Comparison of the Transcutaneous Bilirubin Readings at the Forehead during Crying with Those during Quiet State in Neonatal Jaundice

Abstract

We compared TcB readings at the forehead and the mid-sternum during crying with those during quiet state in 70 healthy full-term neonates in order to investigate the effect of crying on TcB readings by using a Minolta/ Air-Shields Jaundice Meter. The average TcB reading at the forehead during quiet state was 18.37 + 2.41, while during crying the average reading were 17.07 + 2.20. TcB readings at the forehead during crying was significantly decreased compared with the TcB readings during quiet state with a difference of 1.30+0.96(r=0.78, P<O.OI). The average TcB reading at the mid-sternum during quiet state was 17.07+ 1.66, while during crying the average reading was 16.80 + 1.66. TcB readings at the mid-sternum during crying were not significantly decreased compared with TcB readings during quiet state with the difference of 0.20+0.90(P>0.05). The decreasing effect of crying at the forehead was more influential -at the higher TcB reading(TcB>20) than at the lower TcB reading(l5<TcB<20), while at the mid-sternum there was no crying effect on both the lower and the higher TcB readings. As mechanisms of the effect of crying on TcB readings at the forehead, we suggest that wrinkling causes the scattering of light by poor contact between the TcB probe and the surface of the forehead skin and the hemodynamyc effect, that of hemoconcentration and changes of skin color during crying. In conclusion, we should be careful when measuring TcB at the forehead because the babies often cry during measurements. We recommend that TcB measurements at the forehead should be taken during quiet state at the newborn nursery.