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Advancing neonatal jaundice screening with mHealth: a mixed-methods randomised controlled feasibility study in a
Gabriela Jiménez-Díaz1,2, Jesús Elizarrarás-Rivas3,4, Martina Keitsch5
1Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU). Faculty of Medicine and Health Sciences, Trondheim, Trøndelag, Norway gabjimdi@gmail.com.
Insights
A smartphone tool for neonatal jaundice screening improved detection and management in a Mexican healthcare setting. Addressing barriers is key to maximizing its impact on infant health.
Area of Science:
- Neonatal care
- Medical technology
- Public health
Background:
- Neonatal jaundice is common, but severe cases can cause irreversible brain damage.
- Resource-limited settings face challenges in detecting and treating severe neonatal jaundice.
- Smartphone-based tools offer potential solutions for improving jaundice detection.
Purpose of the Study:
- To evaluate the feasibility of implementing Picterus Jaundice Pro, a smartphone-based neonatal jaundice detection tool.
- To assess its effectiveness in a resource-limited Mexican healthcare setting.
Main Methods:
- A mixed-methods approach combining a pragmatic randomized controlled trial (RCT) and qualitative interviews.
- Newborns were randomized to visual assessment alone or with Picterus Jaundice Pro.
- Feasibility outcomes included screening, referral, and management rates, alongside device practicality and acceptability.
Main Results:
- The intervention group showed significantly higher proportions of positive screenings, successful referrals, and jaundice management received compared to the control group.
- Picterus Jaundice Pro was considered user-friendly and integrated well into clinical workflows.
- Logistical barriers and low parental risk perception led to incomplete referrals in 11% of cases.
Conclusions:
- Implementing Picterus Jaundice Pro shows promise for enhancing neonatal jaundice screening and care.
- Addressing systemic barriers and improving awareness among parents and healthcare workers is crucial for successful implementation.
- The study highlights the potential of mobile health technology in improving neonatal outcomes in resource-limited settings.
Background:
Neonatal jaundice is a common and usually harmless condition, but 10% of cases can progress to severe forms that can cause irreversible brain damage or death if undetected and untreated. The prevalence of severe cases is higher in resource-limited settings due to limited access to reliable detection methods among other contributing factors.
Objective:
To assess the feasibility of implementing Picterus Jaundice Pro, a smartphone-based detection tool for neonatal jaundice, in a resource-limited Mexican healthcare setting.
Methods:
A mixed-methods approach was employed, integrating a pragmatic randomised controlled trial (RCT) with qualitative insights from semi-structured interviews, all conducted within a feasibility framework. In the RCT, newborns were randomly assigned to screening by visual assessment alone (control) or visual assessment plus Picterus Jaundice Pro (intervention). Feasibility outcomes included RCT-derived measures - the proportion of positive screenings, successful referrals to emergency room (bilirubin ≥14.6 mg/dL [250 µmol/L]), jaundice management needed and jaundice management received. Recruitment capability, device practicality, integration, acceptability and protocol adherence were also assessed.
Results:
From January to June 2024, 542 newborns were included (273 control, 269 intervention). Compared with control, the intervention arm showed higher proportions (proportional difference [95% CI]) in positive screenings (0.299 [0.230 to 0.362]), successful referrals (0.112 [0.058 to 0.166]), jaundice management needed (0.045 [0.008 to 0.082]), and jaundice management received (0.038 [0.003 to 0.072]).Interviewed participants considered Picterus Jaundice Pro user-friendly and well-integrated into workflows. Despite high protocol adherence, incomplete referrals due to logistical barriers and low perceived risk by parents occurred in 11% of cases.
Conclusions:
Implementing Picterus Jaundice Pro yielded encouraging improvements in screening practices, underscoring its potential to advance neonatal care. Addressing systemic barriers and raising awareness among parents and healthcare workers is crucial for maximizing impact.
Trial Registration Number:
NCT06073444.
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