Application of a mobile app in the detection of neonatal hyperbilirubinemia
Objective To evaluate the accuracy and convenience of a mobile app in detection of neonatal bilirubin by automated image-based bilirubin(AIB).Methods A total of 250 neonates(gestational age≥35 weeks)born in the Jinshan Branch of Shanghai Sixth People's Hospital from January 2020 to August 2021 were selected and enrolled in this prospective study.The transcutaneous bilirubin(TcB)values measured by the jaundice detector in the included newborns were all＞5 mg/dL(1 mg/dL=17.1 μmol/L)with a gestational age of ≥35 weeks.Venous blood was collected to detect total serum bilirubin(TSB).Meanwhile,the bilirubin levels of the forehead and chest were measured with neonatal jaundice detector,and the average value was taken as TcB.The photos(the photographing part is the same as the measurement part of neonatal jaundice detector)was taken by the mobile app,and the average value of neonatal bilirubin was calculated as AIB.The non-inferiority analysis was conducted between AIB and TcB.The correlation and equivalence were analyzed between AIB and TSB.Linear regression analysis was used to investigate the accuracy of AIB in predicting TSB.Results The average AIB was(219.54±57.50)μmol/L,TcB was(220.42±57.91)μmol/L,and TSB was(213.41±58.62)μmol/L.At a degree of freedom of 500,the 97.5％percentile of t distribution was 1.96.Non-inferiority analysis showed that AIB was not inferior to TcB(t=2.48,P=0.007).The correlation analysis showed that there was a good correlation between AIB and TSB(r=0.96,P＜0.001).If 95％Cl is set between-2 to 2,it is regarded as equivalent.AIB and TSB were equivalent in the detection of neonatal bilirubin(95％CI:-0.54 to 0.66).There was a good correlation and equivalence between AIB and TSB in newborns aged 0-3 d and 3 to＜7 d(r=0.95,P＜0.001,95％CI:-0.50 to 1.51;r=0.96,P＜0.001,95％CI:-0.33 to 0.94).There was a good correlation between AIB and TSB in newborns aged≥ 7 d(r=0.99,P＜0.001),but the equivalence was poor(95％CI:-2.44 to 2.89).In newborns with gestational age of 35 to＜37 weeks,there was a strong correlation and poor equivalence between AIB and TSB(r=0.96,P＜0.001,95％CI:-1.65 to 2.76).In newborns with gestational age of 37-42 weeks,there was a good correlation and equivalence between AIB and TSB(r=0.97,P＜0.001,95％Cl:-0.27 to 0.97).The linear regression analysis showed that R2 values of the training and testing sets obtained were 0.95 and 0.92,respectively,indicating that it is credible to a certain extent to predict TSB with AIB.Conclusion The accuracy of AIB is not inferior to TcB.There is good correlation and equivalence between AIB and TSB.It is reliable to a certain extent to predict TSB with AIB.This mobile app has good performance in detecting neonatal bilirubin for full-term newborns 3 to＜7 days after birth and in the peak period of jaundice.
HyperbilirubinemiaSmartphoneApp softwareNewbornBilirubin value
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