OKLAHOMA CITY -- New mom Stephanie Thompson is filled with joy after the recent birth of her daughter at OU MEDICAL CENTER.  Like most parents, she wants to protect her child from disease and pain – which is one reason why so many parents dread the required test to check blood bilirubin levels in newborns. The test traditionally involves the drawing of blood with one or more required lancet cuts to the heel.   This can be very traumatic for new parents and for the baby.

Bilirubin is a chemical breakdown product of hemoglobin, a substance in red blood cells that takes on oxygen in the lungs then carries it to the tissues of the body.  When these red blood cells wear out, they get trapped in the spleen and are destroyed, releasing bilirubin into the blood.  Whenever bilirubin reaches high levels, it can cause the skin to become yellowed or jaundiced.  Bilirubin can also cross through the blood brain barrier, which can lead to some serious complications and brain damage.
Treatable once detected, a parent’s biggest worry in checking bilirubin levels is the lancet cuts in their baby’s fragile feet.

“Yeah, I am nervous about the test,” said Thompson, hours before her daughter was checked for bilirubin levels.  “I don’t want her to be hurt.”
Kenneth Blick, PhD, a director of the chemical laboratory at OU MEDICAL CENTER, knew there had to be a better way to test for bilirubin.  So, he and others began to research for an alternative, one that was more friendly to the baby and the parents.

“I remember vividly, walking into the lab and seeing a lab technologist and a nurse having an intense discussion about a baby’s blood sample,” said Blick.  “The technologist thought he needed a better blood sample for an accurate measurement, which would have required the baby’s third heel stick.  I knew then, we had to find a better way to check bilirubin levels and we found that better way in the transcutaneous method.”

Using a special instrument that is placed against the chest, the transcutaneous method shines a light through the skin, which can read blood bilirubin levels directly.  This new method does not break the skin.  The bilirubin in the blood reacts to the light, which is measured by the hand-held instrument.  The amount of light absorbed indicates the level of bilirubin in their blood.  If the results are abnormal or high then a heel sample collection is necessary to confirm the findings but most often infants are able to completely avoid the painful heel stick. 

The bilirubin test is required on all newborns prior to being discharged from the hospital.  High levels of bilirubin in infants can cause jaundice.  When jaundice is caught early, it is very treatable with exposure to sunlight or special UV light beds.  The phototherapy breaks down bilirubin until it is at normal levels.  If left untreated, high levels of bilirubin can lead to kernicterus, an irreversible condition.

“Before the transcutaneous method, we would have to restick some babies up to three times because of bad readings due to ruptured red blood cells releasing hemoglobin into the sample,” Blick said.  “Hemoglobin contaminated samples could come from a heel stick that was being performed too aggressively, which would cause too much hemoglobin to get into the blood sample.  This contamination made it impossible to get a correct bilirubin reading.”

The hand-held transcutaneous device has a built in auto validation system, to provide instant results, according to Blick.  Faster results allows the new family to be discharged sooner.  With the heel stick method, it took at least 30 minutes to get results back and could take longer if the lab was very busy. 

As the time for her discharge neared, Thompson was worried about her daughter and the heel stick – but she learned about the new painless method, and was relieved.

“I think this is great,” said Thompson.  “I wish there would have been this option when I had my first baby.”

Thompson’s daughter was tested with the new transcutaneous method before being discharged, and the test showed normal levels of bilirubin and they went home later that day.