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.