Aune Anders, Jímenez-Díaz Gabriela, Gierman Lobke Marijn, Vartdal Gunnar, Reyes Berlanga Mónica, Tusoy Jorge, Bergseng Håkon, Shakya Sunila, Darj Elisabeth
Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
Department of Pediatrics, St Olav's Hospital HF, Trondheim, Norway.
BMJ Paediatr Open. 2025 May 8;9(1):e002242. doi: 10.1136/bmjpo-2023-002242.
Neonatal hyperbilirubinemia (NHB) is a significant cause of morbidity and mortality, particularly in low and middle-income countries (LMICs). Transcutaneous bilirubinometers offer a non-invasive method for assessing NHB but have limited availability due to cost and maintenance requirements. Visual assessment of jaundice is shown to be inaccurate. Smartphone-based technologies have the potential to provide innovative and accessible healthcare solutions. This study aimed to evaluate the Picterus system, a smartphone-based tool for screening of NHB, in three non-Caucasian populations in LMICs.
Between 2018 and 2022, cross-sectional studies were conducted in three countries: Mexico, Nepal and the Philippines. Newborns meeting the inclusion criteria were recruited, and data on demographic characteristics, skin type and visual assessment of jaundice were collected. Bilirubin levels were measured using both the Picterus system and total serum bilirubin (TSB) analysis. Correlation analyses, Bland-Altman plots and receiver operating characteristic (ROC) curves were used to evaluate the Picterus system.
A total of 416 infants were included in the analysis. The Picterus smartphone system demonstrated a significant positive correlation with TSB levels across all sites (r=0.76). The correlation coefficient was significantly higher in Mexico compared with Nepal and the Philippines. Bland-Altman plots showed limits of agreement ±89.2 µmol/L. Picterus values were underestimated in Mexico, whereas they were overestimated in Nepal and the Philippines. ROC analysis for detection of infants with TSB >225 µmol/L indicated that the Picterus system had higher sensitivity and specificity compared with visual assessment using the Kramer scale.
This study shows that the Picterus system can potentially be used in screening for neonatal jaundice in populations with moderate dark skin types. Further studies are needed before the system can be used in clinical practice.
新生儿高胆红素血症（NHB）是发病和死亡的重要原因，在低收入和中等收入国家（LMICs）尤为如此。经皮胆红素仪为评估NHB提供了一种非侵入性方法，但由于成本和维护要求，其可用性有限。黄疸的视觉评估被证明是不准确的。基于智能手机的技术有潜力提供创新且易于获得的医疗保健解决方案。本研究旨在评估Picterus系统，这是一种用于筛查LMICs中三个非白种人群NHB的基于智能手机的工具。
2018年至2022年期间，在三个国家开展了横断面研究：墨西哥、尼泊尔和菲律宾。招募符合纳入标准的新生儿，并收集有关人口统计学特征、皮肤类型和黄疸视觉评估的数据。使用Picterus系统和总血清胆红素（TSB）分析测量胆红素水平。采用相关性分析、布兰德-奥特曼图和受试者工作特征（ROC）曲线来评估Picterus系统。
共有416名婴儿纳入分析。Picterus智能手机系统在所有地点与TSB水平均呈现显著正相关（r = 0.76）。与尼泊尔和菲律宾相比，墨西哥的相关系数显著更高。布兰德-奥特曼图显示一致性界限为±89.2µmol/L。墨西哥的Picterus值被低估，而尼泊尔和菲律宾的Picterus值被高估。检测TSB>225µmol/L婴儿的ROC分析表明，与使用克莱默量表的视觉评估相比，Picterus系统具有更高的敏感性和特异性。
本研究表明，Picterus系统有可能用于筛查中等深色皮肤类型人群中的新生儿黄疸。在该系统可用于临床实践之前，还需要进一步研究。
