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Transcutaneous Bilirubin Measurement is as Effective as Laboratory Serum Bilirubin Measruement at Detecting Hyperbilirubinemia


  • Is transcutaneous measurement of bilirubin levels in infants less than 28 days old and greater than 30 weeks gestation as effective as serum bilirubin measurements in detecting hyperbilirubinemia?

Clinical Bottom Lines

  1. Hyperbilirubinemia occurs in 30-60% of term infants, and is significant (levels >13) in 3.5-12% of these children.
  2. The sensitivity of transcutaneous bilirubin measurement using the BiliCheck(forehead) vs. HPLC(gold standard) at higher levels (>17) is 50%, with a specificity of 99%, giving a positive likelihood ratio (+LR) of 50 and a negative likelihood ratio (-LR) of 0.5. When comparing the lab serum bilirubin vs. HPLC, the sensitivity is 40% with a specificity of 98% which gives a +LR of 20 and an -LR of 0.6.1
  3. In this study, the mean error of BiliCheck compared with the mean error of HPLC is independent of race, age, and birth weight.
  4. Therefore, transcutaneous bilirubin measurement with the BiliCheck(forehead) can not only be used as a screening tool, but also as a direct substitute for serum lab bilirubin measurement.

Summary of Key Evidence

  1. 210 babies in six European hospitals, who were undergoing evaluation for jaundice, had serum bilirubin (both standard lab methods and HPLC) and transcutaneous bilirubin measurements performed within 30 minutes of each other.1
  2. The gold standard (HPLC) was applied uniformly to the group and HPLC technicians were blinded to the results of lab and BiliCheck measurements.
  3. The prevalence of significant hyperbilirubinemia (defined as >15mg/dl) in this population was estimated to be 3%. With the +LRs of 50 and 20, respectively, for a bilirubin level of 17, the post-test probability is 53% with the BiliCheck and 33% with the lab test. The +LR at lower bilirubin levels (13 and 15mg/dl) is higher in the lab test compared to the BiliCheck, but is still significant with the BiliCheck measurement.
  4. Forehead measurement with BiliCheck is more accurate when compared with HPLC than is sternum measurment.
  5. An analysis of covariance revealed that race, gestational age, postnatal age, and birth weight do not affect BiliCheck measurements when compared with HPLC.

Additional Comments

  • Although this study population was not very heterogenous (66.7% of the patients were white. while only 4.3% were black), Buthani et al also demonstrated similar findings of racial independence using the BiliCheck.2
  • Maisels et al used a similar device in a community hospital and found savings of $1600 a year when transcutaneous bilir measured instead of serum bili.3


  1. Rubaltelli FF, et al. Transcutaneous bilirubin measurement: A multicenter evaluation of a new device. Pediatrics 2001;107(6):1264-1271.
  2. Butani VK, et al. Noninvasive measurement of total serum bilirubin in a multiracial predischarge populatioin to assess the risk of severe hyperbilirubinemia. Pediatrics 2000; 106(2): electronic pages
  3. Maisels M et al. Transcutaneous bilirubinometry decreases the need for serum bilirubin measurments and saves money. Pediatrics 1997;99(4):599-601.

CAT Author: Julia E. Madison, MD

CAT Appraisers: Robert E. Schumacher, MD

Date appraised: January 18, 2002

Last updated October 15, 2002
Department of Pediatrics and Communicable Diseases
© 1998-2002 University of Michigan Health System