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Can transcutaneous bilirubin levels obtained from covered skin replace serum bilirubin measurement in neonates undergoing phototherapy?

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31. Aug. 2025

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COVER HERUNTERLADEN

Figure 1.

TcB measurements after PT. (A) TcB measurement at the exposed area and (B) TcB measurement under the covered shield. The neonate’s face is shown with full, explicit written informed consent obtained from the parents for publication of this identifiable image. The parents were informed about the nature, purpose, and extent of the publication, including digital distribution. PT, phototherapy; TcB, transcutaneous bilirubin.
TcB measurements after PT. (A) TcB measurement at the exposed area and (B) TcB measurement under the covered shield. The neonate’s face is shown with full, explicit written informed consent obtained from the parents for publication of this identifiable image. The parents were informed about the nature, purpose, and extent of the publication, including digital distribution. PT, phototherapy; TcB, transcutaneous bilirubin.

Figure 2.

Correlation between TSB and covered skin TcB (A) and exposed skin TcB (B) measurement after 24 h of PT. Correlation between TSB and covered skin TcB (C) and exposed skin TcB (D) measurements 8 h after discontinuing PT. The Bland-Altman plot shows the average of the two methods on the X-axis and the absolute difference between the two methods on the Y-axis. PT, phototherapy; TcB, transcutaneous bilirubin; TSB, total serum bilirubin.
Correlation between TSB and covered skin TcB (A) and exposed skin TcB (B) measurement after 24 h of PT. Correlation between TSB and covered skin TcB (C) and exposed skin TcB (D) measurements 8 h after discontinuing PT. The Bland-Altman plot shows the average of the two methods on the X-axis and the absolute difference between the two methods on the Y-axis. PT, phototherapy; TcB, transcutaneous bilirubin; TSB, total serum bilirubin.

Correlation between TSB values and TcB values measured from covered and exposed skin

Before PT ICC (95% CI) After 24 h of PT ICC (95% CI) 8 h after PT ICC (95% CI)
TSB vs. exposed skin TcB 0.667 (0.513–0.780) 0.229 (0.092–0.544) 0.432 (0.200–0.613)
TSB vs. covered skin TcB 0.665 (0.508–0.778) 0.520 (0.326–0.672) 0.537 (0.339–0.687)
Exposed vs. covered skin TcB 0.828 (0.737–0.890) <0.245 (0.095–0.542) 0.557 (0.056–0.784)

Epidemiological characteristics of the neonates receiving PT for hyperbilirubinemia

Characteristics N (%)
Gestational age (weeks), median (range) 38 (31–42)
Birth weight (g), mean ± SD 3020 ± 556
Sex
  Female 36 (51.4)
  Male 34 (48.6)
Maternal age (years), mean ± SD 26.3 ± 5.7
Maternal disease status
  Yes 8 (11.4)
  No 60 (88.6)
Mode of delivery
  NSVD 51 (72.9)
  C/S 19 (27.1)
Age at admission (days), median (range) 2 (1–13)
Length of stay (days), median (range) 3 (2–27)
Blood incompatibility
  None 25 (35.8)
  ABO incompatibility 41 (58.6)
  Rh incompatibility 3 (4.2)
  ABO + Rh incompatibility 1 (1.4)
DC test
  Negative 47 (67.2)
  Positive 23 (32.8)
Pathological weight loss
  Yes 10 (14.3)
  No 60 (85.7)
Cephalic hematoma
  Yes 2 (2.9)
  No 68 (97.1)

Comparison of TSB and TcB levels from covered and exposed skin measured before, during, and after PT

Mean ± SD
Before PT At 24th hour of PT 8 h after discontinuation of PT
TSB 11.91 ± 4.48 7.67 ± 2.34 7.90 ± 2.09
Covered skin TcB 11.11 ± 3.01 7.07 ± 2.25 8.61 ± 2.39
Exposed skin TcB 11.14 ± 3.11 4.13 ± 1.88 6.85 ± 2.44