EVALUATION OF JAUNDICE METER (JM-103) IN THE MANAGEMENT OF NEONATAL JAUNDICE IN PRETERM NEONATES AT IRRUA SPECIALIST TEACHING HOSPITAL, EDO STATE

Abstract

Background: The objective assessment of the severity of NNJ is Total Serum Bilirubin
(TSB) determination. This requires multiple and frequent blood sampling for monitoring.
This has inherent problems, including risks of anaemia and infection, particularly in preterm
babies. There is therefore the need for a reliable, non-invasive method for assessing the
severity of NNJ which reduces the frequency of blood sampling. Transcutaneous
Bilirubinometry (TcB) meets this need. There is paucity of data on the performance of TcB
relative to TSB in preterm neonates. The aim of the present study was to evaluate the
usefulness of TcB in assessing severity of jaundice in preterm neonates, using the Jaundice
Meter (JM-103).
Methods: The subjects were preterm neonates delivered between 28 and 36 weeks gestation,
seen at Irrua Specialist Teaching Hospital (ISTH) between November 2011 and January
2012. The TSB values were determined by spectrophotometry in the Hospital’s Chemical
Pathology Laboratory. The corresponding TcB values were obtained using the JM-103. The
mean of TcB values was compared with that of TSB using Student’s t-test and the correlation
coefficient (r) between TcB and TSB was determined by regression analysis.
Results: A total of 189 paired TcB and TSB were obtained from 60 neonates. The mean (SD)
of TcB levels was 11.4 (3.1mg/dl). This was significantly higher than the TSB value of 10.2
(2.8 mg/dl) (95% confidence interval of the difference between the means was -2.3, -0.1; with
t = -3.95 and p = 0.028). The TSB-TcB difference ranged between -2.8 and 0.2 mg/dl with a
mean (S.D) of -0.79 (0.64) mg/dl. The TcB values were higher than TSB levels in 181
(95.8%), lower in four (2.1%) and the same in four (2.1%) of the 189 paired readings.
The overall correlation coefficient (r) between TcB and TSB was 0.98 (p = 0.003) and the
coefficient of determination (R2) was 0.96. The relationship between TcB and TSB is
expressed by the linear regression equation: TSB = TcB x 0.93. The correlation coefficient
was not significantly affected by gestational age and birthweight. The correlation coefficient
(r) were = 0.97, 0.98 and 0.98 respectively for the gestational ages of 28-30 weeks, 31-33
weeks and 34-36 weeks. The correlation coefficients were 0.85, 0.98, 0.97 and 0.98
respectively, for ELBW, 1000-1499gm, 1500-2499gm and NBW neonates. The correlation
coefficient (0.78) was lower at TSB of 15 mg/dl and above than that of 0.98 at lower TSB
levels though the difference was not statistically significant (p = 0.09).
Conclusion: There was a strong correlation between TSB and TcB levels. This was not
affected by gestational age, birth weight or TSB levels. The use of TcB in preterm infants
may significantly reduce the frequency of blood sampling for monitoring of severity of NNJ.
It is recommended that TcB should be routinely used for the management of neonatal
jaundice in preterm neonates to reduce the risks associated with frequent blood sampling.

EVALUATION OF JAUNDICE METER (JM-103) IN THE MANAGEMENT OF NEONATAL JAUNDICE IN PRETERM NEONATES AT IRRUA SPECIALIST TEACHING HOSPITAL, EDO STATE