How reliable are point-of-care bilirubin tests in neonates?
Although point-of-care tests for bilirubin in neonates are quicker and use less blood than lab-based tests, they generally underestimate the value. Using point-of-care tests to guide treatment decisions requires caution.
Plan de l'etude:
These researchers searched multiple databases and registries to identify studies comparing at least one point-of-care bilirubin test with lab-based tests in newborns 0 to 28 days of age. The authors performed secondary searches of reference lists and did not restrict study inclusion based on language. The point-of-care tests had to be portable handheld devices capable of providing results within 30 minutes and use either whole blood or serum. The authors included 10 studies with 3122 neonates. All the studies took place outside the United States; 8 evaluated the Bilistick and 2 evaluated the BiliSpec (now called BiliDx). Four of the studies were at low risk of bias. All the Bilistick studies reported the device underestimated the serum bilirubin compared with lab-based testing. In one of the BiliSpec studies, the device overestimated the serum bilirubin; the device underestimated it in the other study. Compared with lab-based tests, the point-of-care tests underestimated bilirubin by 17 µmol/L. The Bilistick test used 25 µL of blood and the BiliSpec used double that amount of blood (50 µL). The lab assays used between 50 and 1500 µLs of blood. Finally, the frequency of not being able to get a result with the point-of-care test varied between 1.5% and 48.6% compared with 1.3% and 2.5% for lab-based tests.
Henry C. Barry, MD, MS
Michigan State University
East Lansing, MI