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LETTER TO EDITOR
Year : 2018  |  Volume : 3  |  Issue : 2  |  Page : 123

Correlation between transcutaneous bilirubin estimation and total serum bilirubin estimation in neonatal hyperbilirubinemia


Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq

Date of Web Publication26-Dec-2018

Correspondence Address:
Prof. Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, PO Box 55302, Baghdad Post Office, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_21_18

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How to cite this article:
Al-Mendalawi MD. Correlation between transcutaneous bilirubin estimation and total serum bilirubin estimation in neonatal hyperbilirubinemia. BLDE Univ J Health Sci 2018;3:123

How to cite this URL:
Al-Mendalawi MD. Correlation between transcutaneous bilirubin estimation and total serum bilirubin estimation in neonatal hyperbilirubinemia. BLDE Univ J Health Sci [serial online] 2018 [cited 2019 May 23];3:123. Available from: http://www.bldeujournalhs.in/text.asp?2018/3/2/123/248551



Sir,

The publication by Mandal et al. on the correlation between transcutaneous bilirubin (TCB) estimation and total serum bilirubin (TSB) estimation in neonatal hyperbilirubinemia in Indian infants was really interesting.[1] The authors found a strong agreement between TSB and TCB in the term population as well as the whole population.[1] Based on their study results, the authors recommended that all normal infants be screened for hyperbilirubinemia initially by measuring their TCB levels. If TCB reading is above the 75th percentile for age, it could then warrant for TSB level estimations.[1] The authors addressed some limitations that might cast some suspicions on the study results and recommendation. I assume that the following four limitations could be further relevant.

First, the authors conducted their study in a single-tertiary center. Therefore, the results could not be generalized to other centers across the country. Large-scale multicenter studies are needed to verify the aforementioned findings and recommendation.

Second, the authors mentioned that TCB readings were done using Konica the Jaundice Meter JM-103 device (manufactured by Draeger Medical Systems, Inc., Lubeck, Germany).[1] It is explicit that there are many different TCB meters in the clinical field to measure TCB and various agreement of TCB with each other and TSB has been reported.[2]

Third, to my knowledge, the Indian population is a unique amalgamation of diverse races and different grade of skin discoloration. I assume that the diverse racial standards of the studied cohort might change the accuracy of the study results. This is based on the observation that TCB bias could be influenced by the race when estimation was done on the forehead, but not when it was done on the sternum.[3]

Fourth, the accurate evaluation of TCB measurement in the neonatal nursery relies upon the hour-specific, percentile-based TCB nomogram.[4] Specific TCB nomogram is not yet built for Indian neonates. The authors employed in the study methodology the American bilirubin nomogram that are specific for American neonates. This ultimately might render interpretation of the reported TCB readings in the study questionable.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mandal A, Bannerji R, Ray J, Mitra M, Azad SM, Basu S. Correlation between transcutaneous bilirubin estimation and total serum bilirubin estimation in neonatal hyperbilirubinemia. BLDE Univ J Health Sci 2018;3:36-42.  Back to cited text no. 1
  [Full text]  
2.
Pratesi S, Boni L, Tofani L, Berti E, Sollai S, Dani C. Comparison of the transcutaneous bilirubinometers BiliCare and Minolta JM-103 in late preterm and term neonates. J Matern Fetal Neonatal Med 2015;2:1-5.  Back to cited text no. 2
    
3.
Holland L, Blick K. Implementing and validating transcutaneous bilirubinometry for neonates. Am J Clin Pathol 2009;132:555-61.  Back to cited text no. 3
    
4.
Mohamed I, Blanchard AC, Delvin E, Cousineau J, Carceller A. Plotting transcutaneous bilirubin measurements on specific transcutaneous nomogram results in better prediction of significant hyperbilirubinemia in healthy term and near-term newborns: A pilot study. Neonatology 2014;105:306-11.  Back to cited text no. 4
    




 

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