Background
Severe neonatal jaundice (SNJ) and associated long term health sequelae are a significant problem in low income countries (LIC) where measurement of total serum bilirubin (TSB) is often unavailable. Transcutaneous bilirubinometry (TcB) provides opportunity for non-invasive, point-of-care monitoring. Few studies have evaluated its agreement with TSB levels during phototherapy in LICs.
Aim
To determine agreement between TcB and TSB during phototherapy in a Haiti newborn population, and to establish if TcB can be safely used to guide treatment during photother-apy when TSB is unavailable.

Methods
A single centre prospective study (February-May 2017) in Cap Haïtien, northern Haiti was conducted. Newborns with clinically detected jaundice, <7 days of age were eligible for inclusion. A TcB device (JM-103) was used to screen for newborn jaundice along with a parallel TSB. A strip of black tape was placed across the sternum during phototherapy and uncovered for subsequent TcB measurements. Phototherapy treatment decisions were based upon UK National Institute of Clinical Excellence (NICE) threshold criteria. Paired TSB and TcB measurements were compared using Bland Altman methods.

Results
The final analysis included 70 parallel TSB/TcB measurements from 35 infants within the first five days of life. 19 (54.3%) were male; 12 (34.3%) were <35 weeks. 32 (91.4%) were receiving phototherapy. There was good agreement between TSB and TcB. TcB tended to overestimate bilirubin in comparison to TSB; mean difference 11.1 µmol/L (95% CI -10.2, 32.5 µmol/L). However, at higher bilirubin levels (>250 µmol/L), TcB tended to underestimate bilirubin in comparison to TSB and the magnitude of the differ-ence increased.

Conclusion
In a LIC setting where serum bilirubin testing is not commonly available, TcB demon-strates good agreement with TSB and can be safely used to guide jaundice treatment dur-ing phototherapy but may lead to overtreatment at lower bilirubin levels and are more in-accurate at higher levels. For TcB levels >250µmol, confirmation with serum bilirubin should be performed if available to avoid underestimation.