Original Paper

Neonatology 2017;111:1–7 Received: November 24, 2015

Accepted after revision: June 21, 2016
DOI: 10.1159/000447736
Published online: August 5, 2016

Diagnosis Accuracy of Transcutaneous

Bilirubinometry in Very Preterm
Newborns
Amandine Rubio a–c Chloé Epiard d Maya Gebus d, e Michel Deiber e
Sylvain Samperiz f Céline Genty g Anne Ego g, h Thierry Debillon b, d
a
Clinique Universitaire de Pédiatrie, CHU de Grenoble Alpes, b Université Grenoble Alpes, c INSERM, U836, and
d
Clinique Universitaire de Médecine Néonatale et Réanimation Pédiatrique, CHU de Grenoble Alpes, Grenoble,
e
Service de Néonatologie et Réanimation Néonatale, CH de Chambéry, Chambéry, f Service de Réanimation
Néonatale et Infantile, CHU Felix Guyon de la Réunion, Saint-Denis, g INSERM CIC 1406, and h CHU de Grenoble Alpes,
Pôle Santé Publique, Grenoble, France

Key Words analyses. Results: Altogether, 481 measurements were ana-

Hyperbilirubinemia · Jaundice · Transcutaneous bilirubin
Abstract
Background: Transcutaneous bilirubin (TcB) is a validated
test for systematic screening of neonatal hyperbilirubinemia
and monitoring term and near-term infants under photo-
therapy. Objectives: To evaluate TcB diagnostic accuracy for
very preterm neonates. Methods: Total serum bilirubin (TSB)
and TcB measurements were performed prospectively in a
multicenter sample of newborns <30 weeks of gestational
age (GA). TcB sensitivity, specificity, predictive values, and
likelihood ratios for the detection of neonates requiring pho-
totherapy were calculated over the first 15 days of life, with
or without phototherapy, with the expectation of achieving
a detection rate of hyperbilirubinemia of over 95%. The po-
tential influence of neonatal characteristics on the discor-
dance between TcB and TSB in very preterm newborns was
analyzed using multivariate multilevel logistic regression
lyzed in 167 preterm patients. Mean GA was 27.6 ± 1.6 weeks.
The rates of newborns requiring phototherapy were 52% in
the first 3 days, 16% from the 4th to the 7th day, and 2% dur-
ing the second week. Diagnostic performance was similar
among babies with or without phototherapy. TcB sensitivity
decreased over time from 100% (93.9–100.0) to 50% (1.3–
98.7). Specificity showed an inverse evolution from 14.8%
(7.0–26.2) to 80.7% (72.2–89.2). The best performance was
that of negative predictive values which varied from 95.5 to
100.0. False negatives were rare throughout the study (0.8%
of measurements). In a multivariate analysis, the only factor
significantly influencing discordance between TcB and TSB
was postnatal age. We did not find any impact of GA and skin
color. Conclusion: Among very preterm babies, TcB mea-
surements might be useful for screening for neonatal jaun-
dice in the first 2 weeks of life. In case of a TcB value below
the phototherapy threshold, invasive TSB quantification
could be unnecessary, with potential avoidance of blood
drawing. © 2016 S. Karger AG, Basel
130.237.122.245 - 8/7/2016 9:42:56 AM
Karolinska Institutet, University Library

© 2016 S. Karger AG, Basel Prof. Thierry Debillon, MD, PhD

Clinique Universitaire de Médecine Néonatale et Réanimation Pédiatrique
CHU de Grenoble Alpes, Avenue Maquis du Grésivaudan
Downloaded by:

E-Mail karger@karger.com
FR–38000 Grenoble (France)
www.karger.com/neo
E-Mail tdebillon @ chu-grenoble.fr
 Introduction
Neonatal jaundice is an extremely frequent [1, 2] and
potentially dangerous condition for preterm babies [3].
Accurate determination of bilirubin levels is therefore es-
sential for diagnosis and therapy. The reference method
is the determination of total serum bilirubin (TSB). As
jaundice is often prolonged and recurrent in preterm in-
fants, this leads to repeated sampling, which can prove
painful and time-consuming, and may lead to significant
blood loss, especially in very-low-birth-weight infants.
Transcutaneous bilirubin (TcB) measurement has
been shown to be a convenient noninvasive, rapid, innoc-
uous, and reliable method for TSB estimation in term and
near-term neonates [4, 5]. However, studies carried out in
preterm neonates have yielded varying results. TcB-TSB
correlation seems to decrease when gestational age (GA)
is low [6–9]. There are few studies of very preterm babies
<30 weeks’ GA, and results have often proven contradic-
tory [10]. Only one study has exclusively explored this
population, but the patient cohort was small (n = 24) [11].
Preterm neonates requiring phototherapy also need
frequent monitoring of bilirubin after treatment initia-
tion to assess response. However, the performance of TcB
during phototherapy and in the hours after discontinua-
tion of phototherapy is still debated, even in term and
near-term neonates [12–14], and has never been explored
in very preterm infants.
BiliCheck® (Philips, USA) is a widespread second-
generation bilirubinometer that has shown good correla-
tions with conventionally determined TSB levels [4, 5].
The intradevice imprecision has been deemed acceptable
in the very preterm population (2.3 ± 13.5 μmol/l) [11].
The purpose of this study was therefore to more pre-
cisely analyze the accuracy of BiliCheck® for the indica-
tion of phototherapy in preterm patients <30 weeks’ GA,
compared to TSB measurements. Diagnostic perfor-
mance was evaluated in two different contexts: for screen-
ing purposes (babies without phototherapy) and for bili-
rubin-monitoring purposes (during phototherapy or up
to 12 h after phototherapy). Secondary objectives includ-
ed the evolution of this performance in the first 15 days
of life and the influence of the newborn’s characteristics
on TcB reliability.
Patients and Methods
Setting and Patients
Our prospective multicenter study was carried out in the neo-
natal intensive care units (NICU) of the University Hospitals of
2 Neonatology 2017;111:1–7
DOI: 10.1159/000447736
Grenoble Alpes and Saint-Denis de la Réunion, France, and the
Regional Hospital of Chambery, France.
Preterm babies <30 weeks’ GA, born between March 2013 and
August 2014 in these 3 hospitals, with one or more TSB determina-
tions during the first 15 days of life, were included in this study.
Patients with conjugated hyperbilirubinemia were excluded. Ba-
bies undergoing phototherapy or who had already received photo-
therapy were not excluded.
Decisions regarding hyperbilirubinemia follow-up and treat-
ment were taken by the NICU team, according to institution pro-
tocols based on the ‘National Institute for Health and Clinical Ex-
cellence’ (NICE) TSB normograms [15].
TcB and TSB Measurements
Our gold standard was the TSB measurement, determined ac-
cording to the diazo reaction, which is currently the reference
method used in French laboratories. Significant hyperbilirubine-
mia was defined by any TSB value that exceeded the hour-specific
threshold for phototherapy. For each TSB quantification, a TcB
measurement was systematically immediately carried out by a
NICU nurse. The NICU clinicians, who are not used to monitoring
bilirubin levels through transcutaneous measurements, were
blinded to each TcB result. Clinical decisions were therefore based
exclusively on bilirubinometry.
The principle of the TcB measurement with BiliCheck® has
been extensively described [11]. If the patient had received photo-
therapy within 12 h prior to the measurements, the scans were
performed between the eyebrows, on zones of skin which had been
shielded from phototherapy light by an opaque protection mask,
as recommended for term babies. There was a safety margin of ≥1
cm between the area of measurement and the border of the mask.
The nurse was blinded to each TSB result. Each TcB value higher
or equal to the hour-specific threshold defined by the reference
curves was considered retrospectively as a positive result.
Data Collection
Neonatal characteristics were collected (GA, birth weight, gen-
der, skin color, small for GA defined as a birth weight below the
10th percentile on the Audipog curves [16], mode of delivery, and
antibiotic treatment). For each patient, intrinsic characteristics at
the time of measurement (postnatal age and weight, hemoglobin
value, skin condition in the TcB measurement zone), and admin-
istered treatment (respiratory support, phototherapy within the
previous 12 h, and inotrope treatment) were collected.
Statistical Analysis
Quantitative data were expressed as means ± SD and range.
Qualitative variables included sample size and percentage of the
study population.
First, to compare diagnosis accuracy of TcB among babies
without or under phototherapy, we selected the sample of new-
borns for whom measurements in both conditions were available.
As the dates for TSB measurements were not standardized, their
number per patient varied. To avoid statistical dependence of re-
peated measurements and unequal weight of each patient in the
database, one paired TSB-TcB measurement per child without and
under phototherapy was randomly selected. Subsequent analyses
were thus done with only one dataset per patient and photothera-
py condition (fig. 1). We estimated the sensitivity, specificity, pos-
itive (PPV) and negative predictive values (NPV), positive (LR+)
130.237.122.245 - 8/7/2016 9:42:56 AM
Karolinska Institutet, University Library
Rubio/Epiard/Gebus/Deiber/Samperiz/
Genty/Ego/Debillon
Downloaded by:
 Patients with both
a ‘without PT’ measure and
a ‘under PT’ measure*
n = 90
M = 310
Fig. 1. Flow chart of the study population.
* Used to compare TcB diagnostic perfor-
mance with or without phototherapy.
** Used to evaluate TcB diagnostic perfor-
mance according to the time period. PT = Period 1: day 0–3
n = 113
Phototherapy; n = sample size; M = total M = 151, m = 113
number of measurements; m = number of
randomly selected measurements.
and negative likelihood ratios (LR–), and their 95% CI in these two
groups.
Secondly, we represented graphically the correlation between
TcB and TSB using Pearson linear regression analysis. TcB-TSB
agreement was further assessed using the Bland-Altman technique
[17].
Considering the slope of the bilirubinemia curve, which rises
during the first 3 days and is stable thereafter, and infant matura-
tion between the first and second week of age, three distinct time
periods were established: from birth to day 3, from day 4 to day 7,
and from day 8 to day 15. By the same random process described
previously, one measurement per child and period was selected to
evaluate the consecutive performances of TcB in each period.
Thirdly, we also investigated whether neonatal characteristics
might influence the discordance between TcB and TSB in very pre-
term newborns, using multivariate multilevel logistic regression
analyses. A p value <0.05 was considered statistically significant.
The study sample size was determined according to the estimated
sensitivity of the BiliCheck®. Among the two possible types of errors,
false-positive results (TcB value above the hour-specific threshold for
phototherapy when the TSB value was below) and false-negative re-
sults (TcB value below the phototherapy threshold when the TSB
value was higher), false negatives are potentially more dangerous and
expose preterm newborns to inadequate care. Consequently, we con-
sidered that BiliCheck® would be efficient if the sensitivity was high-
er or equal to 95% (95% CI: 91–99). We estimated the incidence of
jaundice in very preterm neonates as being 85% within the first week
of life [1]. Considering this prevalence and the expected precision,
the required number of 150 inclusions was retained.
Data were analyzed using STATA 13.0 (StataCorp, College Sta-
tion, Tex., USA).
The study protocol was written and carried out in accordance
with the ethical standards of the Helsinki Declaration of 1975, as
revised in 1983. It was approved by the Rhone-Alpes Auvergne Re-
gional ethics committee on human experimentation (IRB No. 5891,
February 6th, 2013). All parents of the included neonates gave their
informed consent for their child’s participation in the study.
BiliCheck® in Very Preterm Newborns
Patients with only Patients with only
‘without PT’ measures ‘under PT’ measures
n = 44 n = 33
M = 102 M = 69
Overall sample**
n = 167
M = 481
Period 3: day 4–7 Period 3: day 8–15
n = 132 n = 90
M = 191, m = 132 M = 139, m = 90
Results
Study Population
A total of 167 patients were included. Characteristics
of the study population are presented in table 1. Mean GA
was 27.6 ± 1.6 weeks (range: 24–29.9) and the mean birth
weight was 985 ± 248 g (range: 470–1,740). Thirteen pa-
tients died in the NICU. All patients required photother-
apy at least once; 52% of patients had hyperbilirubinemia
which required phototherapy during the first time peri-
od, 16% during the second time period, and 2% during
the third time period. No patient presented with jaundice
requiring exchange transfusion. At the time of bilirubin
measurement, 97% of patients benefited from noninva-
sive (49%) or invasive (48%) respiratory support.
One hundred and ninety-seven measurements were
taken while the patient received phototherapy in the
previous 12 h. Ninety newborns had both one measure-
ment without phototherapy and one measurement per-
formed within 12 h of phototherapy, while 44 patients
had only measurements done without phototherapy and
33 patients had only measurements during photothera-
py. Figure 1 details the 3 groups of patients and how
their measurements were used in the different analyses.
A total of 481 paired TcB-TSB measurements were ob-
tained, and the mean number of measurements per pa-
tient was 3 ± 1 (range: 1–9) (fig.  1). According to the
timing of the measurement, 113 patients had at least one
paired measurement between birth and day 3, 132 be-
tween days 4 and 7, and 90 during the second week of
life (fig. 1).
130.237.122.245 - 8/7/2016 9:42:56 AM
Karolinska Institutet, University Library
Neonatology 2017;111:1–7 3
DOI: 10.1159/000447736
Downloaded by:
Table 1. Characteristics of the study population (n = 167) Diagnostic Quality of the BiliCheck®
From the 90 patients for whom measurements were
Neonatal characteristics taken both during and without phototherapy, the details
Males 97 (58)
GA, weeks 27.6 ± 1.6 of TcB sensitivity, specificity, VPP, VPN, LR+, and LR–
for the diagnosis of hyperbilirubinemia requiring photo-
GA groups therapy are given in table  2, according to the circum-
24 – 26 weeks 29 (17)
26 – 28 weeks 55 (33) stance of the measurements. None of these indicators dif-
28 – 30 weeks 83 (50) fered significantly between the two conditions. With or
without phototherapy, the sensitivity [respectively 100%
Birth weight, g 985 ± 248
(86.3–100) and 100% (78.2–100)] and NPV [respectively
Birth weight groups 100% (91.2–100) and 100% (92.0–100)] of TcB were ex-
<1,000 g 91 (55)
≥1,000 g 76 (46)
cellent. Specificity and PPV did not differ significantly
between the two groups. This allowed us to combine all
Small for GA (10th percentile) 16 (10) of the measurements, performed under or without pho-
Presumed cause of prematurity totherapy, for the subsequent analyses.
Idiopathic preterm labor 84 (50) In table 3, TcB performances are presented according
Vascular placental disease 39 (23) to the time period of the measurement. Sensitivity de-
Maternal infectious disease 17 (10)
Multiple pregnancy 15 (9)
creased over time from 100% (93.2–100.0) to 50% (1.3–
Antenatal intrauterine growth restriction 12 (7) 98.7), while specificity increased from 14.8% (7.0–26.2) to
80.7% (72.2–89.2). LR+ results were rather low [at best
Caesarean section 113 (68)
2.75 (0.64–11.8) during the third period]. Due to the sen-
Hemoglobin at birth, g/l 152 ± 24 sitivity of 100%, LR– in the first period was excellent and
Skin color equal to 0, but its values in the others intervals were not
Pale 127 (76) relevant.
Intermediate 37 (22) Overall, the TcB-TSB correlation was high (r = 0.81,
Dark 3 (2) 95% CI: 0.77–0.84, p < 0.0001) (fig. 2). This correlation
Maternal-fetal infection varied little according to phototherapy (r = 0.84, 95% CI:
None 96 (58) 0.81–0.87, p < 0.0001 without phototherapy, and r = 0.74,
Suspected 57 (34)
95% CI: 0.67–0.80, p < 0.0001 with phototherapy). How-
Proven 14 (8)
ever, the Bland and Altman plot (fig. 3) indicated that TcB
Death 13 (8) tended to overestimate TSB, whatever the sample of mea-
Values are presented as n (%) or means ± SD.
surements, with and without phototherapy (see www.
karger.com/doi/10.1159/000447736 for all online suppl.
material). More precisely, the mean difference was 61 ±
37 μmol/l between birth and day 3, 42 ± 41 μmol/l be-
tween days 4 and 7, and 30 ± 31 μmol/l between days 8
Table 2. Diagnostic performance of TcB for the indication of pho-
totherapy during or without phototherapy: analysis of sensitivity,
and 15.
specificity, PPV, NPV, LR+, LR–, and their 95% CI In a multivariate analysis, the only factor significantly
influencing discordance between TcB and TSB was post-
With phototherapy in Without phototherapy natal age: the difference decreased 3 points per day in the
the 12 h preceding the in the 12 h preceding
measurement (n = 90) the measurement (n = 90)
first 2 weeks of life (p < 0.01). We did not find any impact
from GA and skin color.
Sensitivity 100% (86.3 – 100) 100% (78.2 – 100)
Specificity 61.5% (48.6 – 73.3) 58.7% (46.7 – 69.9) Clinical Interest of TcB in Very Preterm Infants
PPV 50.0% (35.5 – 64.5) 32.6% (19.5 – 48.0) Lastly, the NPV of the TcB for the diagnosis of hyper-
NPV 100% (91.2 – 100) 100% (92.0 – 100)
LR+ 2.6 (1.9 – 3.5) 2.4 (1.9 – 3.2)
bilirubinemia requiring phototherapy was >95% through-
LR– 0 0 out the three time periods, meaning that a negative result
could be considered reassuring in almost all the cases.
The TcB value was below the hour-specific phototherapy
threshold in 215 measurements (45%), and was in agree-
130.237.122.245 - 8/7/2016 9:42:56 AM
Karolinska Institutet, University Library

4 Neonatology 2017;111:1–7 Rubio/Epiard/Gebus/Deiber/Samperiz/

DOI: 10.1159/000447736 Genty/Ego/Debillon
Downloaded by:
Table 3. Diagnostic performance of TcB
for the indication of phototherapy per Period 1 Period 2 Period 3
period: analysis of sensitivity, specificity,
PPV, NPV, LR+, LR–, and their 95% CI Sensitivity 100% (93.2 – 100.0) 86.4% (65.1 – 97.1) 50% (1.3 – 98.7)
Specificity 14.8% (7.0 – 26.2) 57.3% (47.5 – 66.7) 80.7% (72.2 – 89.2)
PPV 50% (40.0 – 60.0) 28.8% (18.3 – 41.3) 5.9% (0.1 – 28.7)
NPV 100% (66.4 – 100.0) 95.5% (87.3 – 99.1) 98.6% (92.6 – 100.0)
LR+ 1.17 (1.06 – 1.30) 2.02 (1.54 – 2.66) 2.75 (0.64 – 11.8)
LR– 0.0 (NA) 0.24 (0.08 – 0.69) 0.61 (0.15 – 2.45)

400 200

300
100

TcB î TSB (μmol/l)

TcB (μmol/l)

200
0

100
–100

0
–200

0 100 200 300 400 0 100 300 400

TSB (μmol/l) (TcB + TSB)/2 (μmol/l)

Fig. 2. Relationship between TcB and TSB values. Fig. 3. Bland-Altman plots for TcB and TSB measurements.

ment with the TSB value for the absence of treatment re-
quirement in 211 of them (98%). These results were not
significantly influenced by the patient’s intrinsic charac-
teristics or treatment at the time of measurement. Relying
solely on the TcB result for screening of very preterm ba-
bies with hyperbilirubinemia requiring phototherapy
would have avoided 211 TSB measurements, with poten-
tial avoidance of blood drawing.
Discussion
The purpose of our study was to analyze the accuracy
of TcB in very preterm patients <30 weeks’ GA, a popula-
tion that has scarcely been represented in previous studies
[11, 18, 19] both for hyperbilirubinemia screening before
phototherapy and for bilirubin monitoring of babies un-
der phototherapy. In this population, we showed diag-
nostic performance of TcB was comparable for hyperbil-
irubinemia screening and for bilirubin monitoring dur-
ing phototherapy and in the hours following treatment
discontinuation. These results had also been found by
others in term or near-term populations [13, 14], al-
though this is still debated [12].
TcB sensitivity and LR– were excellent during the first
days of life, but decreased over time, namely due to a re-
duced requirement for phototherapy, while the NPV re-
mained >95% throughout the 3 time periods. Our results
thereby indicate that the protocol for transcutaneous
screening of hyperbilirubinemia in term neonates could
also be applied, as the first line in the screening strategy,
to the extremely preterm population. Indeed, a negative
TcB value would safely eliminate the need for TSB deter-
mination and phototherapy. This situation represented
45% of the measurements performed in the first 15 days
of life in our study.
This suggestion is in accordance with the recommen-
dation made by Nagar et al. [10] in their review of the re-
liability of TcB devices in preterm infants. Our results fur-
ther showed that this recommendation is also applicable
130.237.122.245 - 8/7/2016 9:42:56 AM
Karolinska Institutet, University Library

BiliCheck® in Very Preterm Newborns Neonatology 2017;111:1–7 5

DOI: 10.1159/000447736
Downloaded by:
to preterm infants during phototherapy and in the 12 h
after phototherapy (a subgroup that had not been includ-
ed in the review), when the tested areas were covered by
opaque patches. Furthermore, these recommendations
could act to significantly reduce or avoid the requirement
for invasive TSB determination. This is particularly inter-
esting during the second week of life when the patient’s
condition is more stable and requires less biological mon-
itoring.
Our study has several limitations. We made the prag-
matic choice to refer to the current standard diagnosis
method for TSB determination in French laboratories,
which is the diazo method, as has been done by others
previously [10]. Other authors have performed analyses
by using plasma high-performance liquid chromatogra-
phy [20]. However, this method is available only in few
centers and not for clinical management. Direct spectro-
photometry of capillary heel blood might have been a
preferable alternative [7], but it is not commonly avail-
able in French NICUs.
We must acknowledge the fact that the lack of effect of
phototherapy on TcB reliability could actually be due to
two factors: the exposure duration to phototherapy be-
fore TcB-TSB measurements, which were different be-
tween subjects and had not been recorded in the study,
and the varying percentage of bilirubin production due to
hemolysis, which could have unbalanced the production/
elimination ratio in some subjects.
The analysis of the correlation between TcB and TSB
did not take into account specific information such as
skin maturity, temperature at the TcB assay, albumin-
emia and capillary pH, as these data were unfortunately
not recorded. These could be confounding factors, in par-
ticular albuminemia and capillary pH which are the main
determinants for bilirubin extravasation and skin deposi-
tion, and thus for TcB. Indeed, it must be kept in mind
that while TcB is strongly related to TSB, it corresponds
to extravascular rather than intravascular bilirubin (bili-
rubin extravasated and deposited in the skin), and is thus
a basically distinct variable from TSB [21].
Although melanin is thought to influence spectral re-
flectance [9], in our very preterm population in which
babies of non-Caucasian origin with intermediate to dark
skin comprised 24%, skin color did not affect the differ-
ence between TcB and TSB. This result supports previ-
ously published studies [4, 22, 23]. Unlike previous anal-
ysis, we found a significant influence from postnatal age
[5, 19, 24]. This effect could reflect the decrease of neona-
tal jaundice in the first weeks of life, lowering the absolute
difference between the two measurements. It is, however,
6 Neonatology 2017;111:1–7
DOI: 10.1159/000447736
noteworthy that our study was not adequately powered to
test risk factors for TcB misclassification for the indica-
tion of phototherapy.
Lastly, despite the fact that all of the patients received
phototherapy at some time during their first week of life,
the requirement for phototherapy amongst the TcB-TSB
measurements that were retained for analysis was lower
than expected (52% vs. an expected 85%). This is partly
due to the fact that 46% of the measurements were made
during or within 12 h of phototherapy. This result implies
that our PPV and NPV results must be considered with
relative caution. In particular, NPV might have been low-
er with a higher frequency of babies requiring photother-
apy.
According to the review by Nagar et al. [10], the pooled
estimates of correlation coefficients in infants <32 weeks’
GA [r = 0.89, 95% CI: 0.82–0.93) were similar to the over-
all preterm and term populations. Our results support
this data, with a correlation coefficient of 0.81 (95% CI:
0.77–0.84) and are also in accordance with the findings of
Willems et al. [11] in their study of 24 extremely-low-
birth-weight patients. However, our data indicate that the
assertion of Nagar et al. [10] that a TcB reading above the
phototherapy threshold may be sufficient grounds to ini-
tiate phototherapy and should be applied with extreme
caution in the preterm population <30 weeks’ GA. In our
series, this would have led to 65% of nonindicated photo-
therapy at the time of measurement due to the high rate
of false-positive results, and the BiliCheck®’s tendency to
overestimate TSB, in particular for high TcB-TSB values.
Altogether, our study established the usefulness of TcB
for screening of hyperbilirubinemia and bilirubin moni-
toring during and in the 12 h following phototherapy in
extremely preterm infants in stable medical conditions.
Therefore, it could find its place as the first-line test in
systematic screening/monitoring and avoid the need for
invasive bilirubin determination in cases of negative re-
sults.
Disclosure Statement
None of the authors have any conflicts of interest to declare.
130.237.122.245 - 8/7/2016 9:42:56 AM
Karolinska Institutet, University Library
Rubio/Epiard/Gebus/Deiber/Samperiz/
Genty/Ego/Debillon
Downloaded by:
 References
1 Cashore WJ, Oh W: Unbound bilirubin and
kernicterus in low-birth-weight infants. Pedi-
atrics 1982;69:481–485.
2 Watchko JF: Hyperbilirubinemia and biliru-
bin toxicity in the late preterm infant. Clin
Perinatol 2006;33:839–852; abstract ix.
3 Badiee Z, Mohammadizadeh M, Shamee M:
Diagnostic usefulness of transcutaneous bili-
rubinometry in very preterm newborns. Int J
Prev Med 2012;3:262–265.
4 Bhutani VK, Gourley GR, Adler S, Kreamer B,
Dalin C, Johnson LH: Noninvasive measure-
ment of total serum bilirubin in a multiracial
predischarge newborn population to assess
the risk of severe hyperbilirubinemia. Pediat-
rics 2000;106:E17.
5 Ebbesen F, Rasmussen LM, Wimberley PD:
A new transcutaneous bilirubinometer, Bili-
Check, used in the neonatal intensive care
unit and the maternity ward (in French). Acta
Paediatr 2002;91:203–211.
6 Mercanti I, Michel F, Thomachot L, Loundou
DA, Nicaise C, Vialet R, Di Marco JN, Lagier
P, Martin C: Transcutaneous bilirubin mea-
surement in preterm infants. Arch Pediatr
2007;14:875–880.
7 Fouzas S, Karatza AA, Skylogianni E, Manta-
gou L, Varvarigou A: Transcutaneous biliru-
bin levels in late preterm neonates. J Pediatr
2010;157:762–766.e1.
8 Tan KL, Mylvaganam A: Transcutaneous bil-
irubinometry in preterm very low birthweight
infants. Acta Paediatr Scand 1988; 77: 796–
801.
9 Knupfer M, Pulzer F, Braun L, Heilmann A,
Robel-Tillig E, Vogtmann C: Transcutaneous
bilirubinometry in preterm infants. Acta Pae-
diatr 2001;90:899–903.
BiliCheck® in Very Preterm Newborns
10 Nagar G, Vandermeer B, Campbell S, Kumar
M: Reliability of transcutaneous bilirubin de-
vices in preterm infants: a systematic review.
Pediatrics 2013;132:871–881.
11 Willems WA, van den Berg LM, de Wit H,
Molendijk A: Transcutaneous bilirubinome-
try with the BiliCheck in very premature new-
borns. J Matern Fetal Neonatal Med 2004;16:
209–214.
12 Nagar G, Vandermeer B, Campbell S, Kumar
M: Effect of phototherapy on the reliability of
transcutaneous bilirubin devices in term and
near-term infants: a systematic review and
meta-analysis. Neonatology 2016; 109: 203–
212.
13 Nanjundaswamy S, Petrova A, Mehta R, He-
gyi T: Transcutaneous bilirubinometry in
preterm infants receiving phototherapy. Am J
Perinatol 2005;22:127–131.
14 Fonseca R, Kyralessa R, Malloy M, Richard-
son J, Jain SK: Covered skin transcutaneous
bilirubin estimation is comparable with se-
rum bilirubin during and after phototherapy.
J Perinatol 2012;32:129–131.
15 Rennie J, Burman-Roy S, Murphy MS: Neo-
natal jaundice: summary of NICE guidance.
BMJ 2010;340:c2409.
16 Mamelle N, Munoz F, Grandjean H: Fetal
growth from the AUDIPOG study. I. Estab-
lishment of reference curves (in French). J
Gynecol Obstet Biol Reprod (Paris) 1996; 25:
61–70.
Neonatology 2017;111:1–7
DOI: 10.1159/000447736
17 Bland JM, Altman DG: Statistical methods for
assessing agreement between two methods of
clinical measurement. Lancet 1986; 1: 307–
310.
18 Ahmed M, Mostafa S, Fisher G, Reynolds TM:
Comparison between transcutaneous biliru-
binometry and total serum bilirubin mea-
surements in preterm infants <35 weeks ges-
tation. Ann Clin Biochem 2010;47:72–77.
19 Schmidt ET, Wheeler CA, Jackson GL, Engle
WD: Evaluation of transcutaneous bilirubi-
nometry in preterm neonates. J Perinatol
2009;29:564–569.
20 Chawla D, Jain S, Kaur G, Sinhmar V, Guglani
V: Accuracy of transcutaneous bilirubin mea-
surement in preterm low-birth-weight neo-
nates. Eur J Pediatr 2014;173:173–179.
21 Bosschaart N, Kok JH, Newsum AM, Ouwe-
neel DM, Mentink R, van Leeuwen TG,
Aalders MC: Limitations and opportunities of
transcutaneous bilirubin measurements. Pe-
diatrics 2012;129:689–694.
22 Robertson A, Kazmierczak S, Vos P: Im-
proved transcutaneous bilirubinometry: com-
parison of SpectR(X) BiliCheck and Minolta
Jaundice Meter JM-102 for estimating total
serum bilirubin in a normal newborn popula-
tion. J Perinatol 2002;22:12–14.
23 Rubaltelli FF, Gourley GR, Loskamp N, Modi
N, Roth-Kleiner M, Sender A, Vert P: Trans-
cutaneous bilirubin measurement: a multi-
center evaluation of a new device. Pediatrics
2001;107:1264–1271.
24 De Luca D, Zecca E, de Turris P, Barbato
G, Marras M, Romagnoli C: Using BiliCheck
for preterm neonates in a sub-intensive unit:
diagnostic usefulness and suitability. Early
Hum Dev 2007;83:313–317.
130.237.122.245 - 8/7/2016 9:42:56 AM
Karolinska Institutet, University Library
7
Downloaded by: