Commentary on “The point-of-care Bilistick method has very short turn-around-time and high accuracy at lower cut-off levels to predict laboratory-measured TSB.”

Hyperbilirubinemia is the most frequent clinical problem neonatologists must deal with during the newborn period because it can affect more than 60% of late preterm and term infants. Hyperbilirubinemia represents a relevant workload for neonatal units and it has been observed to be the primary reason for about 5% of hospital admissions and 22% of re-admissions.¹ High levels of total serum bilirubin (TSB) can be toxic to the central nervous system. Gale et al., using data from the National Neonatal Research Database, have reported that bilirubin encephalopathy was the sixth cause of neonatal brain injuries in the United Kingdom during the period of 2012–2015 with a rate of about one case per 100 000 live births per year.² Recently, the systematic nomenclature of bilirubin-induced brain injuries has been updated: the term acute bilirubin encephalopathy should be used only to designate the acute phase of bilirubin encephalopathy, while the term kernicterus spectrum disorders (KSDs) should be used to encompass all the neurological sequelae of bilirubin neurotoxicity.³ Moreover, KSDs should be classified as auditory-predominant, motor-predominant, or both auditory and motor dysfunction subtypes, and on the basis of clinical disorder severity (mild, moderate, and severe).³

Several national recommendations have been developed to prevent KSDs by establishing TSB threshold levels associated with risk for neurological damage at which to start phototherapy treatment, the first-line treatment for neonatal hyperbilirubinemia and, eventually, to perform exchange transfusions. Thus, the question of TSB monitoring is very important and having accurate methods for its assessment is crucial. In the clinical practice, TSB is generally measured on plasma using a diazotization reaction or on whole blood using a blood gas analyzer with a spectrophotometer module.⁴ Moreover, to limit frequent and painful blood sampling, transcutaneous bilirubin (TcB) measurement, which is a less invasive method, has widespread use. This measurement is performed using spectral reflectance instruments. However, the use of TcB measurements has some limitations such as ±15–20% imprecision depending on gestational age, skin pigmentation, TSB > 188 µmol/L (10.9 mg/dL), and its inaccuracy during phototherapy.⁴

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