Bilirubinometer: Complete Guide to Jaundice Meters for Newborn Care
What is a Bilirubinometer?
A bilirubinometer, also called a jaundice meter, is a medical device designed to measure bilirubin levels in newborns and infants. Bilirubin is a yellow pigment produced when red blood cells break down naturally in the body. When bilirubin levels become too high, it causes jaundice, making the skin and whites of the eyes appear yellow.
This device helps healthcare professionals quickly identify and monitor jaundice in babies, allowing for timely treatment and preventing serious complications like kernicterus, a condition where high bilirubin levels damage the brain.
Brief History
The journey of bilirubinometers began with the recognition that yellow skin color in jaundiced babies was due to bilirubin deposits. For many years, doctors relied only on visual inspection, which often led to inaccurate estimates. Research in the late 1970s showed that visual assessment alone was unreliable for detecting dangerous bilirubin levels.
In 1980, the first transcutaneous bilirubinometer was introduced by Minolta, marking a breakthrough in non-invasive jaundice monitoring. This device used a simple two-filter design to measure the yellowness of skin. Since then, technology has advanced significantly. Modern bilirubinometers can now report actual bilirubin values, correct for skin pigmentation differences, and even connect to electronic medical records. These devices have become essential screening tools in hospitals worldwide, making jaundice detection faster, painless, and more accurate.
Purpose and Where They Are Used
Common Settings Where Bilirubinometers Are Used:
- Neonatal Intensive Care Units (NICU): For continuous monitoring of premature and high-risk babies
- Newborn Nurseries: For routine screening of all newborns before hospital discharge
- Maternity Wards: For checking mothers and babies together
- Pediatric Clinics: For follow-up visits after hospital discharge
- Emergency Departments: For urgent assessment of babies with suspected jaundice
- Community Health Centers: For accessible screening in resource-limited areas
- Home Care Settings: For monitoring babies receiving home phototherapy
Types of Bilirubinometers
1. Transcutaneous Bilirubinometers (TcB)
The most common type used today. These are non-invasive, handheld devices that measure bilirubin levels through the skin.
How They Work: The device shines light into the baby's skin and measures how much light of specific wavelengths reflects back. Since bilirubin absorbs certain wavelengths of light, the device can estimate bilirubin levels based on skin yellowness.
Advantages:
- Completely painless for the baby
- Results available in under one minute
- Can be repeated as often as needed
- Reduces need for blood tests
- Battery-operated and portable
2. Serum Bilirubinometers (Laboratory-Based)
These devices measure bilirubin in blood samples taken from the baby.
How They Work: A small blood sample is collected, usually from a heel prick, and processed in a laboratory machine that uses chemical analysis or spectrophotometry to measure exact bilirubin levels.
When Used: This is the gold standard method used when transcutaneous readings are very high, when treatment decisions need confirmation, or when skin readings may be inaccurate.
3. Point-of-Care Blood Bilirubinometers
Newer devices that can test a few drops of blood at the bedside without sending samples to a laboratory.
Features: These portable devices can give accurate blood bilirubin measurements in just a few minutes, useful in clinics and resource-limited settings.
How to Use a Bilirubinometer: Step-by-Step Guide
This guide focuses on transcutaneous bilirubinometers, as they are most commonly used for initial screening.
Before You Start
- Ensure the device is fully charged or has fresh batteries
- Check that the device has passed its calibration check
- Clean the probe tip according to manufacturer instructions
- Wash your hands thoroughly
- Gather the baby's information for recording
Measurement Procedure
- Turn on the bilirubinometer and wait for it to complete its automatic self-test. The device should display a ready message.
- Choose the measurement site. The forehead and sternum (breastbone) are the two standard sites. The sternum often gives more accurate readings, but the forehead is easier to access.
- Ensure the skin at the measurement site is clean, dry, and intact. Avoid areas with birthmarks, bruises, rashes, or broken skin.
- If the baby has been under phototherapy lights, turn them off for a few seconds before measuring.
- Place the probe tip firmly and gently against the skin. Apply steady, even pressure. You should hear a beep or see a light indicating the measurement is being taken.
- Hold the device steady for the duration of the measurement, usually 2-5 seconds. Do not move or lift the probe until the reading is complete.
- The device will display the bilirubin reading on the screen, usually in mg/dL or micromol/L units.
- Most guidelines recommend taking three measurements at the same site and using the average. Some devices automatically calculate this average.
- Record the reading along with the measurement site, date, time, and baby's age in hours.
- Clean the probe tip with an appropriate disinfectant wipe between patients to prevent infection transmission.
Understanding the Results
Bilirubin levels are measured in milligrams per deciliter (mg/dL) or micromoles per liter (micromol/L). Different values have different meanings:
| Bilirubin Level | Interpretation | Action Needed |
|---|---|---|
| Below 5 mg/dL | Normal range | Continue routine monitoring |
| 5-12 mg/dL | Mild jaundice | Close monitoring, recheck in 12-24 hours |
| 12-15 mg/dL | Moderate jaundice | May need phototherapy, confirm with blood test |
| Above 15 mg/dL | Significant jaundice | Urgent blood test, likely needs phototherapy |
| Above 20 mg/dL | Severe jaundice | Immediate treatment, may need intensive therapy |
Precautions and Important Safety Information
When Transcutaneous Readings May Be Inaccurate
- During or after phototherapy: Blue light therapy affects skin bilirubin differently than blood bilirubin
- Very dark skin: Melanin can interfere with light absorption measurements
- Extremely premature babies: Less reliable in babies born before 32 weeks gestation
- After blood transfusion: Can give falsely low readings
- On bruised skin: Hemoglobin from bruising interferes with measurements
- Birthmarks or skin conditions: Abnormal pigmentation affects accuracy
- Very high bilirubin levels: Readings above 15-18 mg/dL should always be confirmed with blood tests
Safety Precautions
- Never rely solely on transcutaneous readings for treatment decisions at high bilirubin levels
- Never use the device on broken or irritated skin
- Always clean the probe between patients to prevent infection transmission
- Do not press too hard on the baby's skin, as this can cause discomfort and affect readings
- Ensure proper calibration checks are performed regularly as per manufacturer guidelines
- Do not use the device if it fails calibration checks or shows error messages
- Keep the device away from water and extreme temperatures
Clinical Dangers if Jaundice is Not Detected
- Cerebral palsy
- Hearing loss
- Developmental delays
- Vision problems
- Dental enamel problems
Prevention: Early screening with bilirubinometers helps identify at-risk babies before bilirubin reaches dangerous levels.
How to Keep Your Bilirubinometer Safe
Daily Maintenance
- Clean the probe tip after each use with manufacturer-approved disinfectant wipes
- Check battery level before starting daily use
- Wipe down the device exterior with a soft, slightly damp cloth
- Store in a clean, dry place when not in use
Regular Maintenance
- Perform calibration checks as recommended, typically daily or weekly
- Use the calibration device or checker port provided by the manufacturer
- Replace batteries when the low battery warning appears
- Keep the docking station clean and free of dust
Long-term Care
- Schedule annual servicing by qualified technicians
- Keep records of all calibration checks and maintenance
- Update software when manufacturer releases new versions
- Replace the probe tip if it becomes scratched or damaged
- Store in the original case when transporting
- Avoid dropping or exposing to impact
- Keep away from extreme heat, cold, or moisture
Available Brands and Cost Information
Several reputable manufacturers produce bilirubinometers used globally:
Major Brands
General Cost Information
The cost of bilirubinometers varies significantly based on features, technology, and region:
- Basic handheld transcutaneous models: Generally start from a few hundred to several thousand dollars
- Advanced transcutaneous models with data connectivity: Can range from several thousand to over ten thousand dollars
- Laboratory serum bilirubinometers: Typically range from several thousand to tens of thousands of dollars
- Point-of-care blood testing devices: Mid-range pricing, often a few thousand dollars
Prices vary by country, distributor, and whether purchasing new or refurbished equipment. Contact local medical equipment suppliers or manufacturers directly for current pricing in your region.
Frequently Asked Questions
Is the bilirubinometer test painful for babies?
No. Transcutaneous bilirubinometers are completely painless. The device simply touches the baby's skin gently for a few seconds. Babies usually do not even notice the test is happening.
How accurate are transcutaneous bilirubinometers?
Transcutaneous bilirubinometers are very good screening tools with accuracy within 1-2 mg/dL of blood tests in most cases. However, they are less accurate at very high bilirubin levels, on dark skin, or during phototherapy. Blood tests should confirm high readings before treatment decisions.
Can I use a bilirubinometer at home?
While some newer devices are being developed for home use, currently most bilirubinometers are professional medical devices requiring training. Only healthcare professionals should interpret readings and make treatment decisions. Home visual assessment is not reliable for detecting dangerous jaundice levels.
Where should I measure on the baby's body?
The two standard sites are the forehead (center, just above eyebrows) and the sternum (center of the chest over the breastbone). Studies show the sternum often correlates better with blood tests, but both sites are acceptable. Always use the same site for repeat measurements.
How often should babies be checked for jaundice?
All newborns should be checked before hospital discharge. Babies at higher risk may need checking every 8-12 hours. After discharge, follow-up within 1-2 days is recommended, especially if jaundice was detected. Your healthcare provider will advise on the schedule based on individual risk factors.
What bilirubin level needs treatment?
This depends on the baby's age in hours, gestational age at birth, and risk factors. Generally, full-term healthy babies may need phototherapy if bilirubin is above 12-15 mg/dL in the first few days, but this varies. Treatment thresholds are lower for premature babies and those with risk factors.
Can bilirubinometers be used on adults?
Most transcutaneous bilirubinometers are designed and approved only for newborns and infants. The technology is optimized for neonatal skin characteristics. For adults with jaundice, blood tests are the standard method for measuring bilirubin levels.
Do bilirubinometers work on all skin colors?
Modern bilirubinometers have been designed to work across different skin tones and include corrections for melanin. However, accuracy may decrease in babies with very dark skin. When in doubt, especially at high readings, blood tests should confirm transcutaneous measurements regardless of skin color.
How do I know if the device needs calibration?
Most devices have automatic calibration reminders. Perform calibration checks daily or as recommended by the manufacturer. If the device fails calibration or shows error messages, do not use it until it has been serviced. Keep records of all calibration checks.
Can the device spread infections between babies?
If proper cleaning protocols are not followed, there is a theoretical risk. Always clean the probe tip with appropriate disinfectant between patients. Follow your facility's infection control guidelines and manufacturer cleaning instructions.
Additional Important Information
Integration with Electronic Health Records
Many modern bilirubinometers can connect to hospital information systems, allowing readings to be automatically recorded in the baby's electronic medical record. This reduces documentation errors and improves efficiency. Some devices have barcode scanners to ensure correct patient identification.
Training Requirements
Healthcare professionals using bilirubinometers should receive proper training on:
- Device operation and troubleshooting
- Proper measurement technique
- When to obtain confirmatory blood tests
- Interpretation of results
- Maintenance and calibration procedures
- Infection control practices
Quality Assurance
Healthcare facilities should establish quality assurance programs including:
- Regular calibration checks
- Periodic comparison with laboratory blood tests
- Documentation of maintenance and service
- Staff competency assessments
- Review of measurement protocols
Suggested Resources
For more detailed information about bilirubinometers and neonatal jaundice management, consult these resources:
Professional Guidelines
- American Academy of Pediatrics Clinical Practice Guidelines for Management of Hyperbilirubinemia
- World Health Organization Guidelines on Neonatal Health
- National Institute for Health and Care Excellence (NICE) Guidelines on Jaundice in Newborns
Medical Textbooks
- Nelson Textbook of Pediatrics (chapters on neonatal jaundice)
- Avery's Diseases of the Newborn
- Cloherty and Stark's Manual of Neonatal Care
Official Websites
- Manufacturer websites for specific device manuals and training materials
- American Academy of Pediatrics official website
- Centers for Disease Control and Prevention (CDC) resources
- WHO Newborn Health Resources
Labels: Neonatal-Care