Transcutaneous Bilirubin Decision Rules Are Effective, but Imperfect

Transcutaneous bilirubin (TcB) meters provide a noninvasive, rapid bilirubin screening option in the birth-hospital setting. Multiple decision rules have been proposed to guide when a TcB measurement warrants obtaining blood for total serum bilirubin (TSB) measurement. Researchers analyzed roughly 1800 paired TcB/TSB measurements from newborns at 34 sites to test the performance of three such decision rules.

The rules recommend measuring TSB when TcB is as follows: rule 1: ≥75th percentile on the Bhutani nomogram; rule 2: ≥70% of the recommended phototherapy threshold; rule 3: within 3 mg/dL of the recommended phototherapy threshold. Two sets of data were analyzed: Sample 1 included sites that routinely measured TcB; the researchers retrospe…