Image-Based Neonatal Hyperbilirubinemia Screening after Hospital Discharge

Background: newborn infants who are risk for severe hyperbilirubinemia and cared at home should be monitored for progression of jaundice. we aimed to verify if a smart phone application (biliscan inc), which uses automated imaging for bilirubin (aib), can be used to estimate total serum bilirubin (tsb) levels at home. methods: a convenience sample of 1038 “healthy” infants in china were prospectively enrolled to a single-center study in 2016. correlations between aib and tcb measurements were correlated to tb measurements. bias and im-precision of aib measurements were determined using bland-altman analysis. the diagnostic value of aib was compared by the area-under-curve (auc) values of receiver operator characteristic (roc) curves. results: the best correlation and auc for aib were at the sternum, both with values of 0.76. we truncated performances to 369 tb values >5 and <15 mg/dl, and sternal aib showed the best correlation to tb (r =0.5, p<0.0001). the auc for this range was 0.54. however, from a subset of 200 aib values >13.5 mg/dl (n=369 babies), the sensitivity and negative predictive value (npv) were 100% with a specificity of 50%. furthermore, bland-altman analyses showed a bias and imprecision of aib and tcb when tb was >13.5 and <15 mg/dl. conclusion: the use of aib may be a potentially useful screening device for neonatal jaundice. its performance requires additional improvements for accurate measurements across wider ranges of tb levels.