Transcutaneous bilirubin levels in newborns < 35 weeks' gestation

OBJECTIVE: In infants <35 weeks' gestation, we sought to define the transcutaneous bilirubin (TcB) levels at which a total serum bilirubin (TSB) level suggesting the need for phototherapy is unlikely to occur and a TSB measurement can, therefore, be avoided. STUDY DESIGN: Nursing staff performed 896 TcB measurements within 1 h of a TSB on 225 neonates 26 0/7-34 6/7 weeks' postmenstrual age (PMA). Generalized linear models were fit with generalized estimating equations (GEEs) to model the probability of having a TSB level at or above the phototherapy initiation cutpoint as a function of the TcB; these methods allow for multiple tests per infant. RESULTS: The mean difference between TcB and TSB measurements was <1mg dl(-1) for each PMA category. When the TcB was at least 3mg dl(-1) below the TSB cutpoint for phototherapy, there was a. 98% probability that the TSB was not at, or above, the recommended phototherapy level. The single exception to this was a phototherapy level of 6mg dl(-1) for infants of 28 0/7-29 6/7 weeks' PMA, where a TcB of 4mg dl(-1) below the phototherapy level (ie a TcB <= 2mg dl(-1)) was necessary to achieve. 98% probability. CONCLUSION: Our data support the use of routine TcB screening for infants 28-34 6/7 weeks' gestation. TcB screening in the neonatal intensive care unit can identify infants who require a TSB to confirm or exclude the need for phototherapy.