Text Box: A NEW TRANSCUTANEOUS BILIRUBINOMETER, BILICHECK, USED IN THE NEONATAL INTENSIVE CARE UNIT (NICU) AND THE MATERNITY WARD Ebbesen F, Rasmussen L, Wimberley P. Departments of Paediatris and Clinical Chemistry, Aalborg Hospital, Aalborg, Denmark Objective: 1) Investigate imprecision and inaccuracy of BiliCheck, 2) give indications for its use, 3) evaluate how many blood samples which can be saved by routine use of BiliCheck. Methods: Transcutaneous bilirubin, TcB, was measured in 261 jaundiced infants in the NICU (gestational age (GA) 25-43 wks) (group 1) and in 227 healthy jaundiced term and near term infants (GA 35-43 wks) (group 2). Results: Imprecision of a single determination of TcB, expressed as 1 standard deviation was 15-18 Fmol/L. No statiscically significant difference between intra- and interoperator imprecision was found. Inaccuracy. The was a good correlation between TcB and total serum bilirubin (TSB) in both groups of infants, though TcB was on an average 20% lower than TSB. In the NICU infants, TcB, other things being equal, was lower in males than in females, and decreased with increasing postnatal age, for the same TSB level. In the infants in both groups who had a GA $ 35 wks, sick infants had a higher TcB than healthy infants, for the same TSB level. The differences were statistically significant, but small and of minor clinical significance. Blood hemoglobin conc, GA and ethnic origin were not found to influence TcB, i.e. BiliCheck corrects sufficiently for these factors. Indications. By retrospective analysis of our data, a screening model is presented whereby TcB can be used to screen infants who require phototherapy. We found that using screening limits for TcB, which are 70% of the currently used phototherapy limits for TSB, 80% of blood samples in healthy term and near term infants, and 42% of NICU infants with GA $ 32 wks could be avoided. Conclusion: BiliCheck is suitable for screening both NICU and healthy neonates with jaundice, with regard to phototherapy. We recommend using a TcB limit which is 70% of the currently recommended TSB limits for phototherapy, in order to decide wheather TSB needs to be measured. 2300