{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T01:57:29Z","timestamp":1769219849427,"version":"3.49.0"},"reference-count":24,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T00:00:00Z","timestamp":1747267200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: We recently reported that the transcutaneous bilirubinometer (TCB) tends to underestimate the severity of neonatal jaundice (NJ). We hypothesize that the cumulative ambient light exposure contributes to the discrepancy. Objectives: This study aimed to identify factors that affect the TCB underestimation. Methods: We analyzed prospectively collected data over a twenty-month period at a level III medical facility. Neonates at risk for NJ who couldn\u2019t secure an appointment with the primary practitioner were followed by the nursery team. Neonates who had phototherapy or forehead bruises were excluded. Concurrently collected total serum bilirubin (TSB) was determined by the diazo method. The primary endpoint was the discrepancy between TCB and the corresponding TSB (TCB-TSB). A mixed-effects model was used to assess the correlation between (TCB-TSB) and potential contributors, including visit age (in hours), gestational age (GA), sex, TSB, season, birth weight, and race. Results: There were 795 visits for 559 neonates, including 341 males, 179 white, 235 black, 103 Hispanic, 41 Asian, and one unrecorded race. The TSB ranged between 1.8 and 33.9 mg\/dL. The (TCB-TSB) ranged between \u221220.0 and 6.4 mg\/dL. The median GA and birth weight were 38.7 weeks and 3214.5 g. The visits occurred between 48 and 381 h of age. 133, 148, 132, and 146 visits were in Spring, Summer, Autumn, and Winter, respectively. Fifty-four neonates (9.7%) were admitted for management. 500 sternum TCB readings were also collected from 350 neonates together with the corresponding forehead TCBs. We found that the forehead (TCB-TSB) was significantly less in winter than in spring and summer (p = 0.0014 and 0.0003, respectively). There was a negative correlation between forehead (TCB-TSB) and visit age in hours (p = 0.0006). After adjusting for visit age and season, the (TCB-TSB) is significantly correlated with TSB (p &lt; 0.0001). Similar findings were also seen in the sternum (TCB-TSB) except for the season (p = 0.0808). Conclusions: Cumulative ambient light exposure and the severity of NJ may contribute to (TCB-TSB).<\/jats:p>","DOI":"10.3390\/children12050639","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T09:58:27Z","timestamp":1747303107000},"page":"639","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cumulative Ambient Light Exposure Affects Outpatient Transcutaneous Bilirubinometer Readings"],"prefix":"10.3390","volume":"12","author":[{"given":"Emily","family":"Zhang","sequence":"first","affiliation":[{"name":"Human Biology, Health, and Society, College of Human Ecology, Cornell University, Ithaca, NY 14853, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tzong-Jin","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark L.","family":"Hudak","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, University of Florida Health Science Center at Jacksonville, Jacksonville, FL 32209, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ke","family":"Yan","sequence":"additional","affiliation":[{"name":"Division of Bioinformatics and Quantitative Child Health, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4321-2452","authenticated-orcid":false,"given":"Ru-Jeng","family":"Teng","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e898","DOI":"10.1542\/peds.2012-0732","article-title":"Trends of transcutaneous bilirubin in neonates who develop significant hyperbilirubinemia","volume":"130","author":"Mantagou","year":"2012","journal-title":"Pediatrics"},{"key":"ref_2","first-page":"599","article-title":"Hyperbilirubinemia in the term newborn","volume":"65","author":"Porter","year":"2002","journal-title":"Am. Fam. Physician"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"(2004). Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 114, 297\u2013316.","DOI":"10.1542\/peds.114.1.297"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1542\/peds.65.2.195","article-title":"Transcutaneous bilirubinometry: Preliminary studies of noninvasive transcutaneous bilirubin meter in the Okayama National Hospital","volume":"65","author":"Yamanouchi","year":"1980","journal-title":"Pediatrics"},{"key":"ref_5","first-page":"Cd012660","article-title":"Transcutaneous bilirubinometry versus total serum bilirubin measurement for newborns","volume":"5","author":"Okwundu","year":"2023","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e2022058859","DOI":"10.1542\/peds.2022-058859","article-title":"Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation","volume":"150","author":"Kemper","year":"2022","journal-title":"Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.siny.2014.12.003","article-title":"Impact of bilirubin-induced neurologic dysfunction on neurodevelopmental outcomes","volume":"20","author":"Wusthoff","year":"2015","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1446524","DOI":"10.3389\/fped.2024.1446524","article-title":"Optimal site for applying transcutaneous bilirubinometer as an outpatient screening tool for neonatal jaundice: A comparison between the sternum and forehead","volume":"12","author":"Zhang","year":"2024","journal-title":"Front. Pediatr."},{"key":"ref_9","first-page":"e55608","article-title":"Illuminating Progress: A Comprehensive Review of the Evolution of Phototherapy for Neonatal Hyperbilirubinemia","volume":"16","author":"Patel","year":"2024","journal-title":"Cureus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2819","DOI":"10.1007\/s00431-024-05516-4","article-title":"Transcutaneous bilirubin reliability during and after phototherapy depending on skin color","volume":"183","year":"2024","journal-title":"Eur. J. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Dam-Vervloet, A.J., Morsink, C.F., Krommendijk, M.E., Nijholt, I.M., van Straaten, H.L.M., Poot, L., and Bosschaart, N. (Pediatr. Res., 2024). Skin color influences transcutaneous bilirubin measurements: A systematic in vitro evaluation, Pediatr. Res., ahead of print.","DOI":"10.1038\/s41390-024-03081-y"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"010901","DOI":"10.1117\/1.JBO.29.1.010901","article-title":"Effect of skin color on optical properties and the implications for medical optical technologies: A review","volume":"29","author":"Setchfield","year":"2024","journal-title":"J. Biomed. Opt."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1038\/sj.jp.7211141","article-title":"Comparison of skin sites for estimating serum total bilirubin in in-patients and out-patients: Chest is superior to brow","volume":"24","author":"Poland","year":"2004","journal-title":"J. Perinatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1503\/cmaj.060328","article-title":"Incidence and causes of severe neonatal hyperbilirubinemia in Canada","volume":"175","author":"Sgro","year":"2006","journal-title":"CMAJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2021","DOI":"10.1056\/NEJMra1308124","article-title":"Bilirubin-induced neurologic damage\u2014Mechanisms and management approaches","volume":"369","author":"Watchko","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_16","first-page":"354","article-title":"The incidence and outcome of bilirubin encephalopathy in Nigeria: A bi-centre study","volume":"16","author":"Ogunlesi","year":"2007","journal-title":"Niger. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"F480","DOI":"10.1136\/archdischild-2013-305699","article-title":"Influence of skin colour on diagnostic accuracy of the jaundice meter JM 103 in newborns","volume":"99","author":"Feberova","year":"2014","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1007\/s00431-020-03885-0","article-title":"Reliability of transcutaneous bilirubin determination based on skin color determined by a neonatal skin color scale of our own","volume":"180","year":"2021","journal-title":"Eur. J. Pediatr."},{"key":"ref_19","first-page":"352","article-title":"Measurement and clinical usefulness of bilirubin in liver disease","volume":"2","author":"Crespo","year":"2021","journal-title":"Adv. Lab. Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ho, S.R., Lin, Y.C., and Chen, C.N. (2021). The Impact of Phototherapy on the Accuracy of Transcutaneous Bilirubin Measurements in Neonates: Optimal Measurement Site and Timing. Diagnostics, 11.","DOI":"10.3390\/diagnostics11091729"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1111\/j.1442-200X.1991.tb01883.x","article-title":"Transcutaneous bilirubinometry: Effect of postnatal age","volume":"33","author":"Yamauchi","year":"1991","journal-title":"Acta Paediatr. Jpn."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1542\/peds.2014-1919","article-title":"Discrepancies between transcutaneous and serum bilirubin measurements","volume":"135","author":"Taylor","year":"2015","journal-title":"Pediatrics"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e1324","DOI":"10.1542\/peds.2014-1677","article-title":"Transcutaneous bilirubin after phototherapy in term and preterm infants","volume":"134","author":"Grabenhenrich","year":"2014","journal-title":"Pediatrics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e2023062335","DOI":"10.1542\/peds.2023-062335","article-title":"Transcutaneous Bilirubin Accuracy Before, During, and After Phototherapy: A Meta-Analysis","volume":"152","author":"Woolderink","year":"2023","journal-title":"Pediatrics"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/5\/639\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:33:19Z","timestamp":1760031199000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/5\/639"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,15]]},"references-count":24,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["children12050639"],"URL":"https:\/\/doi.org\/10.3390\/children12050639","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,15]]}}}