Comparisons of Optimal Point of Care Bilirubin Testing for Accuracy and Convenience

Abstract Objectives To identify a precise and convenient bedside methodology for determining neonatal bilirubin levels. In the context of shortening hospital stays, implementing high-precision point-of-care testing provides rapid results within minutes, ensuring faster and safer neonatal management and more efficient discharge planning. Methods A total of 131 term neonates were evaluated for total bilirubin concentrations using five different methods: two transcutaneous measurements (TcB test on the forehead [h] and sternum [s]), heel-stick total serum bilirubin (TSB) capillary blood testing via a bedside gas analyzer (Radiometer) and a point-of-care spectrophotometer (Bilimeter 3D POCT), and a laboratory analysis of venous blood samples using a chemistry analyzer (Beckman Coulter). The venous blood test was used as the standard against which the other four methods were compared. Results No significant statistical differences were found between the heel-stick plasma bilirubin values obtained with the Pfaff Bilimeter 3D (3D POCT) spectrophotometer and the laboratory reference method.The 3D POCT method showed a minimal mean bias of 2.36 µmol/L compared to the venous standard. In contrast, transcutaneous (TcB) measurements and the bedside gas analyzer (Radiometer) (TSB POCT) data, characterized by significantly higher mean biases, reduced correlation coefficients for TcB, and wider 95% limits of agreement. These findings indicate a higher risk of clinical misclassification when using TcB (from the forehead and sternum) or gas analysis compared to the 3D POCT spectrophotometer. Conclusions Our study suggests that total bilirubin determination from capillary blood samples (30 µl) using the Bilimeter 3D POCT method provides results with a high level of agreement compared to venous samples analyzed via a Beckman Coulter system. This bedside methodology demonstrates strong analytical consistency with standard laboratory techniques, offering a rapid and clinically relevant alternative for neonatal bilirubin monitoring. The findings highlight the significant advantages of this spectrophotometric approach, which provides a faster diagnostic turnaround while maintaining accuracy levels suitable for clinical decision-making within the studied population.