(48) Smart-phone Capabilities Screening for Neonatal Jaundice

Background: Neonatal jaundice, characterized by elevated bilirubin levels affects over 1 million newborns annually. Severe cases can lead to kernicterus, which may cause brain damage and long-term neurodevelopmental complications. Current diagnostic tools, including transcutaneous bilirubin (TcB) and total serum bilirubin (TSB), are recommended by the AAP but can be costly and less accessible in resource-limited settings. Mobile health technologies, such as the Picterus Jaundice Pro app, present a promising, cost-effective alternative using smartphone cameras to assess bilirubin levels non-invasively.

Objectives: We hypothesize that Picterus Jaundice Pro can be used as a safe and reliable screening tool for the evaluation of neonatal jaundice in infants of all skin tones.

Design/Methods: A cross-sectional study that included 85 newborns was conducted at the University of Chicago. Newborns ≥ 35 weeks gestation, birth weight ≥ 1800 grams, age 24 hours-14 days, and suspected jaundice requiring TSB measurement met inclusion criteria. Inborn error of metabolic disease, skin conditions that affect the measurement, recent phototherapy, hepatobiliary pathology, or the need for invasive medical procedures were excluded. Within 60 minutes of TSB collection, blinded Picterus Jaundice Pro measurements were taken by trained personnel using a Samsung A23 smartphone. A calibration card was placed on the neonate's chest, and images were captured. The calibration card allowed correction for lighting variation and camera performance to give the most accurate color analysis. Each image generated a code and was sent to the Picterus algorithm to create a corresponding bilirubin value.

Results: A strong correlation (r=0.72) between the Picterus app and TSB was found for the 85 newborns tested. For a TSB threshold of 14.6 mg/dL that would otherwise qualify for serum draw by the Picterus app, the app demonstrated 86% sensitivity and 82% specificity. Most importantly, Picterus did not miss any infants that would have qualified for phototherapy by serum bilirubin levels. Picterus for this study demonstrated a negative predictive value of 96%.

Conclusions: The Picterus Jaundice Pro app demonstrates strong correlation with TSB and missed no newborns that would have qualified for phototherapy, suggesting its value as an effective non-invasive mobile health tool for jaundice screening. Feedback from providers highlighted the app's ease of use and rapid results, supporting its potential to improve neonatal care in low-resource settings and contribute to better global health outcomes.