Clinical utility of hand held, non invasive transcutaneous bilirubinometer in neonatal jaundice: a prospective observational study

Bibhudatta Mishra, Bishwajit Mishra, Guruveera Jeyasingh Malini, Arjit Mohapatra, Prafulla Kumar Biswal, Shalini Sinha, Subodh Saha, Wrunda Sakhare, Sanjeevani Patel


Background: Neonatal Jaundice is the most common morbidity in the first week of life, occurring in 60% of term and 80% of preterm newborn. However, visual inspection, being subjective, usually inaccurate and unreliable and will result in a number of unnecessary blood sampling. Taking all these in to considerations, transcutaneous bilirubinometer (TCB) may provide a solution which is an objective, noninvasive, fast and painless method of bilirubin estimation.

Methods: Transcutaneous bilirubinometer levels were measured at forehead and sternum and blood samples for TSB were collected by venepuncture within 30 minutes and sent to biochemistry lab. After getting serum bilirubin reports, TCB and TSB values were compared by using Bhutani’s hour specific nomogram.

Results: The correlation between serum bilirubin and transcutaneous bilirubin measured at forehead and sternum is very good at serum bilirubin <15 mg/dl, r value (Karl Pearson’s Correlation co-efficient) is 0.93 and 0.94 respectively.

Conclusions: The findings of the present study indicate that the TCB is a reliable screening tool for hyperbilirubinemia in newborns >35 weeks of gestation, especially with bilirubin levels ≤15 mg/dl in 2-7 days of life. TCB can be a viable option for universal screening. Incorporating the use of TCB devices in clinical practice, can reduce the need for blood sampling for the management of neonatal jaundice.


Neonatal jaundice, Transcutaneous bilirubinometer, Serum bilirubin, Kernicterus

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Knudsen A, Brodersen R: Skin colour and bilirubin in neonates. Arch Dis Child. 1989;64(4):605-9.

Kaplan M, Shchors I, Algur N, Bromiker R, Schimmel MS, Hammerman C. Visual screening versus transcutaneous biliru- binometry for predischarge jaundice assessment. Acta Paediatr. 2008;97(6):759-63.

Keren R, Tremont K, Luan X, Cnaan A. Visual assessment of jaundice in term and late preterm infants. Arch Dis Child Fetal Neonatal Ed. 2009;94: F317-22.

Bhutani VK, Gourley GR, Adler S, Kreamer B, Dalin C, Johnson LH. Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia. Pediatrics. 2000;106:E17-10.

Carbonell X, Botet F, Figueras J, Riu-Godo A: Prediction of hyperbilirubinaemia in the healthy term newborn. Acta Paediatr. 2001;90(2):166-70.

Engle WD, Jackson GL, Sendelbach DM, Manning DM, Frawley WH. Assessment of a transcutaneous device in the evaluation of neonatal hyperbilirubinemia in a primarily Hispanic population. Pediatrics. 2002;110:61-7.

Robertson A, Kazmierczak S, Vos P. Improved transcutaneous bilirubinometry: comparison of SpectR(X) Bili-Check and Minolta Jaundice Meter JM-102 for estimating total serum bilirubin in a normal newborn population. J Perinatol. 2002;22(1): 12-4.

Mishra S, Chawla D, Agarwal R, Deorari AK, Paul VK, Bhutani VK. Transcutaneous bilirubinometry reduces the need for blood sampling in neonates with visible jaundice. Acta Paediatr. 2009;98(12):1916-9.

Peterson JR, Okorodudu AO, Mohammad AA, Fernando A, Shattuck KE. Association of transcutaneous bilirubin testing in hospital with decreased readmission rate for hyperbilirubinemia. Clin Chem. 2005;51(3):540-4.

Stevenson DK, Wong RJ, VremanHJ. Reduction in hospital readmission rates for hyperbilirubinemia is associated with use of transcutaneous bilirubin measurements. Clin Chem. 2005;51(3):481-2.

El-Beshbishi SN, Shattuck KE, Mohammad AA, Petersen JR. Hyperbilirubinemia and Transcutaneous Bilirubinometry. Clin Chem. 2009;55(7):1280-7.

Ho HT, Ng TK, Tsui KC, Lo YC. Evaluation of new transcutaneous bilirubinometer in Chinese new-borns. Arch Dis Child Foetal Neonatal Ed. 2006;91(6):434-8.

Mahajan G, Kaushal R K, Sankhyan N, Sharma RL, Nakra M. Transcutaneous bilirubinometer in assessment of neonatal jaundice in Northern India. Indian Pediatr. 2005;42(1):41-5.

Grohmann K, Roser M, Rolinski B, Kadow I, Müller C, Goerlach-Graw A, et al. Bilirubin measurement for neonates: comparison of 9 frequently used methods. Pediatrics. 2006;117(4):1174-83.

Weerakul J, Boonsopa C, Sungprem K. Accuracy of transcutaneous bilirubinometry Compare to serum microbilirubin measurement in Naresuan University Hospital. Chula Med J. 2015;59(3):265-73.

Gupta BK, Chaudhary N, Bhatia B, Gupta B. Non invasive transcutaneous bilirubin as a screening test to identify the need for serum bilirubin assessment in healthy term neonates. J Univer Coll Med Sci. 2014; 1(4);17-21.

Nichols JH, Christenson RH, Clarke W, Gronowski A, Hammett- Stabler CA, Jacobs E, et al. The national academy of clinical biochemistry laboratory medicine practice guideline: evidence-based practice for point-of-care testing. Clin Chim Acta. 2007;379:14-28.

Kazmierczak S, Bhutani V, Gourley G, Kerr S, Lo S, Robertson A, Sena SF. Transcutaneous bilirubin testing. In: Laboratory medicine practice guideline: evidence-based practice for point-of-care testing. AACC Press. 2007.12:1-10.

Hemmati F, Kiyani Rad NA. The value of bilicheck as a screening tool for neonatal jaundice in the South of Iran. Iran J Med Sci. 2013; 38(2):122-8.

Stillova L, Matasova M, Zibolen M, Stilla J and Kolarovszka H. Transcutaneous Bilirubinometry in Preterm Neonates. Indian Pediatrics. 2009;46(5):405-8.

Janjindamai W, Tansantiwong T. Accuracy of transcutaneous bilirubinometer estimates using Bilicheck in Thai neonates. J Med Asso Thai. 2004;88(2):187-90.

Kolman K, Mathieson K, Frias C. A Comparison of transcutaneous and total serum bilirubin in newborn hispanic infants at 35 or more weeks of gestation. J Am Board Family Med. 2007;20(3):266-71.

Harish R, Sharma DB. Transcutaneous bilirubinometer in neonates: evaluation of Minolta Airshields Jaundicemeter. Indian Pediatr. 1998;35:264-7.

Maisels MJ, Ostrea EM, Jr, Touch S, Clune SE, Cepeda E, Kring E, et al. Evaluation of a new transcutaneous bilirubinometer. Pediatrics. 2004;113(6):1628-35.

Yamauchi Y, Yamanouchi I. Transcutaneous bilirubinometry: effect of postnatal age. Acta Paediatr Jpn. 1991;33(5):663-7.

Maisels MJ, Ostrea EM, Touch S, Clune SE, Cepeda E, Kring E, et al. Evaluation of a new transcutaneous bilirubinometer. Pediatrics. 2004;113(6):1628-35.

Neonatal Jaundice. Available at: http://www.nice. Accessed on 25 May 2016.