Evaluation of a new transcutaneous bilirubinometer.

OBJECTIVE: The objective of this study was to evaluate the Minolta/Hill-Rom Air-Shields Transcutaneous Jaundice Meter model JM-103. METHODS: We studied a convenience sample of 849 newborns > or =35 weeks of gestation in 3 hospitals. These infants had total serum bilirubin (TSB) levels measured on clinical indication, and transcutaneous bilirubin (TcB) levels were obtained within 1 hour of the TSB levels. The population was 59.2% white, 29.8% black, 4.5% East Asian, 3.8% Middle Eastern, 1.6% Indian/Pakistani, and 1.1% Hispanic. RESULTS: There was a close correlation between TSB and TcB values in all of the population groups: white (n = 503, r =.949); black (n = 253, r =.822); and East Asian, Indian/Pakistani, and Hispanic (n = 93, r =.926). In the black population, the correlation was less close than in the other groups, and differences between the TcB and TSB measurements tended to increase with rising TSB values. JM-103 values differed from TSB values by 3 mg/dL or more in 2% of white, 3.2% of other, and 17.4% of black infants. In these black infants, the JM-103 value was always greater than the TSB value. CONCLUSIONS: We conclude that TcB measurements using the JM-103 jaundice meter correlate very closely with TSB levels over the range of TSB encountered in this study. Because only 3.3% of our infants had TSB values >15 mg/dL (257 micro mol/L), more data are needed in this range of TSB concentration. The correlation in black infants is not as close as in other groups, but because the tendency in blacks is for the JM-103 to overestimate serum bilirubin levels, dangerous clinical errors are unlikely to occur. The measurement technique is rapid and simple, and it is easy to perform repeated measurements over time, thus reducing the likelihood of error. TcB measurements with the JM-103 jaundice meter should obviate the need for most serum bilirubin levels in newborn infants > or =35 weeks of gestation, although serum bilirubin measurements are still required when treatment with phototherapy or exchange transfusion is being considered.

The changing face of bronchopulmonary dysplasia: Part 2. Discharging an infant home on oxygen.

Transitioning an infant with bronchopulmonary dysplasia (BPD) home on oxygen is a complex process. It requires an interdisciplinary team, with clear but flexible discharge criteria, and a coordinated process to manage the complexity. In "The Changing Face of Bronchopulmonary Dysplasia: Part I" (Advances in Neonatal Care, December 2002, pp 327-338), the evolving nature of BPD was presented, along with new diagnostic criteria, a description of the risk factors and clinical profile of this condition, and a discussion of preventative strategies as well as the medical and neurodevelopmental outcomes. "The Changing Face of Bronchopulmonary Dysplasia: Part 2. Discharging an Infant Home on Oxygen" provides strategies to support families during the pivotal transition home on oxygen and other related technologies. The use of a systematic interdisciplinary discharge planning process, guided by clear criteria for discharge, is presented. An outline of the comprehensive discharge teaching, home care, and multispecialty follow-up that are necessary to ensure a safe and smooth transition into the community to avoid repeat or unnecessary rehospitalizations and to enhance outcomes is provided. Medical fragility persists in infants with BPD, placing additional stress on families. Pragmatic strategies to provide intensive parent support throughout the process are offered.