Bilirubin measurements in neonates: uniform neonatal treatment can only be achieved by improved standardization
Measurement of total bilirubin (TBil) concentration in serum is the gold standard approach for diagnosing neonatal unconjugated hyperbilirubinemia. It is of utmost importance that the measured TBil concentration is sufficiently accurate to prevent under treatment, unnecessary escalation of care, or...
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Veröffentlicht in: | Clinical chemistry and laboratory medicine 2024-09, Vol.62 (10), p.1892-1903 |
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creator | Hulzebos, Christian V. Camara, Johanna E. van Berkel, Miranda Delatour, Vincent Lo, Stanley F. Mailloux, Agnès Schmidt, Marcel C. Thomas, Mercy Mackay, Lindsey G. Greaves, Ronda F. |
description | Measurement of total bilirubin (TBil) concentration in serum is the gold standard approach for diagnosing neonatal unconjugated hyperbilirubinemia. It is of utmost importance that the measured TBil concentration is sufficiently accurate to prevent under treatment, unnecessary escalation of care, or overtreatment. However, it is widely recognized that TBil measurements urgently require improvement in neonatal clinical chemistry. External quality assessment (EQA) programs for TBil assess for differences between laboratories and provide supporting evidence of significant differences between various methods, manufacturers and measurement platforms. At the same time, many countries have adopted or only slightly adapted the neonatal hyperbilirubinemia management guidelines from the USA or UK, often without addressing differences in the methodology of TBil measurements. In this report, we provide an overview of the components of bilirubin that are measured by laboratory platforms, the availability of current reference measurement procedures and reference materials, and the role of EQA surveys in this context. Furthermore, the current status of agreement in neonatal bilirubin against clinical decision thresholds is reviewed. We advocate for enhancements in accuracy and comparability of neonatal TBil measurements, propose a path forward to accomplish this, and reflect on the position of the International Federation for Clinical Chemistry and Laboratory Medicine (IFCC) Working Group Neonatal Bilirubin (WG-NB) in this matter. |
doi_str_mv | 10.1515/cclm-2024-0620 |
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It is of utmost importance that the measured TBil concentration is sufficiently accurate to prevent under treatment, unnecessary escalation of care, or overtreatment. However, it is widely recognized that TBil measurements urgently require improvement in neonatal clinical chemistry. External quality assessment (EQA) programs for TBil assess for differences between laboratories and provide supporting evidence of significant differences between various methods, manufacturers and measurement platforms. At the same time, many countries have adopted or only slightly adapted the neonatal hyperbilirubinemia management guidelines from the USA or UK, often without addressing differences in the methodology of TBil measurements. In this report, we provide an overview of the components of bilirubin that are measured by laboratory platforms, the availability of current reference measurement procedures and reference materials, and the role of EQA surveys in this context. Furthermore, the current status of agreement in neonatal bilirubin against clinical decision thresholds is reviewed. We advocate for enhancements in accuracy and comparability of neonatal TBil measurements, propose a path forward to accomplish this, and reflect on the position of the International Federation for Clinical Chemistry and Laboratory Medicine (IFCC) Working Group Neonatal Bilirubin (WG-NB) in this matter.</description><identifier>ISSN: 1434-6621</identifier><identifier>ISSN: 1437-4331</identifier><identifier>EISSN: 1437-4331</identifier><identifier>DOI: 10.1515/cclm-2024-0620</identifier><identifier>PMID: 39066506</identifier><language>eng</language><publisher>Germany: De Gruyter</publisher><subject>accuracy ; Bilirubin ; Clinical decision making ; Hyperbilirubinemia ; Laboratories ; neonatal bilirubin ; Neonatal care ; Neonates ; Platforms ; Position measurement ; Quality assessment ; Quality control ; Reference materials ; treatment</subject><ispartof>Clinical chemistry and laboratory medicine, 2024-09, Vol.62 (10), p.1892-1903</ispartof><rights>2024 the author(s), published by De Gruyter, Berlin/Boston.</rights><rights>2024. 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subjects | accuracy Bilirubin Clinical decision making Hyperbilirubinemia Laboratories neonatal bilirubin Neonatal care Neonates Platforms Position measurement Quality assessment Quality control Reference materials treatment |
title | Bilirubin measurements in neonates: uniform neonatal treatment can only be achieved by improved standardization |
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