PhD-Candidate Erasmus MC Rotterdam, Zuid-Holland, Netherlands
Background: While mild neonatal jaundice is generally harmless, severe cases can lead to brain damage, making early diagnosis crucial. In the Netherlands, the vast majority of newborns are cared for at home. Jaundice recognition relies heavily on visual inspection, followed by laboratory-based bilirubin (LBB) quantification. However, visual inspection has its limitations. Given the risks of severe hyperbilirubinemia, it is imperative to explore alternative screening methods that offer greater accuracy in detecting and monitoring bilirubin levels in neonates. Objective: Impact of universal transcutaneous bilirubin (TcB) screening versus visual inspection in (near)term neonates cared for at home on timely detection of hyperbilirubinemia, while minimizing the need for invasive heel pricks. Design/Methods: We conducted a prospective multicenter study in nine Dutch midwifery practices, enrolling neonates born after 35 weeks' gestation who had not yet received phototherapy. Midwives used TcB (Draeger, JM-105) on the neonate’s sternum following visual inspection at each home visit. If TcB levels are elevated (i.e. TcB above or < 50 umol/L below the threshold for phototherapy) and/or visual jaundice, LBB quantification was performed. Two McNemar tests assessed whether, conditional on having hyperbilirubinemia necessitating treatment, (1) TcB screening improves detection versus visual inspection, and (2) fewer neonates require a heel prick if TcB screening would replace visual inspection, taking into account the repeated measurements per neonate. Analyses were performed using SPSS (v.28.0.1.0 (142)) and R (v.4.2.3). Results: We enrolled 2320 neonates, with a median gestational age of 39 weeks and birth weight of 3514 grams. According to the Dutch nomogram risk category for developing hyperbilirubinemia, 91% were low risk, 8% medium risk and 1% high risk. Neonates received TcB screening and visual inspection on a median of two visits. 86 (4%) needed treatment for hyperbilirubinemia. TcB screening increased the detection of neonates requiring treatment (+20) versus visual inspection (P=0.003), at the expense of an additional 139 heel pricks (P < 0.001).
Conclusion(s): Implementing universal TcB screening among (near)term neonates cared for at home will ensure the identification of more neonates with hyperbilirubinemia necessitating treatment versus visual inspection. For each additional neonate requiring treatment that is identified, approximately 246 TcB measurements and seven extra heel pricks are required. Future research will assess if adjusting the TcB cut-off improves recognition without excessive LBB quantification.
