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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
Bilimeters are devices that measure bilirubin transcutaneously (ie without drawing blood). They work by directing light into the neonate’s skin and then measuring the intensity of specific wavelengths that return, and using this information to calculate bilirubin level.
Kelly September 2, 2019 - 2:43 pm
Transcutaneous bilirubin (TcB) measurements are often used in nurseries to monitor neonatal jaundice with less frequent blood draws. There is variance from instrument to instrument, however, so two TcB measurements are best compared if done by the same machine. A confirmatory serum bilirubin level should be measured if:
TcB is >= 70% of the serum bilirubin level recommended for phototherapy
TcB is at the 75Th percentile or higher on the Bhutani nomogram
TcB is > 13 mg/dL in a baby presenting after nursery discharge
(Maisels MJ et al, https://www.ncbi.nlm.nih.gov/pubmed/19786452)
Interpretation of bilirubin levels by gestational age, hours since birth, and risk factors, can be aided by http://www.bilitool.org