin neonates

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