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
Hauptverfasser: 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.
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container_issue 10
container_start_page 1892
container_title Clinical chemistry and laboratory medicine
container_volume 62
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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source De Gruyter journals
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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