經皮式黃膽測定儀（BiliCheck）篩選新生兒黃膽之評估

Validating the BiliCheck for Screening of Neonatal Jaundice

Objective:To evaluate whether BiliCheck assay is a useful in non-invasive screening tool for neonated jaundice. Methods:Total serum bilirubin (TSB) was assayed for total bilirubin by direct spectrophotometry using a Unistat bilirubinometer (Leica). Transcutaneous bilirubin (TcB) obtained from the forehead (TcB(f)) and the sternum (TcB(s)) with BiliCheck. Simultaneous TSB and BiliCheck readings as well as correlation data were obtained from 190 neonates. Results:The correlations between TSB and TcB measurements were high, with a coefficient of 0.841 for forehead measurements, and 0.805 for sternum using the BiliCheck. For BiliCheck, a cut-off point of 15 mg/dL at the forehead and at the sternum had a specificity of 85% and 71%, with a sensitivity of 94% for the detection of serum bilirubin concentrations of 15 mg/dL. The AUC (0.938) for TcB(f) was significantly higher than AUC (0.890) for TcB(s) (p = 0.009). A series of ROC curves were plotted and the results showed that the best sensitivity may reach 100% if the bilirubin cut-off point could be set at 14 mg/dL. By estimation, employing TcB(f) will reduce blood test up to 66% in this study. Conclusion: BiliCheck is a useful screening tool for neonatal jaundice and may significantly reduce the need for blood sampling.

目的：評估是否經皮式黃膽測定儀（BiliCheck）有效於篩選新生兒黃膽。方法：針對190位新生兒，同步使用BiliCheck分別在嬰兒額頭與胸口經皮測量膽紅素值，及採取嬰兒足跟血離心後使用Unistat bilirubinometer （Leica）分光光度計比色測量血清總膽紅素值，進行兩者的相關性比較。結果：使用BiliCheck分別在額頭與胸口測量經皮量度的膽紅素值，與足跟血測量血清膽紅素值有極佳的相關性，額頭量度的相關係數為0.841，胸口量度的相關係數為0.805。利用ROC曲線測得BiliCheck量度於額頭及胸口的切斷點皆為15mg/dL，其特異性分別為85％及71％，敏感度皆達94％。ROC曲線下面積分析結果顯示額頭的AUC值為0.938，明顯較胸口AUC值0.890好，兩者具統計學的顯著差異（p=0.009）。為使敏感度達100％，本次研究顯示BiliCheck量度切斷點應定為14mg/dL，若以BiliCheck量度嬰兒額頭的膽紅素值小於14mg/dL則無須扎足跟血測量血清總膽紅素值，計算出可降低新生兒的侵入性採血率達66％。結論：經皮式黃膽測定儀（BiliCheck）為篩選新生兒黃膽的良好工具，並可有效降低新生兒的侵入性採血率。