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Correspondence

Indian Pediatr 2018;55: 79-80

Transcutaneous Bilirubin Measurement in Preterm Neonates Receiving Phototherapy

 

Shahid Akhtar Siddiqui

Department of Pediatrics, SN Children Hospital and MLN Medical College,  Allahabad, Uttar Pradesh, India.
Email: [email protected]

 


Pendse, et al. [1] published their unique study on transcutaneous bilirubin measurement in preterm neonates in a recent issue of Indian Pediatrics. I would like to draw authors’ attention on certain issues.

Authors state that preterm neonates >28 weeks and <37 weeks of gestation having clinically detectable jaundice were included in study. Jaundice first becomes evident on face and progresses in a cephalocaudal direction to involve chest, lower abdomen/ thigh and soles/ palms [2]. Clinically detectable jaundice up to what level was defined for inclusion in the study? Recently, visual inspection of jaundice as being reliable indicator is increasingly debated [3-5].

Authors also acknowledge that no additional blood investigations except for total serum bilirubin before starting phototherapy (PT) and at 12 hours of PT were done for the purpose of study. Exclusion criteria mentioned in the study include conjugated hyperbilirubinemia, evidence of hemolysis or poor perfusion [1]. How preterm babies having conjugated hyperbilirubinemia or evidence of hemolysis were decided clinically? Babies of mothers who are Rh-negative should ideally had a blood type, Rh and Coombs test done at birth as some unsensitized Rh-negative mothers would have needed Anti-D immunoglobulin within 72 hours after delivery.

References

1. Pendse A, Jasani B, Nanavati R, Kabra NK. Comparison of transcutaneous bilirubin measurement with total serum bilirubin levels in preterm neonates receiving phototherapy. Indian Pediatr. 2017;54:641-3.

2. Kramer LI. Advancement of dermal icterus in jaundiced newborn. Am J Dis Child. 1969;118:454-8.

3. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infants 35 or more weeks of gestation. Pediatrics. 2004;114:297-316.

4. Keren R, Tremont K, Luan X, Cnaan A. Visual assessment of jaundice in term and late preterm infants. Arch Dis Child Fetal Neonatal Ed. 2009;94:F317-22.

5. Rennie J, Burman-Roy S, Murphy MS; Guideline Development Group. Neonatal jaundice: Summary of NICE guidance. BMJ. 2010;340:c2409.

 

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