Um aplicativo de smartphone que detecta icterícia grave em recém-nascidos ao escanear seus olhos pode salvar vidas em lugares sem acesso a ferramentas caras de triagem.
O primeiro grande ensaio clínico é um sucesso para um aplicativo que detecta icterícia em bebês.
De acordo com um estudo de coautoria de cientistas da UCL (University College London) e da Universidade de Gana, um aplicativo de smartphone que detecta icterícia grave em recém-nascidos escaneando seus olhos pode salvar vidas em lugares sem acesso a ferramentas de triagem caras.
Após um teste piloto preliminar em 37 bebês no University College London Hospital (UCLH) em 2020, o aplicativo neoSCB, criado por médicos e engenheiros da UCL, foi usado para testar a icterícia em quase 300 recém-nascidos em Gana.
Os pesquisadores avaliaram quase 300 bebês usando o aplicativo para o estudo em larga escala, publicado na Pediatrics. O programa analisa fotos tiradas com a câmera de um smartphone para medir o amarelamento da área branca do olho (esclera), um indicativo de icterícia no recém-nascido. É impreciso julgar o amarelo do olho apenas olhando, mas o aplicativo neoSCB pode fornecer um diagnóstico precoce de icterícia neonatal que deve ser tratada.
Pesquisadores usam o aplicativo para testar um bebê. Crédito: University College London
O estudo comparou a eficácia do aplicativo neoSCB com os métodos convencionais de triagem. Dos 336 bebês testados pelo aplicativo, 79 eram recém-nascidos com icterícia grave, e o aplicativo identificou corretamente 74 deles. Isso está de acordo com o[{” attribute=””>accuracy of the most common conventional screening method, a non-invasive device known as a transcutaneous bilirubinometer, which correctly identified 76.
The transcutaneous bilirubinometer works by measuring the yellow pigment under the newborn’s skin to give a measure of jaundice levels. All screening results are then followed up by blood tests to determine the type of treatment required.
Dr. Terence Leung (UCL Medical Physics & Biomedical Engineering) who developed the technology behind the app, said: “The study shows that the neoSCB app is as good as commercial devices currently recommended to screen for severely jaundiced newborns, but the app only requires a smartphone which costs less than a tenth of the commercial device. We hope that once rolled out widely, our technology can be used to save the lives of newborns in parts of the world that lack access to expensive screening devices.”
Study lead Dr. Christabel Enweronu-Laryea (University of Ghana Medical School) said: “The neoSCB method was acceptable to mothers in urban and rural communities where the study was conducted. Mothers easily devised ways to keep the baby’s eye open, most often by initiating breastfeeding.”
Jaundice, where the skin and whites of the eye turn yellow, is common in newborns and is usually harmless. The yellowness is caused by a substance called bilirubin, which in severe cases can enter the brain, leading to death or disabilities such as hearing loss, neurological conditions such as athetoid cerebral palsy, and developmental delays.
Every year severe jaundice causes about 114,000 newborn deaths and 178,000 cases of disability worldwide, despite it being a treatable condition. Most cases of neonatal jaundice occur in the first week after birth, and routine screening for early diagnosis in higher-income countries has reduced the risks of severe complications.
Newborns in low- and middle-income countries are typically at a greater risk of severe jaundice, or neonatal hyperbilirubinemia, because of the lack of resources required for screening. A commercial transcutaneous bilirubinometer typically costs around £4,000 ($4900) per device, and blood tests require a large amount of capacity. Additional factors such as a higher prevalence of home births and early postnatal discharge can contribute to fewer newborns going through screening.
Babies in sub-Saharan Africa are also at a greater risk because of a high prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency, which is an inherited genetic disorder associated with an increased risk of hemolysis – where red blood cells break down at a faster rate than they are made – and hyperbilirubinemia.
Senior author Dr. Judith Meek (UCLH) added: “This app has the potential to prevent death and disability worldwide in many different settings. It will reduce unnecessary hospital visits and potentially empower community health workers and parents to care for newborn babies safely.”
In total, 724 newborns aged between 0 and 28 days were initially considered for the study. The 336 whose datasets were used for the paper had had no prior treatment for jaundice. Babies who were born at less than 35 weeks, were critically ill, or had a very low birth weight were excluded from the final study. The app was tested with frontline healthcare workers and the babies’ mothers, who provided feedback on the usability of the app.
Reference: “Validating a Sclera-Based Smartphone Application for Screening Jaundiced Newborns in Ghana” by Christabel Enweronu-Laryea, Terence Leung, Felix Outlaw, Nana Okai Brako, Genevieve Insaidoo, Nana Ayegua Hagan-Seneadza, Mary Ani-Amponsah, Miranda Nixon-Hill and Judith Meek, 1 July 2022, Pediatrics.
DOI: 10.1542/peds.2021-053600
The study was funded by the Saving Lives at Birth consortium and the EPSRC UCL Centre for Doctoral Training in Intelligent Integrated Imaging in Healthcare.
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