Accuracy of smartphone application to quantify jaundice in neonates: A systematic review with meta-analysis

Abstract Purpose Neonatal jaundice is a common clinical condition which can progress to acute bilirubin encephalopathy with serious consequences if diagnosis and treatment are delayed. Timely and frequent screening by parents at home has the potential for early identification of high bilirubin levels. In this study, we aimed to analyse the current evidence on the accuracy of smart phone applications to detect neonatal jaundice. Methods PubMed, EMBASE, EMCARE, MEDLINE, The Cochrane Library and Google Scholar were searched from inception until July 2022. Grey literature was searched on ‘Opengrey’ and ‘Mednar’ databases. We included prospective and retrospective cohort studies that recruited infants with a gestation of ≥ 35 weeks and reported paired total serum bilirubin (TSB) and smartphone app-based bilirubin (ABB) levels. Two reviewers independently selected the studies for inclusion. In case of discrepancies, discussions were held with the third reviewer prior to reaching consensus. We conducted the review using the guidelines of the Cochrane Collaboration Diagnostic Test Accuracy Working Group and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-diagnostic test accuracy (PRISMA-DTA) statement. The data was pooled using the random effects model. The outcome of interest was agreement between ABB and TSB measurements, provided as correlation coefficient. Certainty of Evidence (COE) was assessed based on GRADE guidelines. Results 14 studies (n = 2256) were included in the meta-analysis. The number of infants in individual studies ranged between 35 and 530. The pooled correlation coefficient (r) was 0.77 [95% CI 0.69 to 0.83; p < 0.01], indicating a statistically significant and strong positive correlation between ABB and TSB. Reported sensitivities for predicting a TSB of 250 µmol/L in individual studies ranged between 75 and 100% and specificities 61 to 100%. Similarly, a sensitivity of 83 to 100% and a specificity of 19.5 to 76% were reported for predicting a TSB of 205 µmol/L. Overall COE was considered moderate. Conclusions Smart phone App based bilirubin estimation showed a strong correlation to TSB levels. Well-designed studies are required to determine its utility as a screening tool for various TSB cut-off levels to commence phototherapy.