Journal of Perinatology https://doi.org/10.1038/s41372-018-0154-3 ARTICLE Transcutaneous bilirubinometer use and practices surrounding jaundice in 150 California newborn intensive care units Dilip R. Bhatt 1 ● Alexandria I. Kristensen-Cabrera 2 ● Henry C. Lee 2 ● Sunjeeve Weerasinghe 1 ● David K. Stevenson 2 ● Vinod K. Bhutani 2 ● M. Jeffrey Maisels 3 ● Rangasamy Ramanathan 4 Received: 5 September 2017 / Revised: 10 April 2018 / Accepted: 17 May 2018 © Nature America, Inc., part of Springer Nature 2018 Abstract Objectives Transcutaneous bilirubin measurements (TcBs) provide a noninvasive method for screening infants for hyper- bilirubinemia and have been used extensively in term and late preterm newborns in well baby nurseries, offices, and outpatient clinics. Several studies have also demonstrated the utility of TcBs as a screening tool for infants > 28 weeks’ gestation and their ability to reduce the need for blood sampling. The objectives of this study are to identify how often TcBs are used among California Newborn Intensive Care Units (NICUs) in preterm, late preterm and term infants, and other aspects of jaundice management. Methods We conducted a survey on TcB use and practices relating to jaundice management in 150 California NICUs between April and October 2016. Results TcB screening is routinely used in 28% (42/150) of NICUs. Only 7% (11/150) of NICUs use TcB in preterm infants < 28 weeks. Practice varied similarly across NICU levels of care. Among the subset of NICUs that responded to questions related to phototherapy and screening practices, prophylactic phototherapy was used in 38% (23/59) and 90% (55/61) screened for glucose-6-phosphate dehydrogenase deficiency based on race, ethnicity, and/or family history. Conclusion(s) Despite studies validating the accuracy of TcB in preterm infants > 28 weeks, only 28% of California NICUs routinely use TcB devices. TcB screening in infants < 28 weeks gestation is not widely used and no recommendation can be made in this regard until there is more experience with its application using a standardized protocol in these infants and on a large scale. Introduction Transcutaneous bilirubinometers (TcBs) provide a non- invasive, pain-free, rapid estimation of bilirubin levels [1]. When used as a screening technique that tells the caretaker when to obtain a total serum bilirubin (TSB), TcBs have been shown to reduce the need for blood sampling, improve patient safety, decrease resource utilization, and decrease the need for phototherapy [2–4]. The 2004 hyperbilirubinemia guideline of the Amer- ican Academy of Pediatrics (AAP) and the update in 2009 recommended the use of TcBs for infants > 35 weeks’ gestation [5, 6], but the “consensus-based” recommenda- tion for the management of hyperbilirubinemia in preterm infants < 35 weeks did not mention TcBs [7]. In term infants, a consistently strong correlation has been shown between TcB and TSB levels [8, 9] and a systematic review concluded that TcB devices provide a reliable estimate of TSBs in preterm infants [10]. The use of TcBs in infants receiving phototherapy remains controversial [11, 12]. Although there is a moderate correlation between TcB and TSB during phototherapy, TcB levels are con- sistently lower than TSB values during phototherapy [13]. Because we do not know how TcB devices are currently utilized in NICUs, we sought this information from California NICUs. * Dilip R. Bhatt dilip.r.bhatt@kp.org 1 Pediatrics Department- Neonatology, Kaiser Permanente, Fontana, CA, United States 2 Pediatrics, Stanford University, Stanford, CA, United States 3 Pediatrics, Oakland University William Beaumont School of Medicine and Beaumont Children’s, Royal Oak, MI, United States 4 Pediatrics- Division of Neonatology, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, CA, United States 1234567890();,: 1234567890();,: