Trans-Cutaneous Bilirubinometery versus Serum Bilirubin in Neonatal Jaundice

  • Manoochehr Mahram Department of Pediatrics, Children Growth Research Center, Qazvin University of Medical Science, Qazvin, Iran.
  • Sonia Oveisi Mail Department of Community of Medicine, Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
  • Najmeh Jaberi School of Medicine, Qazvin University of Medical Science, Qazvin, Iran.
Neonatal Jaundice, Transcutaneous bilirubinometery, Bilirubin, Sensitivity, Specificity


Hyperbilirubinemia is a common problem in neonates and causes serious complications. Thus, serial measurements of bilirubin should be done. This assessment is done through two methods of laboratory measurement in serum sample and transcutaneous bilirubinometer. This descriptive study compared transcutaneous bilirubin assessment and laboratory serum bilirubin. Bilirubin level was assessed among 256 neonates admitted to the Qods Children’s Hospital in Qazvin- Iran, because of neonatal indirect jaundice, through two methods of transcutaneous bilirubinometery from two sites of forehead and sternum and laboratory measurement of bilirubin in serum. The cases were non-hemolytic icteric term neonates weighing 2500 gram or more and had not received phototherapy or other treatments. Neonates with hemolytic forms of jaundice, sepsis and suspicious to metabolic disorders were excluded. Assessments by means of KJ-8000 transcutaneous bilirubinometer from two sites of forehead and sternum and through laboratory measurement of serum bilirubin were registered and analyzed. The results of the current study showed that there was a correlation of 0.82 between serum bilirubin and transcutaneous forehead bilirubin assessment and for the used device sensitivity of 0.844; specificity of 0.842, Youden Index of 0.709 and Shortest of 0.042 for a cut-off of 12.4 in bilirubin of participants. Furthermore, Likelihood Ratio positive and negative (LR) were 5.665 and 0.164, respectively and diagnostic Odds Ratio (LR+/LR-) was 34.56. Transcutaneous bilirubinometery can be considered as a reliable tool to assess bilirubin for the screening of neonatal jaundice in term neonates.


Ambalavanan N, Carlo WA. Jaundice and Hyperbilirubinemia in the Newborn and Kernicterus. In: Kliegman RM, Stanton BF, Schor NF, et al, editors. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Elsevier Saunders; 2011: p. 603-4,608.

el-Beshbishi SN, Shattuck KE, Mohammad AA, et al. Hyperbilirubinemia and transcutaneous bilirubinometry. Clin Chem 2009;55(7):1280-7.

Ebbesen F, Rasmussen LM, Wimberley PD. A new transcutaneous bilirubinometer, BiliCheck™, used in the neonatal intensive care unit and maternity ward. Acta Paediatr 2002;91(2):203-11.

Sankaran K. Transcutaneous bilirubinometry in neonates. Paediatr Child Health 2006;11(2):75-6.

Tan KL, Dong F. Transcutaneous bilirubinometry during and after phototherapy. Acta Paediatr 2003;92(3):327-31.

Rubaltelli FF, Gourley GR, Loskamp N, et al. Transcutaneous bilirubin measurement: a multicenter evaluation of a new device. Paediatr 2001;107(6):1264-71.

Perkins NJ, Schisterman EF. The inconsistency of "optimal" cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol 2006;163(7):670-5.

Pepe MS, editor. The statistical evaluation of medical tests for classification and prediction. 1st ed. Oxford: Oxford University Press; 2004: 66-129.

Schisterman EF, Perkins NJ, Liu A, et al. Optimal Cutpoint and Its Corresponding Youden Index to Discriminate Individuals Using Pooled Blood Samples. Epidemiology 2005;16(1):73-81.

Zhou H. Statistical Inferences for the Youden Index. Mathematics Dissertations. Georgia State University. (Accessed in May 2015, 4, at Available 04&context=math_diss).

Akobeng AK. Understanding diagnostic tests 2: likelihood ratios, pre- and post-test probabilities and their use in clinical practice. Acta Paediatr 2006;96(4):487-91.

Beardsell A, Bell S, Robinson S, et al. MCEM Part A: MCQs, Royal Society of Medicine Press Ltd, UK., 2009.

Rodríguez-Capote K, Kim K, Paes B, et al. Clinical implication of the difference between transcutaneous bilirubinometry and total serum bilirubin for the classification of newborns at risk of hyperbilirubinemia. Clin Biochem 2009;42(3):176-9.

Wainer S, Parmar SM, Allegro D, et al. Impact of a Transcutaneous Bilirubinometry Program on Resource Utilization and Severe Hyperbilirubinemia. Paediatr 2012;129(1):77-86.

Sajjadian N, Shirazi H, Saalehi Z, et al. Transcutaneous Bilirubin Measurement in Preterm Neonates. Acta Med Iran 2012;50(11):765-70

Panburana J, Boonkasidach S, Rearkyai S. Accuracy of transcutaneous bilirubinometry compare to total serum bilirubin measurement. J Med Assoc Thai 2010;93(Suppl2):S81-86.

Amoozgar H, Rastegar M. Making a transcutaneous icterometer in Neonates. Iran J Pediatr 2007;17(Suppl 12):224-30.

De Luca D, Zecca E, de Turris P, et al. Using BiliCheck for preterm neonates in a sub-intensive unit: diagnostic usefulness and suitability. Early Hum Dev 2007;83(5):313-7.

Badiee Z, Mohammadizadeh M, Shamee M. Diagnostic usefulness of transcutaneous bilirubinometry in very preterm newborns, Int J Prev Med 2012;3(4):262-5.

Schmidt ET, Wheeler CA, Jackson GL, et al. Evaluation of transcutaneous bilirubinometry in preterm neonates. J Perinatol 2009;29(8):564-9.

Ahmed M, Mostafa S, Fisher G, et al. Comparison between transcutaneous bilirubinometry and total serum bilirubin measurements in preterm infants <35 weeks gestation. Ann Clin Biochem 2010;47(Pt 1):72-7.

Namba F, Kitajima H. Utility of a new transcutaneous jaundice device with two optical paths in premature infants. Pediatr Int 2007;49(4):497-501.

Mishra S, Chawla D, Agarwal R, et al. Transcutaneous bilirubinometry reduces the need for blood sampling in neonates with visible jaundice. Acta Paediatr 2009;98(12):1916-19.

How to Cite
Mahram M, Oveisi S, Jaberi N. Trans-Cutaneous Bilirubinometery versus Serum Bilirubin in Neonatal Jaundice. Acta Med Iran. 53(12):764-769.
Original Article(s)