🎯 Objective

To help caregivers and frontline health workers understand the differences, advantages, and limitations of skin-based vs. blood-based bilirubin testing in newborns.

🔍 Why Compare These Two?

Bilirubin can build up in the baby’s blood and tissues—causing jaundice. Accurate measurement of bilirubin is essential to determine whether a baby needs treatment. But different testing methods are used depending on equipment, cost, training, and urgency.

🧪 Option 1: Transcutaneous Bilirubin Testing (TcB)

✅ Non-invasive skin test using a handheld device

How it works:

• A nurse or CHW places a small device on the baby’s forehead or chest

• It uses light to scan beneath the skin and estimate bilirubin level

• Takes just a few seconds

• Does not require blood or needles

👍 Advantages:

• Painless and safe for babies

• Instant results

• Easy to use in community or rural clinics

• Ideal for screening large numbers of babies

⚠️ Limitations:

• May be less accurate in very dark-skinned babies or very sick newborns

• Does not replace blood testing for high-risk or treatment-level cases

• Some devices are expensive and not widely available in rural areas

📍 Common Devices:

• Dräger JM-105 (widely used globally)

• Bilicare, Bilitron, and MBJ20 (used in pilot projects in Nigeria, Kenya, Ethiopia)

📚 Clinical Review:

• Accuracy of TcB in sub-Saharan Africa: https://doi.org/10.1136/bmjopen-2020-037200

🧫 Option 2: Serum (Blood) Bilirubin Testing

✅ Lab-based blood test

How it works:

• A healthcare worker collects a few drops of blood from the baby’s heel or vein

• The blood is sent to a lab to measure total and direct bilirubin levels

• More accurate than TcB, especially when jaundice is worsening

👍 Advantages:

• Gold standard for accuracy

• Tells doctors if baby needs phototherapy or exchange transfusion

• Can track bilirubin over time during hospital care

⚠️ Limitations:

• Requires lab access or skilled nurse

• May take a few hours to get results in rural settings

• Can be painful or distressing to newborn

• Needs sterile equipment and safety measures

📚 WHO Guideline:

• Managing Hyperbilirubinemia in Newborns

🆚 Summary Table – Skin Test vs. Blood Test

📝 When to Use Each?

• Use Skin Test: For initial screening in the first few days of life — especially in clinics or by CHWs

• Use Blood Test: If jaundice is getting worse, baby is <37 weeks, or TcB results are high

🧠 Real Example:

“At a mission clinic in rural Ghana, a TcB reading showed high bilirubin on Day 3. The baby was referred, and a blood test confirmed a dangerously high level. The baby received phototherapy and survived. Without both tests, this outcome could have been fatal.”

📚 Further Reading & Tools

• Kenya Ministry of Health: Neonatal Jaundice Guidelines: https://health.go.ke/

• Neotree Mobile App (for CHWs and nurses): https://www.neotree.org/

• AAP Bilirubin Guidelines Tool: https://bilitool.org

• WHO Global Newborn Guidelines (2022): https://www.who.int/publications/i/item/9789240049072

🧪 Mini Quiz: Skin vs. Blood Tests

Q1. Which method gives instant results without pain?
A. Serum bilirubin test
B. Glucose test
C. Transcutaneous bilirubin test
D. Jaundice rub test

✅ Answer: C
Rationale: TcB is painless and quick, ideal for screening.

Q2. When should a blood test be used instead of skin test?
A. When baby is sleeping
B. If skin test shows high reading or baby is premature
C. Only if baby is more than 6 months
D. If baby is hungry

✅ Answer: B
Rationale: Blood testing is needed when risk is high or TcB readings are elevated.

Q3. Which test is more accessible in remote villages?
A. MRI
B. Blood test
C. Skin test with handheld device
D. CT Scan

✅ Answer: C
Rationale: Skin testing can be done by trained CHWs using portable TcB devices.