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NeoReviews Vol.7 No.5 2006 e217
© 2006 American Academy of Pediatrics

Historical Perspectives: Transcutaneous Bilirubinometry

The first 300 words of the full text of this article appear below.

	Introduction

 
When the bilirubin concentration in the serum increases, bilirubin is deposited in the skin and subcutaneous tissues, (1) producing the (yellow) physical sign of jaundice or icterus. There is a well-established relationship between the total serum bilirubin (TSB) concentration and the intensity of jaundice, and the possibility of quantifying the bilirubin value by assessing skin color is not new. This relationship was documented in 1913 by Ylppö, (2) although he measured the bilirubin concentration in whole blood, not serum. The next major advance was the recognition that bilirubin could be toxic, that its toxicity was related to its concentration, and that it was possible to treat hyperbilirubinemia (and prevent neurologic damage) with exchange transfusion. (3) Pediatricians measured TSB in infants if jaundice appeared early (in the first 24 hours after birth) or appeared excessive for the infant’s age. Unfortunately, it is neither possible, nor desirable, to measure the serum bilirubin daily in every infant for the first week after birth. Accordingly, clinicians have used the clinical sign of jaundice as the trigger for deciding when to measure the TSB concentration.

	The Clinical Diagnosis of Hyperbilirubinemia

 
     How Good is the Visual Assessment of Jaundice?
Although there is a clear and semiquantitative relationship between the yellowness of the skin and the TSB, the variations in color perception by the human eye, differences in neonatal skin pigmentation, and variations in both the intensity and color of the available light affect the ability to estimate the TSB by assessing the degree of jaundice in a newborn. In 1941, Davidson and associates (4) described their experience evaluating the degree of jaundice in 99 infants. They examined each infant in daylight, applying a tongue depressor to the mucous membrane of the lower jaw as well as the skin of the forehead or the chin. Based on the icterus they observed following . . . [Full Text of this Article]

M. Jeffrey Maisels, MB, BCh^*

^* Department of Pediatrics, William Beaumont Hospital, Royal Oak, Mich

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