Visual assessment of bilirubin and transcutaneous bilirubinometry in detecting rebound hyperbilirubinemia requiring phototherapy re-initiation in neonates: a prospective diagnostic accuracy study.

UNLABELLED: To evaluate the diagnostic performance of and the potential reduction in blood sampling by (a) visual assessment (VA) for jaundice and (b) transcutaneous bilirubinometry (TcB) at 12-24 h after stopping phototherapy in detecting rebound hyperbilirubinemia requiring re-initiation of phototherapy in neonates born at ≥ 35 weeks' gestation. This prospective observational study was conducted at a tertiary neonatal unit in India. Eligible neonates underwent VA using Modified Kramer's method by a neonatal fellow with > 3 years of pediatrics training, TcB using Dräger JM-105™, and total serum bilirubin (TSB) by point-of-care spectrophotometry (One Beam; Ginevri, Italy) at either 12 h (neonates with hemolytic jaundice) or 24 h (neonates with non-hemolytic jaundice) after phototherapy cessation. Outcomes included sensitivity, specificity, likelihood ratios, and reduction in TSB sampling. Among 160 enrolled neonates (gestation: 36 ± 3 weeks; birthweight: 2743 ± 483 g; 35 [21.9%] with hemolytic jaundice), rebound hyperbilirubinemia occurred in 8 (5%). Sensitivity was 100% for both VA and TcB, with VA demonstrating higher specificity (88.2% vs. 71.7%). Positive predictive values were low (VA: 30.8%; TcB: 15.7%), while negative predictive values were 100% for both. Positive likelihood ratios for VA and TcB were 8.4 and 3.5, respectively. VA and TcB could have reduced TSB sampling in 134 (83.8%; 95%CI 77.0-88.7) and 109 (68.1%; 95%CI 60.4-70.9) neonates, respectively.

CONCLUSIONS: Given their excellent sensitivity and negative predictive values, VA and TcB can enable ruling out rebound hyperbilirubinemia after stopping phototherapy. Using them as primary screening tools can significantly reduce the need for blood sampling to detect rebound hyperbilirubinemia.

WHAT IS KNOWN: • Rebound hyperbilirubinemia requiring re-initiation of phototherapy occurs in a subset of neonates with pathological hyperbilirubinemia. • While visual assessment (VA) and transcutaneous bilirubinometry (TcB) are non-invasive methods for monitoring jaundice, their role in identifying rebound hyperbilirubinemia remains unclear.

WHAT IS NEW: • This study shows excellent sensitivity and negative predictive values of VA and TcB for detecting rebound hyperbilirubinemia. • The results suggest the potential of these two non-invasive methods to decrease blood sampling for serum bilirubin levels, making them valuable tools particularly in resource-constrained settings.