Journal of perinatology : official journal of the California Perinatal Association · 2026
Transcutaneous bilirubin measurements in preterm infants: the impact of race, age, and phototherapy.
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Cordero Natasha, Petrova Anna, Halari Amrryn, Hegyi Thomas
Аннотация
BACKGROUND: Monitoring bilirubin in preterm neonates is essential to prevent neurotoxicity. Total serum bilirubin (TSB) remains the diagnostic standard, while transcutaneous bilirubinometry (TcB) offers a rapid, non-invasive, and cost-effective alternative. However, TcB's accuracy in preterm infants, especially during phototherapy and across racial or gestational groups, remains uncertain.
OBJECTIVE: To assess concordance between TcB and TSB in preterm neonates across gestational ages, racial/ethnic groups, and phototherapy exposure.
METHODS: We analyzed 330 paired TcB-TSB readings from 113 preterm infants (postnatal age 5-408 h, mean ± SD: 91.8 ± 64.2) in a NICU. Infants were categorized by gestational age (<28, 28-32, 32-36 weeks), including self-reported maternal race and ethnicity. We employed correlation analysis, paired t-tests, linear regression, and Bland-Altman plots. TcB was evaluated under phototherapy (exposed vs. patched skin) in relation to escalation of care thresholds (ECT).
RESULTS: TcB and TSB were strongly correlated overall (r = 0.822), but the level of agreement varied by gestational age and phototherapy exposure. Accuracy declined with phototherapy, especially on exposed skin. Bland-Altman analysis showed that TSB and TcB are not interchangeable. Finally, TcB-ECT concordance was low.
CONCLUSION: TcB correlates with TSB but lacks sufficient accuracy for standalone use in preterm infants, particularly during phototherapy. Caution is called for in clinical application.
OBJECTIVE: To assess concordance between TcB and TSB in preterm neonates across gestational ages, racial/ethnic groups, and phototherapy exposure.
METHODS: We analyzed 330 paired TcB-TSB readings from 113 preterm infants (postnatal age 5-408 h, mean ± SD: 91.8 ± 64.2) in a NICU. Infants were categorized by gestational age (<28, 28-32, 32-36 weeks), including self-reported maternal race and ethnicity. We employed correlation analysis, paired t-tests, linear regression, and Bland-Altman plots. TcB was evaluated under phototherapy (exposed vs. patched skin) in relation to escalation of care thresholds (ECT).
RESULTS: TcB and TSB were strongly correlated overall (r = 0.822), but the level of agreement varied by gestational age and phototherapy exposure. Accuracy declined with phototherapy, especially on exposed skin. Bland-Altman analysis showed that TSB and TcB are not interchangeable. Finally, TcB-ECT concordance was low.
CONCLUSION: TcB correlates with TSB but lacks sufficient accuracy for standalone use in preterm infants, particularly during phototherapy. Caution is called for in clinical application.