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Performance of smartphone application to accurately quantify hyperbilirubinemia in neonates: a systematic review with
Deeparaj Hegde1,2, Chandra Rath3,4,5, Sathika Amarasekara1,2
1King Edward Memorial Hospital, Subiaco, WA, 6008, Australia.
Insights
Smartphone apps can estimate newborn bilirubin levels, showing a reasonable correlation with serum tests. Further research is needed to confirm their effectiveness as a screening tool for neonatal jaundice.
Area of Science:
- Medical Diagnostics
- Neonatal Care
- Digital Health
Background:
- Neonatal jaundice is common and can lead to severe hyperbilirubinemia if not identified promptly.
- Timely screening and intervention are crucial to prevent neurological complications.
- While transcutaneous bilirubinometers are used, they have limitations in accessibility and cost.
Purpose of the Study:
- To systematically review and meta-analyze the accuracy of smartphone applications for quantifying neonatal bilirubin levels.
- To assess the performance of app-based bilirubin (ABB) estimations compared to total serum bilirubin (TSB) measurements.
- To evaluate the potential utility of smartphone applications as a screening tool for neonatal hyperbilirubinemia.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (PubMed, Embase, Cochrane Library, etc.) until July 2022.
- Included prospective and retrospective cohort studies comparing smartphone app-based bilirubin (ABB) with total serum bilirubin (TSB) in infants ≥35 weeks gestation.
- Data were pooled using a random effects model, with outcomes including correlation coefficient, mean difference, and standard deviation; certainty of evidence was assessed using GRADE guidelines.
Main Results:
- Fourteen studies with 35 to 530 infants were included in the meta-analysis.
- A pooled correlation coefficient (r) of 0.77 (95% CI 0.69 to 0.83) was found between ABB and TSB.
- Sensitivities and specificities varied for predicting TSB thresholds of 250 µmol/L and 205 µmol/L, with overall moderate certainty of evidence.
Conclusions:
- Smartphone app-based bilirubin estimation demonstrates a reasonable correlation with TSB levels.
- The current evidence suggests potential utility, but well-designed studies are needed to establish its role as a reliable screening tool.
- Further research should focus on validating app performance across diverse populations and TSB cut-off levels.
Abstract:
Neonatal jaundice is a common clinical condition that can progress to severe hyperbilirubinemia if identification and intervention are delayed. In this study, we aimed to analyze the current evidence on the accurate performance of smartphone applications to quantify bilirubin levels. PubMed, Embase, Emcare, MEDLINE, the Cochrane Library, and Google Scholar were searched from inception until July 2022. Grey literature was searched on "OpenGrey" and "MedNar" databases. We included prospective and retrospective cohort studies that recruited infants with a gestation of ≥ 35 weeks and reported paired total serum bilirubin (TSB) and smartphone app-based bilirubin (ABB) levels. We conducted the review using the guidelines of the Cochrane Collaboration Diagnostic Test Accuracy Working Group and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-diagnostic test accuracy (PRISMA-DTA) statement. The data were pooled using the random effects model. The outcome of interest was agreement between ABB and TSB measurements, provided as correlation coefficient, mean difference, and standard deviation. Certainty of evidence (COE) was assessed based on GRADE guidelines. Fourteen studies were included in the meta-analysis. The number of infants in individual studies ranged between 35 and 530. The pooled correlation coefficient (r) between ABB and TSB was 0.77 (95% CI 0.69 to 0.83; p < 0.01). Reported sensitivities for predicting a TSB of 250 µmol/L in individual studies ranged between 75 and 100% and specificities ranged from 61 to 100%. Similarly, a sensitivity of 83 to 100% and a specificity of 19.5 to 76% were reported for predicting a TSB of 205 μmol/L. Overall COE was considered moderate. Conclusion: Smartphone app-based bilirubin estimation showed a reasonable correlation to TSB levels. Well-designed studies are required to determine its utility as a screening tool for various TSB cut-off levels. What is Known: • Neonatal jaundice is a common clinical condition. Timely screening and intervention are necessary to prevent neurological morbidities • Transcutaneous bilirubinometer is a widely used non-invasive screening device but is mostly available in hospital settings and has cost limitations. Researchers have recently explored the utility of smartphone applications to estimate bilirubin levels in neonates. What is New: • This is the first systematic review and meta-analysis conducted to assess the performance of smartphone applications to detect neonatal hyperbilirubinemia. • Bilirubin estimates of newborn infants obtained through smartphone applications had a reasonable correlation with serum bilirubin levels.
