Assessment of jaundice in preterm neonates: comparison between clinical assessment, two transcutaneous bilirubinometers and serum bilirubin values


HU Bucher, Clinic of Neonatology, University Hospital, Frauenklinikstrasse 10, CH-8091 Zurich, Switzerland (Tel. +41 1 255 53 40, fax. 0041 1 255 44 42, e-mail.


Aim: 1) To compare the clinical assessment of craniocaudal progression of jaundice and two transcutaneous bilirubinometers with serum bilirubin values in preterm neonates; 2) to identify factors affecting the difference between non-invasive bilirubin estimation and serum bilirubin. Methods: Serum bilirubin was clinically estimated in healthy preterm newborn infants (34 to 36.9 gestational weeks) independently by a primary investigator and by nurses, and subsequently compared with separate measures of two transcutaneous bilirubinometers. Results: A total of 107 measurements were performed on 69 infants. Minolta JM-102 showed the best performance, with ROC area under the curve of 0.96, followed by BiliCheck™ over the sternum (0.89) and over the forehead (0.88), clinical assessment by nurses (0.73) and by a physician (0.70). Serum bilirubin <190 μmol/l can be detected with 95% sensitivity with Minolta JM–102 ≫19 units, with BiliCheck™≫145 μmol/l over the sternum and ≫165 μmol/l over the forehead and with jaundice progression to the trunk or further (Kramer zone ≫2). Gestational age affects all non-invasive methods in the estimation of serum bilirubin, whereas skin colour affects both BiliCheck™ and clinical assessment. Ambient light affects only clinical assessment.

Conclusion: Minolta JM-102 showed the best performance, closely followed by BiliCheck™, with clinical assessment performing far worse than either transcutaneous method. None of the three methods are recommended as complete substitutes for serum bilirubin values in jaundiced preterm infants.