Date of Publication


Project Team

Jean Pelski, PhD, APRN, NNP-BC


Purpose: Up to 84% of term neonates develop jaundice, a sign of hyperbilirubinemia that warrants bilirubin measurement. The AAP recommends systematic evaluation of hyperbilirubinemia risk for every infant. Serum bilirubin tests involve needle sticks, introducing anxiety, pain, and cost. Transcutaneous bilirubin (TcB) measures bilirubin without needle sticks, may offer reduced costs, but is less accurate, and may increase phototherapy rates. This determined the effect of TcB measurement on needle sticks, phototherapy rates, and cost of bilirubin measurement at a rural teaching hospital.

Methods: A retrospective data analysis compared rates of bilirubin screening, needle stick testing, and phototherapy treatment for a three-month period prior to the introduction of TcB measurement with a three-month period following introduction. Rate differences were calculated with SPSS statistical package. A comparison of error test determined statistical significance. The institution’s billing and purchasing department provided cost data.

Results: The introduction of TcB measurement increased hyperbilirubinemia screening from 21.1% to 83%, which was statistically significant. Needle stick testing decreased to a degree that was clinically but not statistically significant. Phototherapy treatment increased but was not statistically significant. The charge was $33.00 less per incidence than needle stick testing.

Conclusions: This quality improvement assessment demonstrates that TcB screening increases systematic assessment for hyperbilirubinemia, thereby increasing adherence to AAP recommendations. This assessment highlights the need for formal studies to investigate an appropriate TcB threshold for needle stick testing, as well as the effect of such a threshold on needle stick testing to inform best practice.

Document Type


Included in

Nursing Commons