Transcutaneous Bilirubin Accuracy Before, During, and After Phototherapy: A Meta-Analysis

Abstract

CONTEXT Transcutaneous bilirubinometry (TcB) is used as a valid screening to identify neonates requiring measurement of total serum bilirubin (TSB) before phototherapy. Its use during and after phototherapy is not advised yet because of unknown reliability. OBJECTIVES To determine the agreement of TcB and TSB measurements before, during, and after phototherapy. DATA SOURCES PubMed Medline, Cochrane Library, and references of eligible studies were searched. STUDY SELECTION Prospective and retrospective cohort and cross-sectional studies reporting Bland-Altman statistics of paired TcB and TSB measurements in term and preterm newborns. DATA EXTRACTION Meta-analysis was performed using the Mantel-Haenszel weighted approach. The agreement between TcB and TSB in μmol/L was described by pooled mean differences (MDs) and limits of agreement (LoA). RESULTS Fifty-four studies were included. The pooled MD before phototherapy is 2.5 μmol/L (LoA −38.3 to 43.3). The pooled MD during phototherapy is −0.3 μmol/L (LoA −34.8 to 34.2) on covered skin and −28.6 μmol/L (LoA −105.7 to 48.5) on uncovered skin. The pooled MD after phototherapy is −34.3 μmol/L (LoA −86.7 to 18.1) on covered skin and −21.1 μmol/L (LoA −88.6 to 46.4) on uncovered skin. Subgroup analysis revealed the best agreement at the forehead. We did not find any difference in agreement between term and preterm neonates. LIMITATIONS Language restriction. CONCLUSIONS TcB measurements before and during phototherapy on covered skin show good agreement compared with TSB in term and preterm newborns. More studies are needed to evaluate the accuracy after phototherapy.