A smartphone app that identifies severe jaundice in newborns by scanning their eyes could save lives in areas that don’t have access to expensive screening devices, suggests a study co-authored by researchers at the UCL (University College London) and the University of Ghana.
The app, called neoSCB, was developed by UCL clinicians and engineers and has been used to screen more than 300 newborn babies in Ghana for jaundice, following an initial pilot study of 37 new -born at University College London Hospital (UCLH) in 2020.
For the large-scale study, published in Pediatrics, the team tested more than 300 babies with the app, which analyzes images taken on a smartphone camera to quantify yellowing of the white part of the eye (sclera) – a sign of neonatal jaundice. Analysis of yellowness of the eye simply by looking is unreliable, and the neoSCB app can give early diagnosis of neonatal jaundice requiring treatment.
The study compared the effectiveness of the neoSCB app with conventional screening methods. Of the 336 babies tested by the app, 79 were newborns with severe jaundice, and the app correctly identified 74 of them. This is in line with the accuracy of the most common conventional screening method, a non-invasive device known as a transcutaneous bilirubinometer, which correctly identified 76.
The transcutaneous bilirubinometer works by measuring the yellow pigment under the newborn’s skin to give a measure of jaundice levels. All screening results are then followed by blood tests to determine the type of treatment required.
Dr Terence Leung (UCL Medical Physics & Biomedical Engineering) who developed the technology behind the app, said: “The study shows that the neoSCB app is as good as currently recommended commercial devices for screening newborns. severely jaundiced, but the application only requires a smartphone which costs less than a tenth of the commercial device. We hope that once deployed on a large scale, our technology can be used to save the lives of newborns in parts of the world that do not have access to expensive screening devices.
Dr Christabel Enweronu-Laryea (University of Ghana School of Medicine), study leader, said: “The neoSCB method was acceptable to mothers in the urban and rural communities where the study was conducted. Mothers have easily found ways to keep the baby’s eye open, most often by initiating breastfeeding.
Jaundice, where the skin and the whites of the eyes turn yellow, is common in newborn babies and is usually harmless. The yellowing is caused by a substance called bilirubin, which in severe cases can enter the brain, leading to death or disabilities such as hearing loss, neurological disorders such as athetoid cerebral palsy, and developmental delays.
Every year, severe jaundice causes approximately 114,000 newborn deaths and 178,000 cases of disability worldwide, although it is a treatable condition. Most cases of neonatal jaundice occur within the first week after birth, and routine screening for early diagnosis in high-income countries has reduced the risk of serious complications.
Newborns in low- and middle-income countries are generally at higher risk of severe jaundice or neonatal hyperbilirubinemia, due to lack of resources for screening. A commercial transcutaneous bilirubinometer usually costs around £4,000 per device, and blood tests require a large capacity. Additional factors such as a higher prevalence of home births and early postnatal discharge may contribute to reducing the number of newborns screened.
Babies in sub-Saharan Africa are also at greater risk due to a high prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency, which is an inherited genetic condition associated with an increased risk of haemolysis – where blood cells red cells are broken down at a faster rate than they are made – and hyperbilirubinemia.
Lead author Dr Judith Meek (UCLH) added: “This app has the potential to prevent death and disability around the world in many different settings. It will reduce unnecessary hospital visits and enable potentially enable community health workers and parents to safely care for newborns.
A total of 724 neonates between the ages of 0 and 28 days were initially considered for the study. The 336 whose datasets were used for the article had had no prior treatment for jaundice. Babies born at less than 35 weeks, seriously ill or with very low birth weight were excluded from the final study. The app was tested with frontline healthcare workers and the babies’ mothers, who provided feedback on the usability of the app.
The study was supported by the Saving Lives at Birth Consortium and the UCL EPSRC Center for Doctoral Training in Intelligent Integrated Imaging in Healthcare.
Notes to Editors
This study is made possible through the generous support of Saving Lives at Birth partners: United States Agency for International Development (USAID), Government of Norway, Bill & Melinda Gates Foundation, Grand Challenges Canada , the UK government and the Korea International Cooperation Agency (KOICA).
For more information or to speak to the researchers involved, please contact
Christabel Enweronu-Laryea, Terence Leung, Felix Outlaw, Nana Okai Brako, Geneviève Insaidoo, Nana Ayegua Hagan Seneadza, Mary Ani-Amponsah, Miranda Nixon-Hill, Judith Meek; Validation of a sclera-based smartphone application for screening neonates with jaundice in Ghana will be published in Pediatrics on Friday June 3, 2022, 05:01 UK time / 00:01 ET and is under strict embargo until that time.
The DOI for this article will be 10.1542/2021-053600
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The title of the article
Validation of a sclera-based smartphone application for screening neonates with jaundice in Ghana
Publication date of articles
June 3, 2022