The smartphone camera as a potential method for transcutaneous bilirubin measurement

• Published in: PloS one Vol. 13; no. 6; p. e0197938
• Main Authors: Munkholm, Sarah B., Krøgholt, Tobias, Ebbesen, Finn, Szecsi, Pal B., Kristensen, Søren R.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.06.2018; Public Library of Science (PLoS)
• Subjects: Bilirubin; Bilirubin - blood; Biochemistry; Biology and Life Sciences; Blood Chemical Analysis - instrumentation; Cameras; Channels; Computer aided medical diagnosis; Computer and Information Sciences; Data collection; Diagnosis; Digital imaging; Engineering and Technology; Female; Gestational age; Health aspects; Health care; Humans; Hyperbilirubinemia; Hyperbilirubinemia, Neonatal - blood; Hyperbilirubinemia, Neonatal - diagnosis; Image acquisition; Infant, Newborn; Informed consent; Internet; Jaundice; Lesions; Light sources; Light therapy; Male; Measurement; Medical devices; Medical electronics; Medical equipment; Medical imaging; Medicine and Health Sciences; Methods; Neonatal jaundice; Neonatal screening; Neonates; Newborn babies; Pediatrics; Research and Analysis Methods; Screening; Skin; Skin diseases; Smart phones; Smartphone - instrumentation; Smartphones; Technology application; Denmark; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0197938

Hyperbilirubinemia is a common problem in neonates that can progress into kernicterus. Suspected neonatal hyperbilirubinemia is a common reason for contact with the healthcare system. The severity and management of jaundice are determined based on estimated bilirubin levels. However, no easy and accessible tool for self-assessing neonatal jaundice is currently available. Smartphones could potentially be transformed into a medical device that could be used by both patients and practitioners. To investigate whether a digital image produced by a camera embedded on a smartphone can be a used as a screening tool for neonatal hyperbilirubinemia. A total of 64 randomly selected newborns were enrolled. The inclusion criteria were healthy Caucasians, gestational age >35 weeks, age >24 hours and ≤14 days old, and parental informed consent. The exclusion criteria were facial skin lesions and light treatment. Images of the glabella were obtained with an iPhone 6 via i) directly applied pressure, ii) a dermatoscope, or iii) a dermatoscope equipped with a Wratten No. 11 filter. The red, green and blue colour intensities of each image were compared to bilirubin levels. Only the dermatoscope-acquired intensities of the green and blue channels were significantly correlated (p < 0.001) with bilirubin measurements (Pearson's r: 0.59 and 0.48, respectively). For the green and blue channels, discrimination limits of 212 and 190, respectively, revealed a sensitivity and specificity of 100% and 62.5%, respectively, for green and 90.9% and 60%, respectively, for blue for a plasma bilirubin above 205 μmol/L. The results of this study indicate that a smartphone equipped with a consistent light source in the form of a dermatoscope may be a simple screening tool for neonatal hyperbilirubinemia. However, the method requires some improvement before clinical application.