Implementation of a neonatal transcutaneous bilirubin screening programme in rural India

Abstract

Background: Universal pre-discharge assessment of risk for neonatal hyperbilirubinaemia is recommended by the American Academy of Pediatrics. A common algorithm is universal transcutaneous bilirubin (TcB) screening, followed by confirmatory total serum bilirubin (TSB) testing for results which cause concern. There is a paucity of data on the feasibility of TcB screening in low-income settings.

Objectives: To evaluate the acceptability and feasibility of implementing universal TcB screening at a resource-limited hospital in rural India, and to determine if it was associated with increased recognition of high-risk hyperbilirubinaemia.

Methods: In December 2012 at Vivekananda Memorial Hospital, Karnataka, India, universal TcB screening at 24–48 hours of life was implemented, with TSB estimated if TcB was >75th percentile for age. The proportion of families that provided consent and the proportion of infants who underwent TcB and TSB testing were calculated. The rates of phototherapy pre- and post-implementation and the rate of high-risk hyperbilirubinaemia (TSB >95th percentile for age) post-implementation among infants ≥ 35 weeks gestation were determined.

Results: Parents of 568 of 660 (86%) eligible infants consented to participation. All of these infants were screened with TcB. The proportion who had TSB testing was similar in the pre- (6%) and post-implementation (7%) periods. The rate of phototherapy was not significantly different after implementation (2% vs 3%). Five cases of high-risk hyperbilirubinaemia were identified post-implementation.

Conclusions: The study demonstrates the acceptability and feasibility of universal TcB screening at a resource-limited hospital in rural India. In settings in which early post-discharge follow-up cannot be assured, TcB can play a valuable role in identifying infants who need evaluation.

Keywords:

• Neonatal jaundice
• Hyperbilirubinaemia
• Transcutaneous bilirubin screening
• MBJ20 bilirubinometer
• Resource-limited setting

Acknowledgments

We are grateful to the parents who allowed their infants to be included in the study, and to members of the Vivekananda Hospital Research Team who assisted with TcB screening and data collection.