Project Details

Validation of a low-cost icterometer for community-based screening of newborn jaundice in Pakistan and Tanzania

Alyssa Shapiro, PhD

Summary

BACKGROUND: Newborn jaundice (NNJ), or accumulation of bilirubin molecules in blood, ranked 7th in cause of neonatal deaths in Asia and Africa. More than 80% of newborns are affected by some degree of NNJ in their first week of life, and 10-25% develop moderate to severe NNJ requiring treatment. GAP: Universal screening is recommended to identify and treat NNJ early. The, the standard of care, visual inspection, has a low sensitivity of 42%. Low-cost, noninvasive screening tools must be validated, especially in populations with diverse skin tones and gestational ages, to address this high burden of NNJ worldwide. HYPOTHESIS: Bili-ruler, a plastic ruler with six shades of yellow, could enable simple, low-cost screening of NNJ with high sensitivity in diverse settings. The primary aim of this study is to evaluate the sensitivity and specificity of Bili-ruler compared to other NNJ screening tools; we also hypothesize that bili-ruler readings taken by two users will have high levels of agreement. METHODS: We will enroll 300 infants each at the Aga Khan University Hospital in Pakistan and Muhimbili National Hospital in Tanzania. Bilirubin, the primary outcome, will be measured in the first 0-72 hours of life using four techniques (Bili-ruler, serum bilirubin measurement, a transcutaneous device, and visual inspection of the skin). RESULTS: Pending. IMPACT: This project will generate evidence needed to use Bili-ruler in diverse populations. Bili-ruler can empower front-line healthcare workers to correctly identify at-risk newborns and provide timely referrals for NNJ, thus reducing mortality and severe neurodevelopmental disability.