A recent UK study evaluated the Delta Medical International transcutaneous jaundice meter over a 7 month period and demonstrated excellent results. The clinical audit concluded that there was a good statistical correlation between the transcutaneous measurements and serum bilirubin (SBr) tests. It went on to estimate that the community service using the jaundice meter has probably saved the NHS Trust over £200k annually and reduced the need for blood sampling for SBr tests by 65%.
The study was carried out by a community healthcare team, the Warrington & Halton NHS Trust paediatric acute response service. They had evaluated the transcutaneous jaundice meter before they purchased it but wished to verify the performance on a wider patient population in routine practice. They recorded the transcutaneous bilirubin measurements for all patients who would normally have been referred for SBr testing based on clinical assessment and then correlated the results at the end of the study period. Protocols and clinical criteria for the study were based on NICE Guidance1, but with a safety margin to remove the risk of missing any patient with hyperbilirubinaemia. The analysis included measurements from 163 patients taken over the 7 month period.
The transcutaneous measurements were compared to the SBr values from the blood sample analysis and a Bland-Altman analysis2 was carried out to quantify the variability between readings. The results obtained indicated that there was a good statistical correlation between the use of transcutaneous measurements with the chosen device (MBJ20 from Delta Medical International) and serum bilirubin tests. The Bland-Altman analysis in particular confirmed that more than 95% of the difference values fall within 2SD of the mean difference.
The study reached significant positive conclusions. It noted that since initiating the screening programme, using admission criteria from the NICE guidance, the service had saved 96% of admissions that would have arisen previously. This has significantly reduced the burden on the Paediatric department and delivered substantial cost savings. In addition, the number of SBr tests that would have been carried out has reduced by 65%.
The use of a transcutaneous jaundice meter for screening has saved the need to carry out well over 500 SBr tests per year. A conservative analysis for the NHS Trust, based on the cost to them of SBr testing alone, estimated they would recover the cost of a jaundice meter in less than 6 months. Where total costs of admissions are taken into account the case is so compelling it could justify every community midwife having a transcutaneous jaundice meter.
Further conclusions noted that the new approach and protocols have also impacted on the care of the babies and on their families, providing easier access to care and preventing unnecessary admission to hospital, helping to improve infant maternal bonding and reducing the stress on new families. The use of a Transcutaneous Jaundice Meter has impacted on the infants as the non-invasive test avoids babies being subjected to painful stimuli, which can have a negative effect on their neurodevelopment.
Click to download the full paper: Screening newborn babies for jaundice in the community setting using a transcutaneous bilirubinometer.
- National Institute for Health & Care Excellence. Jaundice in newborn babies under 28 days – Clinical Guideline CG98. nice.org.uk/guidance/cg98.
- Altman DG, Bland JM. Measurement in medicine: the analysis of method comparison studies. Statistician. 1983;32:307–17