Jaundice skin color and labs

[JenTheRN]

I just have loads of questions today!

We have a baby in the ny who is very yellow/orange in color (eyes clear tho). Her bilichek level is like 14 to 15, but lab is only 11.9. We have replaced our bilichek machine, but are still getting off readings like this.

Is it possible for baby to look really jaundiced without the lab levels being up?

BTW, this is a bottle fed baby who is eating very well and stooling.

My suspiscion is that the lab machine needs to be calibrated. Any thoughts?

[SmilingBluEyes]

Our meters tend to read quite high versus the lab/blood readings. I have seen this time and again.

I have also seen babies who looked extremely yellow have higher-end normal readings. But these little guys bear watching----it seems after a few days the bili jumps up and they wind up in our care, under lights.

I have also seen babies that shocked me; they had no hint of yellowing anywhere yet were reading 12.0 or higher on the lab draws. Just goes to show, we can't go by what we see alone.

[SmilingBluEyes]

PS the lab machine may well need calibrating, if it's been a while.

[ines11]

We had the same problem until we replaced our bilimeter.

[prmenrs, RN]

If the values don't correlate, you might want to ditch the bilicheks and just do labs on the babies whose clinical picture justify it. Like possible ABO incompatibilites, or appear jaundiced. Seems like the device is creating more problems than it is solving. What does the manufacturer say the correlation to lab value should be?

I have seen pediatricians who could predict w/better than expected accuracy how high the bili was by how far down the jaundiced appeared on the baby's body. Kids who were jaundiced below the nipple line or even further--they'd say, "this one's gonna be a 15" or whatever.

[MIA-RN1, RN]

Ethnicity and skin tone have a lot to do with it as well. Some babies just have yellowish undertones to their skin that makes them look jaundiced. I have heard as well that the commonly used scales are geared towards caucasian babies, and that african american babies can go undertreated and asian babies over-treated because of their skin undertones. Not sure about sources for that though.

[DebblesRN, ASN, BSN, RN]

We have the same issue at our hospital, and everywhere else I have used the biliscanner. It consistently reads 3-5 points higher than the serum bili comes back as.

Don't you just looooooooooove those biliscanners???