According to a study co-authored by academics from UCL (University College London) and the University of Ghana, a smartphone app that detects severe jaundice in newborns by scanning their eyes could save lives in regions without access to pricey screening gear.
Following a pilot trial on 37 newborns at University College London Hospital (UCLH) in 2020, clinicians and engineers at UCL created the neoSCB app to test for jaundice in over 300 newborns in Ghana.
For the large-scale study, which was published in Paediatrics, the team examined more than 300 infants with the app, which analyzes photos captured by a smartphone camera to measure the yellowness of the white area of the eye (sclera) – a marker of newborn jaundice. The neoSCB app can provide an early diagnosis of neonatal jaundice requiring treatment, which cannot be determined just by seeing the eye's yellowness.
The study compared the efficacy of the neoSCB app to that of traditional screening techniques. Among the 336 infants examined by the app, 79 were newborns with severe jaundice, and the app properly recognized 74 of them. This is consistent with the sensitivity of the most prevalent conventional screening approach, a non-invasive instrument called as a transcutaneous bilirubinometer, which properly identified 76.
The transcutaneous bilirubinometer measures jaundice levels by measuring the yellow pigment under the newborn's skin. All screening results are followed up with blood testing to establish the necessary treatment.
Dr. Terence Leung (UCL Medical Physics & Biomedical Engineering), who developed the app's underlying technology, explained: "The study demonstrates that the neoSCB app is as effective as the commercial devices currently recommended to screen for severely jaundiced newborns, but requires only a smartphone that costs less than a tenth of the commercial device. We hope that once our technology is widely deployed, it can be used to save the lives of newborns in regions of the world without access to costly screening instruments."
Jaundice, characterized by yellowing of the skin and whites of the eyes, is prevalent in neonates and is mostly innocuous. The yellowing is produced by a chemical known as bilirubin, which, in severe cases, can enter the brain and result in death or disabilities such as hearing loss, neurological problems such as athetoid cerebral palsy, and developmental delays.
Despite being a curable illness, severe jaundice causes approximately 114,000 baby deaths and 178,000 cases of impairment annually. Most cases of newborn jaundice occur in the first week after delivery, and screening for early detection has reduced the risk of serious consequences in nations with greater incomes.
Due to a lack of screening resources, newborns in low- and middle-income nations are often at a larger risk for severe jaundice, or neonatal hyperbilirubinemia. A commercial transcutaneous bilirubinometer costs approximately £4,000 per unit, and blood tests require a big capacity. Additional factors, such as a greater prevalence of home deliveries and early postnatal discharge, may contribute to a decrease in the number of newborns undergoing screening.
A high prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency, an inherited genetic disorder associated with an increased risk of haemolysis – in which red blood cells break down faster than they are produced – and hyperbilirubinemia, also puts infants in sub-Saharan Africa at increased risk.
Dr. Judith Meek (UCLH) is the senior author of the following: "This application has the potential to avert mortality and disability in a variety of global situations. It would eliminate unnecessary hospital trips and enable community health workers and parents to provide safe care for newborns."
Initial consideration was given to 724 babies aged between 0 and 28 days for the study. The 336 individuals whose data were included for the study had never received treatment for jaundice. The final study eliminated infants who were delivered at fewer than 35 weeks, were seriously unwell, or had a very low birth weight. The app was evaluated by frontline healthcare staff and the mothers of infants, who provided input on the app's usefulness.
The Saving Lives at Birth partnership and the EPSRC UCL Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare supported the research.
