Comparison of Transcutaneous and Total Serum Bilirubin Measurements in Neonates With Jaundice: A Prospective Study From Nepal

Comparison of Transcutaneous and Total Serum Bilirubin Measurements in Neonates With Jaundice: A Prospective Study From Nepal | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Transcutaneous and Total Serum Bilirubin Measurements in Neonates With Jaundice: A Prospective Study From Nepal Jagdish Kunwar, Bijay Kunwar, Anup Ghimire, Santoshi Pokharel Kunwar, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8496085/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Neonatal jaundice is very common (≈ 60% of term and 80% of preterm newborns) and, if severe, can lead to bilirubin neurotoxicity. The gold-standard total serum bilirubin (TSB) measurement is invasive and time-consuming. Transcutaneous bilirubinometry (TcB) is a quick, noninvasive alternative using a skin bilirubinometer. Leading guidelines recommend universal predischarge jaundice screening using TSB or TcB. However, TcB is underused in Nepal, and its accuracy – especially in preterm neonates – needs validation. This study compares TcB and TSB in jaundiced neonates. Methods: In a single-center prospective study (Oct 2023–Sep 2024) at Paropakar Maternity and Women’s Hospital (Kathmandu, Nepal), 66 neonates with clinical jaundice were enrolled. TcB was measured at the mid-sternum and forehead using a calibrated JM-103 bilirubinometer (Konica Minolta). Venous blood was drawn (within 30 min of TcB) for TSB (BR-5200 spectrophotometer). Mean TcB values (average of three readings per site) were compared with TSB. Statistical analysis included Pearson correlation, Bland–Altman agreement, and ROC curves (SPSS v20). A p-value < 0.05 was considered significant. Results: Among the 66 neonates, 66.7% were male. Most were term (66.7%) and appropriate-for-gestational-age (63.6%). The mean birth weight was 2656.5 ± 795.9 g. Mean TcB values exceeded TSB by ~ 1–2 mg/dL across categories, a statistically significant difference in all groups except large-for-gestational-age (LGA) neonates. Crucially, TcB and TSB were highly correlated. Pearson r was 0.931 (p < 0.001) in term neonates and 0.896 (p < 0.001) in preterm neonates. Among small-for-gestational-age neonates, r was 0.948 (p < 0.001). TcB measured at the sternum versus forehead did not differ in mean value (no significant site effect). Both sites correlated well with TSB (r = 0.923 for sternum vs 0.894 for forehead, p < 0.001 each). Bland–Altman analysis showed a mean TcB–TSB bias of + 1.5 mg/dL (95% limits − 6.8 to + 9.9). ROC analysis for detecting significant hyperbilirubinemia yielded AUC ≈ 0.63 for both TcB and TSB in preterm and term subgroups; TcB thresholds achieved high sensitivity (~ 85%) but low specificity (≈ 45%). Conclusions: Transcutaneous and serum bilirubin levels were strongly, positively correlated across all subgroups (term, preterm, SGA), indicating that TcB is a reliable noninvasive screening tool for neonatal jaundice. Sternum readings correlated slightly better than forehead. Given its rapid, painless measurement, TcB can be used to screen and monitor jaundice, reducing unnecessary blood draws. However, TcB tends to overestimate TSB by about 1.5 mg/dL, and elevated TcB readings near treatment thresholds should be confirmed by TSB. Practically, universal TcB screening (24–48 h postnatal) as endorsed by WHO and AAP could be implemented, with follow-up TSB as needed. Larger multicenter studies and cost-benefit analyses are recommended to confirm these findings in broader settings. Neonatal jaundice Transcutaneous bilirubin Total serum bilirubin Hyperbilirubinemia Newborn screening Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Neonatal jaundice is one of the most common newborn problems. Up to 60% of full-term and 80% of preterm neonates develop clinical jaundice in the first week [ 1 , 2 ]. While usually benign, high bilirubin levels can cause acute bilirubin encephalopathy or kernicterus with serious neurologic sequelae [ 3 ]. Causes range from physiological immaturity to hemolysis, infection, and other disorders [ 1 , 4 ]. Careful monitoring and timely treatment (phototherapy or exchange transfusion) are essential to prevent neurotoxicity [ 3 , 5 ]. Traditionally, total serum bilirubin (TSB) is the gold-standard measurement [ 1 , 3 ]. However, obtaining TSB requires venipuncture or heel-stick blood draws that are invasive, time-consuming, and can be distressing to neonates and parents [ 6 ]. Visual assessment of jaundice is unreliable [ 7 ]. In contrast, transcutaneous bilirubinometry (TcB) offers a noninvasive alternative. A TcB device emits light into the skin and quantifies bilirubin-derived coloration, providing an immediate bilirubin estimate [ 8 ]. TcB meters are portable, painless, and have been shown in multiple studies to correlate well with TSB [ 8 , 10 , 14 ]. They have been used as effective screening tools internationally [ 14 , 11 ]. Current guidelines endorse routine jaundice screening in newborns. The American Academy of Pediatrics (AAP) recommends universal predischarge bilirubin screening, either via TSB or TcB, to assess risk of hyperbilirubinemia [ 3 ]. In 2022, the World Health Organization (WHO) similarly recommended that all neonates be screened with TcB before discharge (ideally between 24–48 hours of age) [ 12 ]. These measures aim to identify neonates who need closer monitoring or treatment. Also, distinguishing CHB from UHB is critical because cholestatic neonatal jaundice is almost always pathologic and warrants prompt evaluation and treatment [ 9 ]. Despite this, TcB is not yet routinely used in Nepal. Multiple heel pricks for TSB can cause blood loss and increase infection risk, especially in preterm neonates [ 6 , 13 ]. Given the global interest and recent guidelines, local validation of TcB utility is needed. This study aimed to compare TcB measurements to TSB in neonates with jaundice at a tertiary hospital in Kathmandu. Specifically, we evaluated the correlation between TcB (measured at forehead and sternum) and TSB, the agreement between methods, and the diagnostic accuracy of TcB for detecting clinically significant hyperbilirubinemia. We also analyzed subgroup performance (term vs preterm, SGA vs AGA) and assessed practical implications for clinical use. Methods We conducted a prospective cross-sectional study at the Neonatal Intensive Care Unit and nursery of Paropakar Maternity and Women’s Hospital (PMWH), Kathmandu. All term and preterm neonates who were diagnosed with clinical jaundice and had TSB ordered by the treating physician were included in the study. Exclusion criteria included previous exchange transfusion or major congenital anomalies, preterm < 28 weeks, neonates with severe sepsis, severe asphyxia, and shock, neonates with skin infection and purpura and bruise at the site of TcB measurement and patient with incomplete required data. In total, 66 neonates (gestational age 28–41 weeks) were enrolled over a 6-month period after parental consent. The study was approved by the Institutional Review Committee of National Academy of Medical Sciences (NAMS). After obtaining informed written consent from the parents, a detailed history was recorded and thorough clinical examination was performed. For each neonate, TcB was measured on the sternum and the forehead using a calibrated Konica Minolta JM-103 bilirubinometer (Supplementary file s1). The device was zeroed per manufacturer instructions and three readings were taken at each site to obtain an average (mg/dL). Blood for TSB was obtained by heelstick or venous draw within 30 minutes of TcB measurements. TSB estimation measured by BR 5200 bilirubinometer, made in Japan by Apel co ltd. The two measurements obtained were compared. Significant hyperbilirubinemia was defined per AAP age-specific guidelines [ 15 ]. Demographic and clinical data (age in days, sex, birthweight, gestational age, feeding) were recorded. Neonates were classified by gestation (term ≥ 37 wk, late preterm 34–36.9 wk, moderate-preterm 28–33.9 wk) and by size for gestational age (small, appropriate, large). Paired TcB and TSB values were compared using paired t-tests (or Wilcoxon tests if non-normal). Subgroup analyses were performed by sex, gestational age group, and birthweight categories. Pearson correlation coefficients were calculated for TcB (forehead and sternum) versus TSB in each group. Bland-Altman analysis determined the mean bias and 95% limits of agreement between TcB and TSB. Receiver-operating characteristic (ROC) curves were constructed for TcB predicting severe hyperbilirubinemia (per AAP thresholds) in term and preterm neonates; optimal cutoffs were identified. Analyses were done in SPSS v.20. A p-value < 0.05 was considered significant, and all tests were two-tailed. Results Patient characteristics (Table 1 ): The cohort included 66 neonates (66.7% male, 33.3% female) with mean gestational age 37.1 ± 3.1 wk and mean birthweight 2656 ± 796 g. Two-thirds (66.7%) were term, with the remainder preterm (22.7% late preterm, 10.6% <34 wk). Thirty (45.5%) neonates were small-for-gestational age (SGA), 56 (84.8%) appropriate (AGA), and 4 (6.1%) large (LGA). Twenty-four (36.4%) had a birthweight < 2500 g. The median age at measurement was 3 days (range 1–12). Table 1 Patient Characteristics Patient characteristics Total number Percentage (%) Mean ± SD Age group of study population 66 37 weeks) 44 66.7 Preterm (≤ 37 weeks) 22 33.3 Gestational age specific birth weight SGA 20 30.3 AGA 42 63.6 LGA 4 6.1 Birth weight of the admitted neonates 2656.5 ± 795.9 grams < 2500 gm 24 36.4 ≥ 2500 gm 42 63.6 TcB vs TSB – overall and by subgroup (Tables , and ): In the entire sample, mean TcB readings were consistently higher than TSB. For example, in male neonates mean TcB was 14.9 mg/dL versus 13.4 mg/dL for TSB (p < 0.001); in females 15.6 vs 13.9 mg/dL (p < 0.001). Term neonates had mean TcB 15.8 vs TSB 14.2 mg/dL (p < 0.001). Among preterm neonates, late-preterm (34–37 wk) neonates had TcB 14.0 vs TSB 12.7 mg/dL (p = 0.024), and moderate-preterm (< 34 wk) had TcB 13.5 vs 11.5 mg/dL (p TSB (14.4 vs 12.6 mg/dL in SGA, p < 0.001; 15.4 vs 14.0 in AGA, p < 0.001). The four LGA neonates had TcB 16.2 vs TSB 15.0 mg/dL (p = 0.138), not reaching significance (likely due to small N). Neonates < 2500 g had TcB 14.0 vs TSB 12.1 (p < 0.001), while those ≥ 2500 g had 15.8 vs 14.9 (p < 0.001). In every subgroup except LGA, mean TcB significantly exceeded TSB by about 1–2 mg/dL. Table 2 Comparison of bilirubin Measurement of TcB and TSB in studied sample Variables N Mean TcB (Range) Mean TSB (Range) t value p-value Sex Male 44 14.9 13.4 6.208 0.000 Female 22 15.6 13.9 6.808 0.000 Term(> 37weeks) 44 15.8 14.2 7.926 0.000 Preterm 34–37 weeks 15 14.0 12.7 2.534 0.024 28–34 weeks 7 13.5 11.5 9.945 0.000 SGA 20 14.4 12.6 7.917 0.000 AGA 56 15.4 14.0 5.780 0.000 LGA 4 16.2 15.0 2.013 0.138 Birth Weight < 2500gm 24(36.4%) 14.0 12.1 -10.839 0.000 ≥ 2500gm 42(63.6%) 15.8 14.9 -5.209 0.000 Table 3 Comparison of sternum TcB, Forehead TcB and TSB by Various Factors Variables Mean TcB-FH (Range) Mean TcB-S (Range) Mean TSB(Range) p-value Sex Male 14.9 14.9 13.4 0.000 Female 15.6 15.7 13.9 0.000 Gestational age Term(> 37 weeks) 15.7 15.8 14.2 0.000 Preterm 34–37 weeks 14.0 14.0 12.7 0.000 28–34 weeks 13.6 13.4 11.5 0.004 SGA 14.4 14.5 12.6 0.000 AGA 15.4 15.4 14.0 0.000 LGA 16.0 16.4 15.0 0.368 Birth Weight ≥ 2500gm 14.1 14.0 12.1 0.000 < 2500gm 15.7 15.8 14.4 0.000 Table 4 Mean comparison between transcutaneous bilirubin from forehead and sternum Variables Mean TcB-FH (Range) Mean TcB-S (Range) p-value Sex Male 14.9 14.9 1.000 Female 15.6 15.7 0.364 Gestational age Term (> 37 weeks) 15.7 15.8 0.672 Preterm 34–37 weeks 14.0 14.0 0.836 28–34 weeks 13.6 13.4 0.779 SGA 14.4 14.5 0.705 AGA 15.4 15.4 0.979 LGA 16.0 16.4 0.273 Birth Weight ≥ 2500gm 14.1 14.0 0.621 < 2500gm 15.7 15.8 0.344 Correlation between TcB and TSB (Table 5 ) : TcB measurements strongly correlated with TSB in all groups. Overall Pearson r was 0.931 in term neonates and 0.896 in preterm neonates (p < 0.001 for both) (Fig. 1 ). Similarly high 2 correlations were seen in SGA neonates (r = 0.948, p < 0.001) and in male and female subgroups. Across the cohort, TcB measured on the forehead correlated with TSB at r = 0.894, and TcB on the sternum at r = 0.923 (both p < 0.001). Both TcB sites yielded similar mean values (difference ~ 0.1 mg/dL, p = ns), but the sternum reading showed a slightly higher correlation with TSB. Table 5 Correlation among various variables Variables r-value p-value Correlation of TCB and TSB by gestational age Term (> 37 weeks) ( 0.931 < 0.0001 Preterm (≤ 37 weeks) 0.896 < 0.0001 Correlation of TcB and TSB in small-for-gestational-age neonates SGA 0.948 < 0.0001 Correlation between (TcB) from forehead (TcB-FH) and sternum(TcB-S) with serum bilirubin(TSB). TcB-FHwith TSB 0.894 < 0.0001 TcB-Swith TSB 0.923 < 0.0001 Bland-Altman analysis (Fig. ): Bland-Altman plots showed a mean bias (TcB–TSB) of + 1.54 mg/dL (95% limits of agreement roughly − 6.8 to + 9.9 mg/dL). In other words, TcB tended to overestimate TSB by about 1–2 mg/ dL on average, though individual differences could be as large as 8–10 mg/dL. Forehead measurements had bias + 1.51 mg/dL (95% LoA − 6.8 to + 9.9); sternum + 1.56 mg/dL (LoA − 6.95 to + 10.80). ROC curve analysis: For term neonates, the TcB area under the ROC curve (AUC) was 0.630 (95% CI 0.485– 0.774, p = 0.150), indicating poor discrimination. Using TcB ≥ 12.4 mg/dL as a cutoff yielded 86.4% sensitivity and 46.5% specificity for identifying neonates requiring TSB confirmation. For preterm neonates, AUC was 0.628 (95% CI 0.432–0.824, p = 0.236). A TcB cutoff of 17.1 mg/dL gave 72.7% sensitivity and 35.2% specificity. These results show that while a low TcB effectively ruled out very high TSB (high sensitivity), the specificity was low, and overall accuracy was limited (Figs. 3 and 4 ). Discussion This study demonstrates that transcutaneous bilirubinometry closely tracks serum bilirubin in jaundiced neonates, although with a systematic bias. We found very strong correlations (r ≈ 0.90) between TcB and TSB across term, preterm, and small-for-gestational-age neonates. This agrees with prior reports; for example, Shrestha et al. from Nepal observed TcB versus TSB correlations of r ≈ 0.98 in a large neonatal cohort [ 17 ]. Other studies from the region, including those by Khan et al. and Panda et al. from India, similarly reported correlation coefficients exceeding 0.90 in mixed neonatal populations [ 19 , 20 ]. The slightly higher correlation observed at the sternum compared with the forehead in our study has also been noted previously. Cetinkaya et al. and Yadav et al. reported comparably high correlations at both measurement sites, suggesting that either location is acceptable for clinical screening [ 21 , 22 ]. On average, TcB values in our cohort were approximately 1–2 mg/dL higher than corresponding TSB measurements. Ng et al. (2023) similarly reported that TcB tends to overestimate TSB by around 1–2 mg/dL, particularly in preterm neonates [ 18 ]. Our Bland–Altman mean bias of + 1.54 mg/dL is consistent with these findings. The wide limits of agreement observed, extending up to ± 10 mg/dL in extreme cases, likely reflect biological variability and inherent measurement error. These findings reinforce that TcB should be considered primarily a screening modality rather than a diagnostic substitute. Receiver operating characteristic analysis confirmed that TcB demonstrates high sensitivity but modest specificity for detecting clinically significant hyperbilirubinemia. In term neonates, a TcB threshold of approximately 12 mg/dL identified most neonates requiring confirmatory TSB testing, although false-positive results were common. This pattern is expected, as TcB is optimized for ruling out severe hyperbilirubinemia and thus exhibits a high negative predictive value. Similar performance characteristics have been documented in systematic reviews and meta-analyses [ 14 , 18 ]. Consequently, in accordance with AAP recommendations, elevated TcB values should prompt confirmatory TSB measurement before initiating treatment decisions [ 15 ]. Clinically, our findings support the integration of TcB screening into routine newborn care. The American Academy of Pediatrics (2022) recommends universal predischarge bilirubin screening using either TSB or TcB in term neonates [ 15 ], while the World Health Organization (2024) now explicitly advises TcB screening for all newborns to prevent kernicterus [ 16 ]. In resource-limited settings such as Nepal, TcB provides a less invasive means of identifying neonates at risk for significant hyperbilirubinemia. Although TcB devices require initial capital investment, their use may reduce cumulative laboratory costs and neonatal discomfort associated with repeated heel-stick sampling. The high correlation and sensitivity observed in this study suggest that adopting TcB-based screening could safely reduce unnecessary serum bilirubin measurements, consistent with international practice. Clinical implications: The strong TcB–TSB correlation supports using TcB as a noninvasive screening tool for neonatal jaundice. In practical terms, TcB can reduce the number of invasive blood draws: healthy-appearing neonates with low TcB can be spared routine venipuncture, while high TcB readings can trigger confirmatory testing. This is particularly valuable in resource-limited settings or in managing preterm neonates, where frequent blood sampling is burdensome. Following AAP and WHO recommendations, implementing universal TcB screening before discharge (at ~ 24–48 hours) could allow early detection of rising bilirubin. For example, an neonate with a TcB well below the phototherapy threshold could be discharged with outpatient follow-up instead of routine TSB. Conversely, an elevated TcB would prompt timely phototherapy or exchange consideration. The slightly higher correlation of sternum TcB suggests using the chest site for greater accuracy. Strengths and limitations: This study has several strengths. It is one of the first in Nepal to systematically compare TcB and TSB in a clinical cohort. We included a broad neonatal population (term and preterm; SGA/AGA), and used rigorous measurement and statistical methods (including Bland–Altman and ROC analyses). All TcB measurements were done by the same trained operator using a calibrated device, reducing variability. However, limitations must be noted. Our sample size was relatively small (N = 66), and the study was single-center, so results may not generalize to all settings. We only studied neonates who already had clinical jaundice and were under physician care, rather than a true universal screening population, which could bias the severity distribution. We did not formally assess the effect of skin pigmentation (we did not record precise ethnicity or skin color), which is known to influence TcB accuracy. Also, our bilirubinometer had an upper measurement limit, so extremely high bilirubins might not have been fully captured. Finally, we did not compare different TcB devices; different manufacturers or models might perform differently. Recommendations: For clinical practice, our findings support the adoption of TcB for initial jaundice screening and monitoring. Hospitals in Nepal and similar settings should consider acquiring TcB meters and training staff in their use, especially for pre-discharge assessment. Given the device cost, a cost-benefit analysis is needed, but the potential to reduce laboratory tests and neonatal distress is compelling. Clinicians should remember that TcB has lower specificity, so a low threshold for confirmatory TSB is prudent when TcB is elevated. Based on our data, we recommend prioritizing sternum measurements for slightly higher accuracy. Future research should include larger, multicenter studies to confirm these findings across diverse populations. Studies that include healthy newborns (for universal screening) and account for skin color would provide more generalizable data. In summary, TcB is a clinically useful tool for neonatal jaundice screening, offering a safe, rapid estimate of bilirubin levels. When used appropriately, it can improve patient care by identifying neonates in need of treatment while minimizing unnecessary blood draws. Abbreviations % Percentage AAP American Academy of Pediatrics AGA Appropriate for Gestational Age CHB Conjugated hyperbilirubinemia FH Forehead GA Gestational age IRB Institutional Review Board KCH Kanti Children’s Hospital LBW Low Birth Weight LGA Large for Gestational Age NICU Neonatal Intensive Care Unit p Probability PMWH Paropakar Maternity and Women's Hospital r Correlation coefficient ROC Receiver Operating Characteristics S Sternum SGA Small for Gestational Age TB Total Bilirubin TcB Transcutaneous Bilirubin TSB Total Serum Bilirubin UHB Unconjugated hyperbilirubinemia WHO World health organization Wk Weeks Declarations Ethics approval and consent to participate: This prospective cross-sectional study was approved by the Institutional Review Committee of National Academy of Medical Sciences, conducted in PMWH, Kathmandu, Nepal. The study was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from the parents or legal guardians of all neonates prior to enrollment. Confidentiality of participant information was strictly maintained, and all data were anonymized before analysis. Clinical Trial Number: Not applicable Consent for publication: Not applicable. (Individual patient data were anonymized, and no identifying images or personal information are included in this manuscript.) Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors’ contributions JK (Dr. Jagdish Kunwar) conceptualized and designed the study, participated in data collection, performed statistical analysis, and drafted the initial manuscript. BK (Dr. Bijay Kunwar) contributed to study conception and design, supervised data analysis, interpreted the results, and critically revised the manuscript; BK also served as the corresponding author. AG (Dr. Anup Ghimire) assisted in study design, data interpretation, and critical revision of the manuscript. SPK (Dr. Santoshi Pokharel Kunwar) contributed to data collection and manuscript drafting. ST (Dr. Sachchu Thapa) assisted with data collection, literature review, and manuscript preparation. PP (Asst. Prof. Dr. Prajwal Paudel) contributed to study methodology, supervised data collection, and critically reviewed the manuscript for important intellectual content. KUS (Prof. Dr. Kalpana Upadhyay Subedi) provided overall supervision of the study, guided the research process, and critically revised the manuscript for intellectual content. All authors read and approved the final manuscript. Acknowledgements: The authors would like to thank the Department of Pediatrics, Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal, for institutional support. We are grateful to the nursing staff and laboratory personnel for their assistance, and to the parents and neonates who participated in this study. References Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, editors. Nelson Textbook of Pediatrics. 21st ed. Philadelphia: Elsevier; 2020. pp. 871–6. Maisels MJ. Neonatal jaundice. Pediatr Rev. 2006;27(12):443–54. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn neonate ≥ 35 weeks of gestation. Pediatrics. 2004;114(1):297–316. Watchko JF, Tiribelli C. Bilirubin-induced neurologic damage—mechanisms and management approaches. N Engl J Med. 2013;369(21):2021–30. Bhutani VK, Johnson L, Keren R. Diagnosis and management of hyperbilirubinemia in the term neonate. Pediatr Clin North Am. 2004;51(4):843–61. Barker DP, Rutter N. Exposure to invasive procedures in neonatal intensive care unit admissions. Arch Dis Child Fetal Neonatal Ed. 1995;72(1):F47–8. Maisels MJ, Newman TB. Visual assessment of jaundice in newborns. Pediatrics. 1995;95(3):383–6. Ebbesen F, Rasmussen LM, Wimberley PD. A new transcutaneous bilirubinometer, BiliCheck, used in the neonatal intensive care unit. Acta Paediatr. 2002;91(2):203–11. Fawaz R, Baumann U, Ekong U, Fischler B, Hadzic N, Mack CL, et al. Guideline for the Evaluation of Cholestatic Jaundice in Neonates: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2017;64(1):154–68. Taylor JA, Burgos AE, Flaherman V, Chung EK, Simpson EA, Goyal NK. Discrepancies between transcutaneous and serum bilirubin measurements. Pediatrics. 2015;135(2):224–31. Hansen TWR. Prevention of neurodevelopmental sequelae of jaundice in the newborn. Dev Med Child Neurol. 2011;53(Suppl 4):24–8. World Health Organization. WHO recommendations on newborn health: guidelines approved by the WHO Guidelines Review Committee. Geneva: WHO; 2022. Widness JA. Pathophysiology of anemia during the neonatal period, including anemia of prematurity. Neonatology. 2008;94(4):243–54. Nagar G, Vandermeer B, Campbell S, Kumar M. Reliability of transcutaneous bilirubin devices in term and preterm neonates: a systematic review and meta-analysis. Pediatrics. 2013;132(5):871–81. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Clinical practice guideline: management of hyperbilirubinemia in the newborn neonate ≥ 35 weeks’ gestation. Pediatrics. 2022;150(3):e2022058859. World Health Organization. WHO recommendations on newborn health. Geneva: World Health Organization; 2024. Shrestha S, Shrestha S, Shakya A, et al. Correlation between transcutaneous bilirubin and total serum bilirubin in Nepalese neonates. JNMA J Nepal Med Assoc. 2019;57(217):15–20. Ng DK, Lam HS, Wong SPS, et al. Accuracy of transcutaneous bilirubinometry in preterm neonates: a multicenter study. Acta Paediatr. 2023;112(4):789–96. Khan KA, Malik SA, Bai S, et al. Evaluation of transcutaneous bilirubinometry in neonates with hyperbilirubinemia. Indian Pediatr. 2017;54(5):385–8. Panda SK, Mishra S, Dash SK, et al. Correlation of transcutaneous bilirubin with serum bilirubin in term and preterm neonates. J Clin Neonatol. 2018;7(3):146–50. Cetinkaya M, Ozkan H, Köksal N. Comparison of transcutaneous bilirubin measurements from the forehead and sternum in neonates. Turk J Pediatr. 2011;53(6):613–7. Yadav RK, Sethi RS, Sethi AS. Site-specific comparison of transcutaneous bilirubin measurement in neonates. Int J Contemp Pediatr. 2016;3(3):867–71. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8496085","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":571265543,"identity":"2f751181-b052-4f14-888e-3bf7585df351","order_by":0,"name":"Jagdish Kunwar","email":"","orcid":"","institution":"National Academy of Medical Sciences, Kanti Children's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jagdish","middleName":"","lastName":"Kunwar","suffix":""},{"id":571265545,"identity":"8eceb854-17e4-4236-8b66-00c17e7e2957","order_by":1,"name":"Bijay 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Campus","correspondingAuthor":false,"prefix":"","firstName":"Anup","middleName":"","lastName":"Ghimire","suffix":""},{"id":571265547,"identity":"4d32a6e0-793f-4987-933a-9dee943dec1c","order_by":3,"name":"Santoshi Pokharel Kunwar","email":"","orcid":"","institution":"Nepalese Army Institute of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Santoshi","middleName":"Pokharel","lastName":"Kunwar","suffix":""},{"id":571265550,"identity":"8874957b-9805-4bb2-b3cb-b8a8889f9466","order_by":4,"name":"Sachchu Thapa","email":"","orcid":"","institution":"National Academy of Medical Sciences, Bir Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sachchu","middleName":"","lastName":"Thapa","suffix":""},{"id":571265552,"identity":"557c1d34-798c-4b6b-acd6-5e11dd3b5b16","order_by":5,"name":"Prajwal Paudel","email":"","orcid":"","institution":"National Academy of Medical Sciences, Paropakar Maternity and Women’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Prajwal","middleName":"","lastName":"Paudel","suffix":""},{"id":571265553,"identity":"c7b3f1f8-f203-40f9-a0db-a1652a94b827","order_by":6,"name":"Kalpana Upadhyay Subedi","email":"","orcid":"","institution":"National Academy of Medical Sciences, Paropakar Maternity and Women’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kalpana","middleName":"Upadhyay","lastName":"Subedi","suffix":""}],"badges":[],"createdAt":"2026-01-01 15:53:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8496085/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8496085/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100124363,"identity":"75d6e5fc-83e9-4156-8f69-1bb52852ce62","added_by":"auto","created_at":"2026-01-13 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09:10:46","extension":"xml","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":87563,"visible":true,"origin":"","legend":"","description":"","filename":"40e9696a89e24ff2a20b78bec1c0fabc1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8496085/v1/4ae1756e2caf79021e59857d.xml"},{"id":100124369,"identity":"f0824160-deb5-4548-9e8f-ed3ee9398b09","added_by":"auto","created_at":"2026-01-13 09:10:46","extension":"html","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103710,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8496085/v1/4bf42991b769e5fa8907bbb4.html"},{"id":100366382,"identity":"ae3a8811-2644-4c23-af77-d88375dcfcd5","added_by":"auto","created_at":"2026-01-16 07:56:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":118147,"visible":true,"origin":"","legend":"\u003cp\u003ea) Scatter plot depicting the correlation between transcutaneous bilirubin (TcB) and total serum bilirubin (TSB) among preterm neonates. b) Scatter plot depicting the correlation between transcutaneous bilirubin (TcB) and total serum bilirubin (TSB) among term neonates. Pearson correlation coefficients indicate a strong positive association in both groups.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8496085/v1/9d25a57b4ee73c9d4a5d675a.png"},{"id":100124361,"identity":"6f24a789-f4cd-4a26-b7ff-4eb8e0af5a2b","added_by":"auto","created_at":"2026-01-13 09:10:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":209620,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(a, b and c)\u003c/strong\u003e Bland–Altman plots demonstrating agreement between transcutaneous bilirubin (TcB) and total serum bilirubin (TSB): (a) agreement between average TcB and TSB, (b) agreement between forehead TcB and TSB, and (c) agreement between sternum TcB and TSB. The central line represents the mean bias, and the outer lines indicate the 95% limits of agreement.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8496085/v1/44435e653a8b9674ae33c8cc.png"},{"id":100367484,"identity":"320107af-4872-4b4a-80f7-a08d22fae10e","added_by":"auto","created_at":"2026-01-16 07:57:06","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":260440,"visible":true,"origin":"","legend":"\u003cp\u003e(a, b and c): Receiver operating characteristic (ROC) analysis for detection of significant hyperbilirubinemia in preterm neonates: (a) ROC curves for transcutaneous bilirubin (TcB) and total serum bilirubin (TSB), (b) sensitivity and specificity of TcB measurements derived from ROC analysis, and (c) sensitivity and specificity of TSB measurements derived from ROC analysis.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8496085/v1/9320f46da659d8e5122a7589.jpeg"},{"id":100366947,"identity":"6b4ba3c5-807d-4029-b3d7-5855cd817353","added_by":"auto","created_at":"2026-01-16 07:56:41","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":238808,"visible":true,"origin":"","legend":"\u003cp\u003e(a, b and c): Receiver operating characteristic (ROC) analysis for detection of significant hyperbilirubinemia in term neonates: (a) ROC curves for transcutaneous bilirubin (TcB) and total serum bilirubin (TSB), (b) sensitivity and specificity of TcB measurements derived from ROC analysis, and (c) sensitivity and specificity of TSB measurements derived from ROC analysis.\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8496085/v1/6d48ada591e0525d12461c88.jpeg"},{"id":104405336,"identity":"662b64ff-a801-4612-93ec-d81338efe556","added_by":"auto","created_at":"2026-03-11 12:22:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1649656,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8496085/v1/97e459d8-775a-4ca9-8021-6055f9ad0c09.pdf"},{"id":100124366,"identity":"c3b661de-f5b2-4880-bc16-a2ff4f819e23","added_by":"auto","created_at":"2026-01-13 09:10:46","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":353389,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfiles1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8496085/v1/fa5272b703cac7c9100dd0f6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of Transcutaneous and Total Serum Bilirubin Measurements in Neonates With Jaundice: A Prospective Study From Nepal","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNeonatal jaundice is one of the most common newborn problems. Up to 60% of full-term and 80% of preterm neonates develop clinical jaundice in the first week [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. While usually benign, high bilirubin levels can cause acute bilirubin encephalopathy or kernicterus with serious neurologic sequelae [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Causes range from physiological immaturity to hemolysis, infection, and other disorders [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Careful monitoring and timely treatment (phototherapy or exchange transfusion) are essential to prevent neurotoxicity [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTraditionally, total serum bilirubin (TSB) is the gold-standard measurement [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, obtaining TSB requires venipuncture or heel-stick blood draws that are invasive, time-consuming, and can be distressing to neonates and parents [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Visual assessment of jaundice is unreliable [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In contrast, transcutaneous bilirubinometry (TcB) offers a noninvasive alternative. A TcB device emits light into the skin and quantifies bilirubin-derived coloration, providing an immediate bilirubin estimate [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. TcB meters are portable, painless, and have been shown in multiple studies to correlate well with TSB [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. They have been used as effective screening tools internationally [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Current guidelines endorse routine jaundice screening in newborns. The American Academy of Pediatrics (AAP) recommends universal predischarge bilirubin screening, either via TSB or TcB, to assess risk of hyperbilirubinemia [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In 2022, the World Health Organization (WHO) similarly recommended that all neonates be screened with TcB before discharge (ideally between 24\u0026ndash;48 hours of age) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These measures aim to identify neonates who need closer monitoring or treatment. Also, distinguishing CHB from UHB is critical because cholestatic neonatal jaundice is almost always pathologic and warrants prompt evaluation and treatment [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite this, TcB is not yet routinely used in Nepal. Multiple heel pricks for TSB can cause blood loss and increase infection risk, especially in preterm neonates [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Given the global interest and recent guidelines, local validation of TcB utility is needed.\u003c/p\u003e \u003cp\u003eThis study aimed to compare TcB measurements to TSB in neonates with jaundice at a tertiary hospital in Kathmandu. Specifically, we evaluated the correlation between TcB (measured at forehead and sternum) and TSB, the agreement between methods, and the diagnostic accuracy of TcB for detecting clinically significant hyperbilirubinemia. We also analyzed subgroup performance (term vs preterm, SGA vs AGA) and assessed practical implications for clinical use.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e We conducted a prospective cross-sectional study at the Neonatal Intensive Care Unit and nursery of Paropakar Maternity and Women\u0026rsquo;s Hospital (PMWH), Kathmandu. All term and preterm neonates who were diagnosed with clinical jaundice and had TSB ordered by the treating physician were included in the study. Exclusion criteria included previous exchange transfusion or major congenital anomalies, preterm\u0026thinsp;\u0026lt;\u0026thinsp;28 weeks, neonates with severe sepsis, severe asphyxia, and shock, neonates with skin infection and purpura and bruise at the site of TcB measurement and patient with incomplete required data.\u003c/p\u003e \u003cp\u003eIn total, 66 neonates (gestational age 28\u0026ndash;41 weeks) were enrolled over a 6-month period after parental consent. The study was approved by the Institutional Review Committee of National Academy of Medical Sciences (NAMS). After obtaining informed written consent from the parents, a detailed history was recorded and thorough clinical examination was performed. For each neonate, TcB was measured on the sternum and the forehead using a calibrated Konica Minolta JM-103 bilirubinometer (Supplementary file s1). The device was zeroed per manufacturer instructions and three readings were taken at each site to obtain an average (mg/dL). Blood for TSB was obtained by heelstick or venous draw within 30 minutes of TcB measurements. TSB estimation measured by BR 5200 bilirubinometer, made in Japan by Apel co ltd. The two measurements obtained were compared. Significant hyperbilirubinemia was defined per AAP age-specific guidelines [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDemographic and clinical data (age in days, sex, birthweight, gestational age, feeding) were recorded. Neonates were classified by gestation (term\u0026thinsp;\u0026ge;\u0026thinsp;37 wk, late preterm 34\u0026ndash;36.9 wk, moderate-preterm 28\u0026ndash;33.9 wk) and by size for gestational age (small, appropriate, large). Paired TcB and TSB values were compared using paired t-tests (or Wilcoxon tests if non-normal). Subgroup analyses were performed by sex, gestational age group, and birthweight categories. Pearson correlation coefficients were calculated for TcB (forehead and sternum) versus TSB in each group. Bland-Altman analysis determined the mean bias and 95% limits of agreement between TcB and TSB. Receiver-operating characteristic (ROC) curves were constructed for TcB predicting severe hyperbilirubinemia (per AAP thresholds) in term and preterm neonates; optimal cutoffs were identified. Analyses were done in SPSS v.20. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant, and all tests were two-tailed.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e):\u003c/h2\u003e \u003cp\u003eThe cohort included 66 neonates (66.7% male, 33.3% female) with mean gestational age 37.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 wk and mean birthweight 2656\u0026thinsp;\u0026plusmn;\u0026thinsp;796 g. Two-thirds (66.7%) were term, with the remainder preterm (22.7% late preterm, 10.6% \u0026lt;34 wk). Thirty (45.5%) neonates were small-for-gestational age (SGA), 56 (84.8%) appropriate (AGA), and 4 (6.1%) large (LGA). Twenty-four (36.4%) had a birthweight\u0026thinsp;\u0026lt;\u0026thinsp;2500 g. The median age at measurement was 3 days (range 1\u0026ndash;12).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal number\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group of study population\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational Age at birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTerm (\u0026gt;\u0026thinsp;37 weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm (\u0026le;\u0026thinsp;37 weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational age specific birth weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth weight of the admitted neonates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2656.5\u0026thinsp;\u0026plusmn;\u0026thinsp;795.9 grams\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2500 gm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2500 gm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTcB vs TSB – overall and by subgroup (Tables , and ):\u003c/h3\u003e\n\u003cp\u003eIn the entire sample, mean TcB readings were consistently higher than TSB. For example, in male neonates mean TcB was 14.9 mg/dL versus 13.4 mg/dL for TSB (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); in females 15.6 vs 13.9 mg/dL (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Term neonates had mean TcB 15.8 vs TSB 14.2 mg/dL (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among preterm neonates, late-preterm (34\u0026ndash;37 wk) neonates had TcB 14.0 vs TSB 12.7 mg/dL (p\u0026thinsp;=\u0026thinsp;0.024), and moderate-preterm (\u0026lt;\u0026thinsp;34 wk) had TcB 13.5 vs 11.5 mg/dL (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Both SGA and AGA groups showed significant TcB\u0026thinsp;\u0026gt;\u0026thinsp;TSB (14.4 vs 12.6 mg/dL in SGA, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; 15.4 vs 14.0 in AGA, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The four LGA neonates had TcB 16.2 vs TSB 15.0 mg/dL (p\u0026thinsp;=\u0026thinsp;0.138), not reaching significance (likely due to small N). Neonates\u0026thinsp;\u0026lt;\u0026thinsp;2500 g had TcB 14.0 vs TSB 12.1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while those\u0026thinsp;\u0026ge;\u0026thinsp;2500 g had 15.8 vs 14.9 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In every subgroup except LGA, mean TcB significantly exceeded TSB by about 1\u0026ndash;2 mg/dL.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of bilirubin Measurement of TcB and TSB in studied sample\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean TcB (Range)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean TSB (Range)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.808\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTerm(\u0026gt;\u0026thinsp;37weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003ePreterm\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e34\u0026ndash;37 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28\u0026ndash;34 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.917\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eBirth Weight\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2500gm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(36.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-10.839\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2500gm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42(63.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-5.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of sternum TcB, Forehead TcB and TSB by Various Factors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean TcB-FH (Range)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean TcB-S (Range)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean TSB(Range)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eGestational age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTerm(\u0026gt;\u0026thinsp;37 weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePreterm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e34\u0026ndash;37 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28\u0026ndash;34 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.368\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eBirth Weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2500gm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2500gm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean comparison between transcutaneous bilirubin from forehead and sternum\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean TcB-FH (Range)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean TcB-S (Range)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.364\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eGestational age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTerm (\u0026gt;\u0026thinsp;37 weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.672\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePreterm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e34\u0026ndash;37 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.836\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28\u0026ndash;34 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.779\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.705\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.979\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eBirth Weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2500gm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.621\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2500gm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.344\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation between TcB and TSB (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) :\u003c/h2\u003e \u003cp\u003eTcB measurements strongly correlated with TSB in all groups. Overall Pearson r was 0.931 in term neonates and 0.896 in preterm neonates (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for both) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Similarly high 2 correlations were seen in SGA neonates (r\u0026thinsp;=\u0026thinsp;0.948, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and in male and female subgroups. Across the cohort, TcB measured on the forehead correlated with TSB at r\u0026thinsp;=\u0026thinsp;0.894, and TcB on the sternum at r\u0026thinsp;=\u0026thinsp;0.923 (both p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Both TcB sites yielded similar mean values (difference\u0026thinsp;~\u0026thinsp;0.1 mg/dL, p\u0026thinsp;=\u0026thinsp;ns), but the sternum reading showed a slightly higher correlation with TSB.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation among various variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003er-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eCorrelation of TCB and TSB by gestational age\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTerm (\u0026gt;\u0026thinsp;37 weeks) (\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.931\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm (\u0026le;\u0026thinsp;37 weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.896\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eCorrelation of TcB and TSB in small-for-gestational-age neonates\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eCorrelation between (TcB) from forehead (TcB-FH) and sternum(TcB-S) with serum bilirubin(TSB).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTcB-FHwith TSB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTcB-Swith TSB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eBland-Altman analysis (Fig. ):\u003c/h3\u003e\n\u003cp\u003eBland-Altman plots showed a mean bias (TcB\u0026ndash;TSB) of +\u0026thinsp;1.54 mg/dL (95% limits of agreement roughly \u0026minus;\u0026thinsp;6.8 to +\u0026thinsp;9.9 mg/dL). In other words, TcB tended to overestimate TSB by about 1\u0026ndash;2 mg/ dL on average, though individual differences could be as large as 8\u0026ndash;10 mg/dL. Forehead measurements had bias\u0026thinsp;+\u0026thinsp;1.51 mg/dL (95% LoA \u0026minus;\u0026thinsp;6.8 to +\u0026thinsp;9.9); sternum\u0026thinsp;+\u0026thinsp;1.56 mg/dL (LoA \u0026minus;\u0026thinsp;6.95 to +\u0026thinsp;10.80).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eROC curve analysis:\u003c/h2\u003e \u003cp\u003eFor term neonates, the TcB area under the ROC curve (AUC) was 0.630 (95% CI 0.485\u0026ndash; 0.774, p\u0026thinsp;=\u0026thinsp;0.150), indicating poor discrimination. Using TcB\u0026thinsp;\u0026ge;\u0026thinsp;12.4 mg/dL as a cutoff yielded 86.4% sensitivity and 46.5% specificity for identifying neonates requiring TSB confirmation. For preterm neonates, AUC was 0.628 (95% CI 0.432\u0026ndash;0.824, p\u0026thinsp;=\u0026thinsp;0.236). A TcB cutoff of 17.1 mg/dL gave 72.7% sensitivity and 35.2% specificity. These results show that while a low TcB effectively ruled out very high TSB (high sensitivity), the specificity was low, and overall accuracy was limited (Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrates that transcutaneous bilirubinometry closely tracks serum bilirubin in jaundiced neonates, although with a systematic bias. We found very strong correlations (r\u0026thinsp;\u0026asymp;\u0026thinsp;0.90) between TcB and TSB across term, preterm, and small-for-gestational-age neonates. This agrees with prior reports; for example, Shrestha et al. from Nepal observed TcB versus TSB correlations of r\u0026thinsp;\u0026asymp;\u0026thinsp;0.98 in a large neonatal cohort [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Other studies from the region, including those by Khan et al. and Panda et al. from India, similarly reported correlation coefficients exceeding 0.90 in mixed neonatal populations [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe slightly higher correlation observed at the sternum compared with the forehead in our study has also been noted previously. Cetinkaya et al. and Yadav et al. reported comparably high correlations at both measurement sites, suggesting that either location is acceptable for clinical screening [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn average, TcB values in our cohort were approximately 1\u0026ndash;2 mg/dL higher than corresponding TSB measurements. Ng et al. (2023) similarly reported that TcB tends to overestimate TSB by around 1\u0026ndash;2 mg/dL, particularly in preterm neonates [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Our Bland\u0026ndash;Altman mean bias of +\u0026thinsp;1.54 mg/dL is consistent with these findings. The wide limits of agreement observed, extending up to \u0026plusmn;\u0026thinsp;10 mg/dL in extreme cases, likely reflect biological variability and inherent measurement error. These findings reinforce that TcB should be considered primarily a screening modality rather than a diagnostic substitute.\u003c/p\u003e \u003cp\u003eReceiver operating characteristic analysis confirmed that TcB demonstrates high sensitivity but modest specificity for detecting clinically significant hyperbilirubinemia. In term neonates, a TcB threshold of approximately 12 mg/dL identified most neonates requiring confirmatory TSB testing, although false-positive results were common. This pattern is expected, as TcB is optimized for ruling out severe hyperbilirubinemia and thus exhibits a high negative predictive value. Similar performance characteristics have been documented in systematic reviews and meta-analyses [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Consequently, in accordance with AAP recommendations, elevated TcB values should prompt confirmatory TSB measurement before initiating treatment decisions [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eClinically, our findings support the integration of TcB screening into routine newborn care. The American Academy of Pediatrics (2022) recommends universal predischarge bilirubin screening using either TSB or TcB in term neonates [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], while the World Health Organization (2024) now explicitly advises TcB screening for all newborns to prevent kernicterus [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In resource-limited settings such as Nepal, TcB provides a less invasive means of identifying neonates at risk for significant hyperbilirubinemia. Although TcB devices require initial capital investment, their use may reduce cumulative laboratory costs and neonatal discomfort associated with repeated heel-stick sampling. The high correlation and sensitivity observed in this study suggest that adopting TcB-based screening could safely reduce unnecessary serum bilirubin measurements, consistent with international practice.\u003c/p\u003e\n\u003ch3\u003eClinical implications:\u003c/h3\u003e\n\u003cp\u003eThe strong TcB\u0026ndash;TSB correlation supports using TcB as a noninvasive screening tool for neonatal jaundice. In practical terms, TcB can reduce the number of invasive blood draws: healthy-appearing neonates with low TcB can be spared routine venipuncture, while high TcB readings can trigger confirmatory testing. This is particularly valuable in resource-limited settings or in managing preterm neonates, where frequent blood sampling is burdensome. Following AAP and WHO recommendations, implementing universal TcB screening before discharge (at ~\u0026thinsp;24\u0026ndash;48 hours) could allow early detection of rising bilirubin. For example, an neonate with a TcB well below the phototherapy threshold could be discharged with outpatient follow-up instead of routine TSB. Conversely, an elevated TcB would prompt timely phototherapy or exchange consideration. The slightly higher correlation of sternum TcB suggests using the chest site for greater accuracy.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations:\u003c/h2\u003e \u003cp\u003eThis study has several strengths. It is one of the first in Nepal to systematically compare TcB and TSB in a clinical cohort. We included a broad neonatal population (term and preterm; SGA/AGA), and used rigorous measurement and statistical methods (including Bland\u0026ndash;Altman and ROC analyses). All TcB measurements were done by the same trained operator using a calibrated device, reducing variability. However, limitations must be noted. Our sample size was relatively small (N\u0026thinsp;=\u0026thinsp;66), and the study was single-center, so results may not generalize to all settings. We only studied neonates who already had clinical jaundice and were under physician care, rather than a true universal screening population, which could bias the severity distribution. We did not formally assess the effect of skin pigmentation (we did not record precise ethnicity or skin color), which is known to influence TcB accuracy. Also, our bilirubinometer had an upper measurement limit, so extremely high bilirubins might not have been fully captured. Finally, we did not compare different TcB devices; different manufacturers or models might perform differently.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations:\u003c/h2\u003e \u003cp\u003eFor clinical practice, our findings support the adoption of TcB for initial jaundice screening and monitoring. Hospitals in Nepal and similar settings should consider acquiring TcB meters and training staff in their use, especially for pre-discharge assessment. Given the device cost, a cost-benefit analysis is needed, but the potential to reduce laboratory tests and neonatal distress is compelling. Clinicians should remember that TcB has lower specificity, so a low threshold for confirmatory TSB is prudent when TcB is elevated. Based on our data, we recommend prioritizing sternum measurements for slightly higher accuracy. Future research should include larger, multicenter studies to confirm these findings across diverse populations. Studies that include healthy newborns (for universal screening) and account for skin color would provide more generalizable data. In summary, TcB is a clinically useful tool for neonatal jaundice screening, offering a safe, rapid estimate of bilirubin levels. When used appropriately, it can improve patient care by identifying neonates in need of treatment while minimizing unnecessary blood draws.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e% Percentage\u003c/p\u003e\u003cp\u003eAAP American Academy of Pediatrics\u003c/p\u003e\u003cp\u003eAGA Appropriate for Gestational Age\u003c/p\u003e\u003cp\u003eCHB Conjugated hyperbilirubinemia\u003c/p\u003e\u003cp\u003eFH Forehead\u003c/p\u003e\u003cp\u003eGA Gestational age\u003c/p\u003e\u003cp\u003eIRB Institutional Review Board\u003c/p\u003e\u003cp\u003eKCH Kanti Children’s Hospital\u003c/p\u003e\u003cp\u003eLBW Low Birth Weight\u003c/p\u003e\u003cp\u003eLGA Large for Gestational Age\u003c/p\u003e\u003cp\u003eNICU Neonatal Intensive Care Unit\u003c/p\u003e\u003cp\u003ep Probability\u003c/p\u003e\u003cp\u003ePMWH Paropakar Maternity and Women's Hospital\u003c/p\u003e\u003cp\u003er Correlation coefficient\u003c/p\u003e\u003cp\u003eROC Receiver Operating Characteristics\u003c/p\u003e\u003cp\u003eS Sternum\u003c/p\u003e\u003cp\u003eSGA Small for Gestational Age\u003c/p\u003e\u003cp\u003eTB Total Bilirubin\u003c/p\u003e\u003cp\u003eTcB Transcutaneous Bilirubin\u003c/p\u003e\u003cp\u003eTSB Total Serum Bilirubin\u003c/p\u003e\u003cp\u003eUHB Unconjugated hyperbilirubinemia\u003c/p\u003e\u003cp\u003eWHO World health organization\u003c/p\u003e\u003cp\u003eWk Weeks\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e This prospective cross-sectional study was approved by the Institutional Review Committee of National Academy of Medical Sciences, conducted in PMWH, Kathmandu, Nepal. The study was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from the parents or legal guardians of all neonates prior to enrollment. Confidentiality of participant information was strictly maintained, and all data were anonymized before analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable. (Individual patient data were anonymized, and no identifying images or personal information are included in this manuscript.)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJK (Dr. Jagdish Kunwar) conceptualized and designed the study, participated in data collection, performed statistical analysis, and drafted the initial manuscript.\u003cbr\u003e\u0026nbsp;BK (Dr. Bijay Kunwar) contributed to study conception and design, supervised data analysis, interpreted the results, and critically revised the manuscript; BK also served as the corresponding author.\u003cbr\u003e\u0026nbsp;AG (Dr. Anup Ghimire) assisted in study design, data interpretation, and critical revision of the manuscript.\u003cbr\u003e\u0026nbsp;SPK (Dr. Santoshi Pokharel Kunwar) contributed to data collection and manuscript drafting.\u003cbr\u003e\u0026nbsp;ST (Dr. Sachchu Thapa) assisted with data collection, literature review, and manuscript preparation.\u003cbr\u003e\u0026nbsp;PP (Asst. Prof. Dr. Prajwal Paudel) contributed to study methodology, supervised data collection, and critically reviewed the manuscript for important intellectual content.\u003cbr\u003e\u0026nbsp;KUS (Prof. Dr. Kalpana Upadhyay Subedi) provided overall supervision of the study, guided the research process, and critically revised the manuscript for intellectual content.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eThe authors would like to thank the Department of Pediatrics, Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal, for institutional support. We are grateful to the nursing staff and laboratory personnel for their assistance, and to the parents and neonates who participated in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, editors. Nelson Textbook of Pediatrics. 21st ed. Philadelphia: Elsevier; 2020. pp. 871\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaisels MJ. Neonatal jaundice. Pediatr Rev. 2006;27(12):443\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn neonate\u0026thinsp;\u0026ge;\u0026thinsp;35 weeks of gestation. Pediatrics. 2004;114(1):297\u0026ndash;316.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatchko JF, Tiribelli C. Bilirubin-induced neurologic damage\u0026mdash;mechanisms and management approaches. N Engl J Med. 2013;369(21):2021\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhutani VK, Johnson L, Keren R. Diagnosis and management of hyperbilirubinemia in the term neonate. Pediatr Clin North Am. 2004;51(4):843\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarker DP, Rutter N. Exposure to invasive procedures in neonatal intensive care unit admissions. Arch Dis Child Fetal Neonatal Ed. 1995;72(1):F47\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaisels MJ, Newman TB. Visual assessment of jaundice in newborns. Pediatrics. 1995;95(3):383\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEbbesen F, Rasmussen LM, Wimberley PD. A new transcutaneous bilirubinometer, BiliCheck, used in the neonatal intensive care unit. Acta Paediatr. 2002;91(2):203\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFawaz R, Baumann U, Ekong U, Fischler B, Hadzic N, Mack CL, et al. Guideline for the Evaluation of Cholestatic Jaundice in Neonates: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2017;64(1):154\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaylor JA, Burgos AE, Flaherman V, Chung EK, Simpson EA, Goyal NK. Discrepancies between transcutaneous and serum bilirubin measurements. Pediatrics. 2015;135(2):224\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHansen TWR. Prevention of neurodevelopmental sequelae of jaundice in the newborn. Dev Med Child Neurol. 2011;53(Suppl 4):24\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. WHO recommendations on newborn health: guidelines approved by the WHO Guidelines Review Committee. Geneva: WHO; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWidness JA. Pathophysiology of anemia during the neonatal period, including anemia of prematurity. Neonatology. 2008;94(4):243\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNagar G, Vandermeer B, Campbell S, Kumar M. Reliability of transcutaneous bilirubin devices in term and preterm neonates: a systematic review and meta-analysis. Pediatrics. 2013;132(5):871\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Clinical practice guideline: management of hyperbilirubinemia in the newborn neonate\u0026thinsp;\u0026ge;\u0026thinsp;35 weeks\u0026rsquo; gestation. Pediatrics. 2022;150(3):e2022058859.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. WHO recommendations on newborn health. Geneva: World Health Organization; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShrestha S, Shrestha S, Shakya A, et al. Correlation between transcutaneous bilirubin and total serum bilirubin in Nepalese neonates. JNMA J Nepal Med Assoc. 2019;57(217):15\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNg DK, Lam HS, Wong SPS, et al. Accuracy of transcutaneous bilirubinometry in preterm neonates: a multicenter study. Acta Paediatr. 2023;112(4):789\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan KA, Malik SA, Bai S, et al. Evaluation of transcutaneous bilirubinometry in neonates with hyperbilirubinemia. Indian Pediatr. 2017;54(5):385\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePanda SK, Mishra S, Dash SK, et al. Correlation of transcutaneous bilirubin with serum bilirubin in term and preterm neonates. J Clin Neonatol. 2018;7(3):146\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCetinkaya M, Ozkan H, K\u0026ouml;ksal N. Comparison of transcutaneous bilirubin measurements from the forehead and sternum in neonates. Turk J Pediatr. 2011;53(6):613\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYadav RK, Sethi RS, Sethi AS. Site-specific comparison of transcutaneous bilirubin measurement in neonates. Int J Contemp Pediatr. 2016;3(3):867\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Neonatal jaundice, Transcutaneous bilirubin, Total serum bilirubin, Hyperbilirubinemia, Newborn screening","lastPublishedDoi":"10.21203/rs.3.rs-8496085/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8496085/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eNeonatal jaundice is very common (\u0026asymp;\u0026thinsp;60% of term and 80% of preterm newborns) and, if severe, can lead to bilirubin neurotoxicity. The gold-standard total serum bilirubin (TSB) measurement is invasive and time-consuming. Transcutaneous bilirubinometry (TcB) is a quick, noninvasive alternative using a skin bilirubinometer. Leading guidelines recommend universal predischarge jaundice screening using TSB or TcB. However, TcB is underused in Nepal, and its accuracy \u0026ndash; especially in preterm neonates \u0026ndash; needs validation. This study compares TcB and TSB in jaundiced neonates.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eIn a single-center prospective study (Oct 2023\u0026ndash;Sep 2024) at Paropakar Maternity and Women\u0026rsquo;s Hospital (Kathmandu, Nepal), 66 neonates with clinical jaundice were enrolled. TcB was measured at the mid-sternum and forehead using a calibrated JM-103 bilirubinometer (Konica Minolta). Venous blood was drawn (within 30 min of TcB) for TSB (BR-5200 spectrophotometer). Mean TcB values (average of three readings per site) were compared with TSB. Statistical analysis included Pearson correlation, Bland\u0026ndash;Altman agreement, and ROC curves (SPSS v20). A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eAmong the 66 neonates, 66.7% were male. Most were term (66.7%) and appropriate-for-gestational-age (63.6%). The mean birth weight was 2656.5\u0026thinsp;\u0026plusmn;\u0026thinsp;795.9 g. Mean TcB values exceeded TSB by ~\u0026thinsp;1\u0026ndash;2 mg/dL across categories, a statistically significant difference in all groups except large-for-gestational-age (LGA) neonates. Crucially, TcB and TSB were highly correlated. Pearson r was 0.931 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in term neonates and 0.896 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in preterm neonates. Among small-for-gestational-age neonates, r was 0.948 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). TcB measured at the sternum versus forehead did not differ in mean value (no significant site effect). Both sites correlated well with TSB (r\u0026thinsp;=\u0026thinsp;0.923 for sternum vs 0.894 for forehead, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 each). Bland\u0026ndash;Altman analysis showed a mean TcB\u0026ndash;TSB bias of +\u0026thinsp;1.5 mg/dL (95% limits \u0026minus;\u0026thinsp;6.8 to +\u0026thinsp;9.9). ROC analysis for detecting significant hyperbilirubinemia yielded AUC\u0026thinsp;\u0026asymp;\u0026thinsp;0.63 for both TcB and TSB in preterm and term subgroups; TcB thresholds achieved high sensitivity (~\u0026thinsp;85%) but low specificity (\u0026asymp;\u0026thinsp;45%).\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eTranscutaneous and serum bilirubin levels were strongly, positively correlated across all subgroups (term, preterm, SGA), indicating that TcB is a reliable noninvasive screening tool for neonatal jaundice. Sternum readings correlated slightly better than forehead. Given its rapid, painless measurement, TcB can be used to screen and monitor jaundice, reducing unnecessary blood draws. However, TcB tends to overestimate TSB by about 1.5 mg/dL, and elevated TcB readings near treatment thresholds should be confirmed by TSB. Practically, universal TcB screening (24\u0026ndash;48 h postnatal) as endorsed by WHO and AAP could be implemented, with follow-up TSB as needed. Larger multicenter studies and cost-benefit analyses are recommended to confirm these findings in broader settings.\u003c/p\u003e","manuscriptTitle":"Comparison of Transcutaneous and Total Serum Bilirubin Measurements in Neonates With Jaundice: A Prospective Study From Nepal","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-13 09:10:41","doi":"10.21203/rs.3.rs-8496085/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fe44b9a1-04e6-43d1-8df1-923b1d49851d","owner":[],"postedDate":"January 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-11T06:10:56+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-13 09:10:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8496085","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8496085","identity":"rs-8496085","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}