Smartphone app might allow outpatient newborn screening for jaundice

Last Updated: 2017-08-25

By Reuters Staff

NEW YORK (Reuters Health) - A new smartphone application, BiliCam, might be useful for assessing neonatal jaundice in outpatient settings, according to a study of more than 500 newborns.

Current American Academy of Pediatrics guidelines recommend that newborns discharged before 72 hours of age should be seen by a healthcare provider within the ensuing 48 to 72 hours to assess for jaundice, as bilirubin levels typically peak at about 96 hours of life.

Studies have shown that healthcare providers often do not accurately estimate the severity of jaundice in this clinical context. Total serum bilirubin (TSB) measurements are more difficult to obtain after discharge, and transcutaneous bilirubin (TcB) meters are not widely available in the outpatient setting given their high cost.

BiliCam is designed to obtain images of the skin overlying a newborn's sternum in a standardized manner, using a color calibration card, and to transmit the image via the Internet to a computer server for analysis.

Dr. James A. Taylor from the University of Washington, Seattle, and colleagues assessed the accuracy of BiliCam assessment, compared with TSB levels, in 530 newborns at seven sites across the United States.

The correlation between BiliCam-based bilirubin levels and the paired TSB measurement was 0.91 and was highest among white neonates (0.92) and lowest among Asian American newborns (0.88), the researchers report in Pediatrics, online August 25.

Among 331 newborns who also had TcB measurements, the correlation between TcB and TSB was 0.91.

BiliCam showed 84.6% sensitivity and 75.1% specificity for identifying newborns with a TSB level in the high-risk zone on the Bhutani nomogram (which predicts the risk of a subsequent bilirubin level in an infant >95th percentile for age) - and 100% sensitivity and 76.4% specificity for identifying neonates with TSB levels of 17.0 mg/dL or higher.

BiliCam was nominally more accurate (AUC, 0.95) than TcB (AUC, 0.92) for detecting a high-risk zone TSB level and for identifying newborns with TSB levels of 17.0 mg/dL or higher (AUC, 0.99 vs. 0.95, respectively), but the differences fell short of statistical significance.

"Our results suggest that BiliCam does not have adequate accuracy to serve as a standalone methodology to assess jaundice in newborns," the researchers note. "Rather, as with TcB meters, BiliCam is best suited as a screening device to aid in determining which neonates require a blood draw for a TSB level, with treatment decisions being based on the TSB level."

"Perhaps most importantly, in low- and middle-income countries with limited resources, BiliCam could be a low-cost technology that is used by health care workers to screen large numbers of newborns for jaundice and effectively identify the few that are at significant risk for extreme hyperbilirubinemia (EHB)," they add. "In combination with low-cost phototherapy devices that have now been developed, BiliCam could thus be part of a system of care that could significantly reduce the morbidity and mortality related to EHB in these areas.

Dr. Taylor did not respond to a request for comment.

Four of the 11 authors designed the software used in this technology. Dr. Taylor and two other authors are cofounders of BiliCam, LLC, which is developing the technology for commercial use.

SOURCE: http://bit.ly/2vbVFCu

Pediatrics 2017.