Department of Family Medicine, Naval Hospital Camp Pendleton, Calif (Dr. Pace); Department of Family Medicine, University of Virginia, Charlottesville (Drs. Brown and DeGeorge) kd6fp@virginia.edu
The authors reported no potential conflict of interest relevant to this article.
The views expressed in this publication are those of the authors and do not reflect the official policy or position of the Department of the Navy, the Department of Defense, or the US government.
TSB measurement is the traditional and most widely used method for screening and diagnosing neonatal hyperbilirubinemia, but the blood draw is invasive and carries a risk (albeit low) of infection and anemia.17 Transcutaneous bilirubin (TcB) assessment is a noninvasive alternative that generally correlates well with TSB values ≤15 mg/dL,17-20 even in Hispanic, African, and multiethnic populations.18,21,22
Diagnosis of hyperbilirubinemia is made with TSB or TcB measured at >95th percentile for age in hours. TcB levels measured at >15 mg/dL should be confirmed with TSB measurement. Visual assessment of jaundice should not be used for diagnosis, as it may lead to errors.9-23
The total cost of testing is lower with TcB ($4-$15 per patient17) than with TSB when the cost of supplies and personnel are considered.24 Although more recent evidence suggests that TcB is an acceptable way to measure bilirubin in premature infants, no professional society currently recommends the use of TcB for the diagnosis of hyperbilirubinemia in infants25 <35 weeks’ gestation.
Screening recommendations lack consensus
There is a lack of consensus among professional societies on appropriate screening for neonatal hyperbilirubinemia, likely due to limited available data, necessitating expert-driven recommendations.
The AAP recommends universal screening of infants ≥35 weeks’ gestation prior to discharge with measurement of TSB/TcB and/or clinical assessment.9 The Canadian Pediatric Society recommends universal screening with TSB/TcB measurement in all infants in the first 72 hours of life.26
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