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G236(P) Introduction of a transcutaneous bilirubinometer into children’s ED – a good initiative?
  1. J Spence1,
  2. C Bevan1,2,
  3. E Walton1
  1. 1Childrens Emergency Department, Royal Alexandra Children’s Hopsital, Brighton, UK
  2. 2Brighton and Sussex Medical School, Brighton University, Brighton, UK

Abstract

Aims Neonatal attendances to Children’s Emergency Departments (CED) are an increasing issue, with jaundice a common presenting problem. Assessment of the level of jaundice has traditionally been by a blood test. This not only has the disadvantages of distress, inconvenience and cost, but also exposes neonates to a busy CED for prolonged time periods. Would the introduction of a simple transcutaneous bilirubinometer into the department safely and accurately improve the delivery of our care?

Methods All neonates who presented to our CED between 17/09/15 and 18/11/15 requiring investigation for jaundice had both a transcutaneous bilirubinometer (three readings taken on the sternum) and a laboratory analysis of serum bilirubin. We compared results obtained from both measurements, determined what proportion of babies could avoid a blood test (in accordance with NICE guidance on the use of transcutaneous bilirubinometers) and whether blood results changed management. The study is ongoing.

Results Figure 1 19 babies presented with jaundice (two were excluded as no serum bilirubin results were available). Babies ranged from gestational ages of 36 to 41 weeks, presenting age range 1 to 28 days. 7 of these were for jaundice alone, referred from community midwives. 12 presented with both jaundice and another complaint e.g. weight loss, poor feeding. On average, the bilirubinometer result was within 12% of the serum bilirubin (mean = 12%, range 1%–30%). 12/17 (71%) had transcutaneous bilirubin readings below 250 nmol/L. In one case only, serum results changed management – initiating phototherapy. However, given transcutaneous levels were above 250nmol/L, in line with NICE guidelines, blood tests would have been initiated regardless. 3/12 (25%) were admitted immediately following high readings, improving patient flow and efficiency.

Abstract G236(P) Figure 1

Comparison of serum bilirubin results with average transcutaneous bilirubinometer readings for seventeen neonates

Conclusion In our initial population, up to 71% of babies could have avoided the need for blood tests, offered simple advice and feeding support. Furthermore, if a community transcutaneous bilirubinometer had been available, potentially 24% of these attendances at CED could have been avoided altogether. When used in line with NICE guidance, the transcutaneous bilirubinometer is an easy to use, safe, non-invasive and accurate method of measuring jaundice in a neonate.

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