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. 2018 Jun 1;13(6):e0197938.
doi: 10.1371/journal.pone.0197938. eCollection 2018.

The smartphone camera as a potential method for transcutaneous bilirubin measurement

Sarah B Munkholm  1 , Tobias Krøgholt  2 , Finn Ebbesen  3 , Pal B Szecsi  4 , Søren R Kristensen  5
Affiliations

The smartphone camera as a potential method for transcutaneous bilirubin measurement

Sarah B Munkholm et al. PLoS One. .

Abstract

Background: 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.

Objective: 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.

Study design: 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.

Results: 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.

Conclusions: 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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Methods of evaluation.
Descriptions of the three methods used in this study. The left picture illustrates the method used to acquire the image, and the right is the resulting image that was used for the data analysis.
Fig 2
Fig 2. The dermatoscope method; A scatterplot of the green and blue channel intensities and plasma bilirubin.
A scatterplot showing the correlation between the green and blue channels using the dermatoscope method and total plasma bilirubin levels.
See this image and copyright information in PMC

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