Author:
Dam-Vervloet Alida J.,Morsink Claudia F.,Krommendijk Marleen E.,Nijholt Ingrid M.,van Straaten Henrica L. M.,Poot Lieke,Bosschaart Nienke
Abstract
Abstract
Objective
Concerns have been raised about the effect of skin color on the accuracy of transcutaneous bilirubin (TcB) measurements, a widely used method for hyperbilirubinemia diagnosis in newborns. Literature is inconclusive, with both reported under- and overestimations of the TcB with increasing skin pigmentation. Therefore, the influence of skin color on TcB measurements was systematically evaluated in a controlled, in vitro setting.
Methods
A bilirubin meter (JM-105) was evaluated on layered phantoms that mimic neonatal skin with varying dermal bilirubin concentrations (0–250 µmol/L) and varying epidermal melanosome volume fractions (0–40%; light-dark skin color).
Results
TcB measurements were influenced by skin pigmentation. Larger mimicked melanosome volume fractions and higher bilirubin levels led to larger underestimations of the measured TcB, compared to an unpigmented epidermis. In the in vitro setting of this study, these underestimations amounted to 26–132 µmol/L at a TcB level of 250 µmol/L.
Conclusion
This in vitro study provides insight into the effect of skin color on TcB measurements: the TcB is underestimated as skin pigmentation increases and this effect becomes more pronounced at higher bilirubin levels. Our results highlight the need for improved TcB meter design and cautious interpretation of TcB readings on newborns with dark skin.
Impact
Key message: Skin color influences transcutaneous bilirubin measurements: the darker the skin, the larger the underestimation.
What this study adds to existing literature: Existing literature is inconclusive regarding the influence of skin color on transcutaneous bilirubin measurements. This study systematically evaluates and clarifies the influence of skin color on transcutaneous bilirubin measurements in a controlled, in vitro setting.
Impact: This study aids to better interpret the measured TcB level in patients with varying skin colors, and is particularly important when using TcB meters on patients with dark skin colors.
Publisher
Springer Science and Business Media LLC
Reference44 articles.
1. Bhutani, V. K. et al. Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. J. Pediatr. 162, 477–482.e1 (2013).
2. Keren, R., Tremont, K., Luan, X. & Cnaan, A. Visual assessment of jaundice in term and late preterm infants. Arch. Dis. Child Fetal Neonatal Ed. 94, 317 (2009).
3. Le Pichon, J. B., Riordan, S. M., Watchko, J. & Shapiro, S. M. The neurological sequelae of neonatal hyperbilirubinemia: Definitions, diagnosis and treatment of the kernicterus spectrum disorders (KSDs). Curr. Pediatr. Rev. 13, 199–209 (2017).
4. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 114, 297–316 (2004).
5. National Institute for Health and Clinical Excellence, (NICE). Neonatal jaundice clinical guideline. https://www.nice.org.uk/guidance/cg98/resources/jaundice-innewborn-babies-under-28-days-975756073669 Updated 2010. Accessed Aug, 2019.