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Review
. 2024 May 28;5(5):CD011060.
doi: 10.1002/14651858.CD011060.pub2.

Transcutaneous bilirubinometry for detecting jaundice in term or late preterm neonates

Charles I Okwundu  1 , Vinod K Bhutani  2 , Olalekan A Uthman  3 , Johan Smith  4 , Abiola Olowoyeye  5 , Michelle Fiander  6 , Charles S Wiysonge  7
Affiliations
Review

Transcutaneous bilirubinometry for detecting jaundice in term or late preterm neonates

Charles I Okwundu et al. Cochrane Database Syst Rev. .

Abstract

Background: The American Academy of Pediatrics and the Canadian Paediatric Society both advise that all newborns should undergo bilirubin screening before leaving the hospital, and this has become the standard practice in both countries. However, the US Preventive Task Force has found no strong evidence to suggest that this practice of universal screening for bilirubin reduces the occurrence of significant outcomes such as bilirubin-induced neurologic dysfunction or kernicterus.

Objectives: To evaluate the effectiveness of transcutaneous screening compared to visual inspection for hyperbilirubinemia to prevent the readmission of newborns (infants greater than 35 weeks' gestation) for phototherapy.

Search methods: We searched CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, ICTRP, and ISRCTN in June 2023. We also searched conference proceedings, and the reference lists of included studies.

Selection criteria: We included randomized controlled trials (RCTs), quasi-randomized, cluster-randomized, or prospective cohort studies with control arm that evaluated the use of transcutaneous bilirubin (TcB) screening for hyperbilirubinemia in newborns before hospital discharge.

Data collection and analysis: We used standard methodologic procedures expected by Cochrane. We evaluated treatment effects using a fixed-effect model with risk ratio (RR) and 95% confidence intervals (CI) for categorical data and mean, standard deviation (SD), and mean difference (MD) for continuous data. We used the GRADE approach to evaluate the certainty of evidence.

Main results: We identified one RCT (1858 participants) that met our inclusion criteria. The study included 1858 African newborns at 35 weeks' gestation or greater who were receiving routine care at a well-baby nursery, and were randomly recruited prior to discharge to undergo TcB screening. The study had good methodologic quality. TcB screening versus visual assessment of hyperbilirubinemia in newborns: - may reduce readmission to the hospital for hyperbilirubinemia (RR 0.25, 95% CI 0.14 to 0.46; P < 0.0001; moderate-certainty evidence); - probably has little or no effect on the rate of exchange transfusion (RR 0.20, 95% CI 0.01 to 14.16; low-certainty evidence); - may increase the number of newborns who require phototherapy prior to discharge (RR 2.67, 95% CI 1.56 to 4.55; moderate-certainty evidence). - probably has little or no effect on the rate of acute bilirubin encephalopathy (RR 0.33, 95% CI 0.01 to 8.18; low-certainty evidence). The study did not evaluate or report cost of care.

Authors' conclusions: Moderate-certainty evidence suggests that TcB screening may reduce readmission for hyperbilirubinemia compared to visual inspection. Low-certainty evidence also suggests that TcB screening probably has little or no effect on the rate of exchange transfusion compared to visual inspection. However, moderate-certainty evidence suggests that TcB screening may increase the number of newborns that require phototherapy before discharge compared to visual inspection. Low-certainty evidence suggests that TcB screening probably has little or no effect on the rate of acute bilirubin encephalopathy compared to visual inspection. Given that we have only identified one RCT, further studies are necessary to determine whether TcB screening can help to reduce readmission and complications related to neonatal hyperbilirubinemia. In settings with limited newborn follow-up after hospital discharge, identifying newborns at risk of severe hyperbilirubinemia before hospital discharge will be important to plan targeted follow-up of these infants.

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Conflict of interest statement

CIO is an Associate Editor for Cochrane Neonatal. However, his participation in the editorial group has not impacted this review. He authored an included study (Okwundu 2020). The funding source for this study was the South African Medical Research Council.

VKB is an author of a study included in this review (Okwundu 2020). The funding source for this study was the South African Medical Research Council. VKB is a member of the American of Pediatrics, Sub‐Committee on Hyperbilirubinemia, and a member of the Committee of Fetus and Newborn. Prof Bhutani has published opinions in medical journals that are relevant to the intervention in the Cochrane review (Bhutani 1999; Bhutani 2000; Bhutani 2013).

OAU: none.

JS is an author of a study included in this review (Okwundu 2020). The funding source for this study was the South African Medical Research Council.

AO: none.

MF is an Information Specialist and Managing Editor with Cochrane Neonatal. However, her participation in the editorial group has not impacted this review.

CSW is an Honorary Professor at Cochrane South Africa. However, his Cochrane affiliation has not impacted this review. He co‐authored an included study (Okwundu 2020). The funding source for this study was the South African Medical Research Council.

Given some authors of the review authored the included study, independent authors, AO and OAU, screened titles and abstracts of the search output to identify potentially eligible studies, assessed the risk of bias, and graded the evidence.

Update of

  • doi: 10.1002/14651858.CD011060

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References

References to studies included in this review

Okwundu 2020 {published data only}
    1. Okwundu C, Bhutani VK, Smith J, Esterhuizen TM, Wiysonge C. Predischarge transcutaneous bilirubin screening reduces readmission rate for hyperbilirubinaemia in diverse South African newborns: a randomised controlled trial. South African Medical Journal 2020;110(3):249-54. [DOI: 10.7196/SAMJ.2020.v110i3.14186] [PMID: ] - DOI - PubMed

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References to other published versions of this review

Okwundu 2014
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