Transcutaneous Bilirubinometry in the Pediatric Emergency Department

Hyperbilirubinemia is a common neonatal condition requiring timely diagnosis and management to prevent complications. While transcutaneous bilirubinometry (TcB) has been widely validated and adopted in outpatient and inpatient pediatric settings, its use has not been established as standard of care in the pediatric emergency department (PED). Reliance on serum bilirubin (TSB) testing may contribute to increased length of stay (LOS) and resource utilization. The objective of this study was to evaluate the accuracy of TcB compared with TSB in neonates presenting to the PED and to assess the potential impact of TcB implementation on PED length of stay.

We conducted a prospective observational study of 36 infants. All infants were age > 168 hours, gestational age > 35 weeks, birth weight > 2500g, and had no prior history of phototherapy. TcB and TSB levels were obtained for each patient. Correlation between TcB and TSB values was assessed. PED length of stay was recorded, and a theoretical reduction in stay was estimated if TcB were implemented as a first-line screening tool.

Mean TcB level was 11.0 and mean TSB level 10.5, with overall agreement of 95.5% (Chi-square, p < 0.001). All except 5 values were under 2.0mg/dL difference between TcB and TSB. Of 36 TcB/TSB pairings, 30 (83.3%) were within 15% of each other. The median LOS in the PED was 151 minutes; modeling suggested that use of TcB as an initial screening measure could have reduced LOS by 105 minutes.

TcB shows strong concordance with TSB in neonates evaluated in the PED, supporting TcB as a reliable screening method in the PED. Implementation of TcB could decrease LOS and improve efficiency of care without compromising diagnostic accuracy. Incorporating TcB into PED workflows has the potential to streamline neonatal hyperbilirubinemia evaluation and optimize resource utilization.