PhD-Candidate Erasmus MC Rotterdam, Zuid-Holland, Netherlands
Background: Severe neonatal hyperbilirubinemia can place a neonate at risk for brain damage. Early diagnosis is essential to prevent these deleterious sequelae. In many settings, jaundice screening primarily relies on visual inspection, but this is known to be unreliable. Objective: We evaluated if universal transcutaneous bilirubin (TcB) screening would enhance early detection in neonates cared for at home, while reducing heel pricks compared to visual inspection. Additionally, we assessed a smartphone app (Picterus) for optical bilirubin estimation. Design/Methods: We conducted a prospective multicenter study in nine Dutch primary care midwifery practices, enrolling neonates born after 35 weeks' gestation who are at home within the first week of life. During each home visit (usually two to three times per neonate), midwives used TcB (Draeger, JM-105) and Picterus after visual inspection. Midwives were blinded to the Picterus app results. Blood pricks were performed based on visual inspection and/or elevated TcB reading. Results: Among 2314 enrolled, 84 (4%) needed treatment for hyperbilirubinemia. TcB screening picked up an additional 27 neonates requiring treatment versus visual inspection (P=0.003), including two cases of extreme hyperbilirubinemia, at the expense of an additional 139 heel pricks (P < 0.001). 246 TcB measurements and seven extra heel pricks were required to identify one additional neonate requiring treatment. Sensitivity analyses, showed that when TcB is used only on those neonates with any degree of jaundice, the extra blood sampling is reduced to 60 while still recognizing all neonates in need for treatment. TcB showed consistent performance across the various Fitzpatrick skin types (I-VI). The picterus app, with a safety margin of 50, picked up an additional 10 infants who required treatment. The extra heel pricks were substantial. We are currently analyzing the Picterus performance across the various Fitzpatrick skin types (I-VI) and will be presenting these at PAS25.
Conclusion(s): Universal TcB screening among (near)term neonates cared for at home improves recognition of hyperbilirubinemia necessitating treatment versus visual inspection at the expense of extra blood pricks. Performance of the Picterus app BEAT version needs more adjustment and analyses for the ideal safety margin. Sequential use of the two screening tools In home setting could be beneficial.
