{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T06:12:21Z","timestamp":1778739141249,"version":"3.51.4"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Transcutaneous bilirubinometry (TcB) is increasingly relied upon for neonatal jaundice management in settings without access to laboratory-based total serum bilirubin (TSB) testing. However, inconsistent agreement between transcutaneous bilirubin levels (TBL) and TSB limits its reliability as a standalone clinical tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To propose and evaluate skin residual bilirubin volume (SRBV) as a physiological explanation for TcB\u2013TSB discordance and to assess its impact on TcB interpretation during diagnosis, treatment, and recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This observational, multicentre study was conducted in resource-limited neonatal care settings. TcB readings were calibrated against laboratory TSB in non-jaundiced neonates (TSB &amp;lt;3\u2005mg\/dL). Neonates undergoing phototherapy were monitored using paired TcB measurements obtained immediately after treatment interruption (TBL-out) and prior to treatment resumption (TBL-return). TSB was measured before treatment, during treatment, and prior to discharge where feasible. Patterns of TcB\u2013TSB disparity and the \u201cRecovery Value Flip (RVP)\u201d phenomenon were analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>TBL consistently equalled or exceeded TSB in cases with paired measurements. Early in treatment at higher bilirubin levels, TBL-return exceeded TBL-out, indicating persistent cutaneous bilirubin. A reproducible RVP was observed, after which TBL-return became lower than TBL-out, coinciding with sustained bilirubin decline. SRBV contribution varied with bilirubin level and treatment phase.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SRBV provides a biologically plausible explanation for TcB\u2013TSB discordance and dynamic TcB behaviour. Incorporating SRBV into TcB interpretation enables physiologically informed monitoring, improving safety and reliability in laboratory-limited neonatal settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1815793","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T05:43:49Z","timestamp":1778737429000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Skin residual bilirubin volume: a physiologically informed framework for transcutaneous bilirubin interpretation in neonates"],"prefix":"10.3389","volume":"14","author":[{"given":"H. O.","family":"Amadi","sequence":"first","affiliation":[{"name":"Department of Bioengineering, Imperial College London","place":["London, United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"B1","article-title":"Neonatal jaundice","volume-title":"StatPearls","author":"Ansong-Assoku","year":"2026"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1212667","DOI":"10.3389\/fpubh.2023.1212667","article-title":"The use of transcutaneous bilirubin nomograms for the prevention of bilirubin neurotoxicity in neonates","volume":"11","author":"Casnocha Lucanova","year":"2023","journal-title":"Front Public Health"},{"key":"B3","first-page":"0319","article-title":"Neonatal jaundice","volume":"2011","author":"Woodgate","year":"2011","journal-title":"BMJ Clin Evid"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1288604","DOI":"10.3389\/fped.2024.1288604","article-title":"Magnitude 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impact of phototherapy on the accuracy of transcutaneous bilirubin measurements in neonates: optimal measurement site and timing","volume":"11","author":"Ho","year":"2021","journal-title":"Diagnostics"},{"key":"B11","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1038\/jp.2016.91","article-title":"Accuracy of transcutaneous bilirubin measurement in newborns after phototherapy","volume":"36","author":"Casnocha Lucanova","year":"2016","journal-title":"J Perinatol"},{"key":"B12","author":"Amadi","year":""},{"key":"B13","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1136\/bmjinnov-2024-001286","article-title":"A solar-powered device for the treatment of neonatal hyperbilirubinemia in hard-to-reach settings tested in Nigeria","volume":"11","author":"Amadi","year":"2025","journal-title":"BMJ Innov"},{"key":"B14","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1080\/08035250152509120","article-title":"Transcutaneous bilirubin measurement: influence of skin pigmentation and haemoglobin","volume":"90","author":"Rubaltelli","year":"2001","journal-title":"Acta Paediatr"},{"key":"B15","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1159\/000014140","article-title":"Transcutaneous bilirubin measurement: comparison of three devices","volume":"76","author":"Rubaltelli","year":"1999","journal-title":"Biol Neonate"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1815793\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T05:43:54Z","timestamp":1778737434000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1815793\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":15,"alternative-id":["10.3389\/fped.2026.1815793"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1815793","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]},"article-number":"1815793"}}