Comparison between visual assessment of jaundice, transcutaneous bilirubin and total serum bilirubin in healthy term neonates needing phototherapy

Abstract

Introduction: Neonatal jaundice is one of the most common clinical conditions in newborns. Objective: To evaluate the correlation between visual assessment of jaundice, transcutaneous bilirubin (TcB) measurement, and total serum bilirubin (TSB) level in newborns requiring phototherapy. Methods: This observational, cross-sectional, and prospective study included term newborns from a tertiary hospital who developed jaundice requiring phototherapy. The correlation between visual assessment, TcB, and TSB was analyzed using one-way analysis of variance (ANOVA) followed by Duncan’s post-hoc test. The correlation and consistency between TcB and TSB were assessed using Pearson's correlation test and Bland-Altman analysis. A p-value <0.05 was considered statistically significant. Results: 187 newborns were included. Visual assessment of jaundice showed a low correlation (22.1%) with TSB levels. The difference between TcB and TSB levels was significantly greater in infants classified as Kramer zones 4 and 5 compared to zones 1-3 (p<0.001). A strong correlation was found between TcB and TSB measurements (r=0.87; p<0.001). TcB values underestimated TSB values by an average of 1.21 mg/dL. Conclusions: TcB showed a good correlation with TSB and should be used as a reliable screening method for neonatal jaundice. However, TcB tended to underestimate TSB levels. The visual assessment of jaundice correlated poorly with bilirubin values and should not be used as a standalone method to estimate bilirubin levels in neonates.