Brigham and Women’s Hospital Develops Simple Ruler to Diagnose Jaundice

Speeches Shim

A mother and her baby as the newborn is examined for jaundice with the Icterometer
A mother and her baby as the newborn is examined for jaundice with the Icterometer
Brigham and Women’s Hospital

Dr. Anne “CC” Lee, a pediatrician in the Department of Newborn Medicine at Brigham and Women’s Hospital in Boston, Massachusetts, had two of her own children born with severe jaundice that required phototherapy treatment and prolonged hospitalization. Jaundice is a yellow coloring of the skin caused by hyperbilirubinemia, or excess bilirubin in the blood that, if left untreated, can release into the brain and can cause severe brain damage or lifelong disability for newborn babies. In developed countries like the United States, we have virtually eliminated adverse outcomes due to jaundice thanks to available screening and treatment. However, that is not the case for many countries in the developing world where jaundice screening in newborns is often unavailable or too expensive.

CC’s children are fortunately healthy after effective jaundice treatment known as blue light phototherapy. She has frequently thought about how that may not be the case if her kids had been born outside of the United States—in particular, in developing countries, where jaundice is often not detected until it is very late and treatment is costly and not always available. After discussion with a friend and newborn health expert, CC decided to focus her research efforts on this cause. “Newborn jaundice is not something that is even listed on the pie charts for causes of death in newborns. That is because we don't have a good estimates of the numbers of babies who are affected or die from this condition in low-middle income countries,” says CC. Cases of jaundice that are identified early are much easier to treat, however most facilities in developing countries do not have the capacity to perform screenings or laboratory tests. “For me, it is personal,” says CC on why she went to work to develop the Icterometer, a simple jaundice screening ruler that could be used anywhere in the world.

Brigham and Women’s Hospital was awarded a Saving Lives at Birth award in 2014 to develop simple, low-cost tools to facilitate better care of newborns with jaundice in developing countries. Each year, severe jaundice affects ~1.1 million babies worldwide. In developing countries, up to 35% of these newborns with severe jaundice die without access to treatment.

CC and her team built upon an idea that was first developed in the 1950s. Dr. Thomas Gosset first developed a version of the Icterometer in the UK, a ruler that tried to match babies’ skin tones with varying hues of yellow on a ruler in order to determine the level of jaundice of the infant. “We built upon his original idea- improving the original device by using advanced digital color processing technology, visual design to facilitate color matching, and including the end-users in development to directly influence the design,” says CC. The final product was a tool tested on 800 newborns in both Boston and Bangladesh, which was simple to use, low-cost, and very accurate for identifying different levels of neonatal jaundice. Preliminary analysis has shown that the jaundice ruler is highly sensitive and specific for identifying moderate-severe jaundice, and has high diagnostic accuracy. This innovation would allow for early detection and treatment of neonatal jaundice in resource limited settings, and therefore, help prevent life-threatening consequences.

The team also developed a mobile app to supplement the Icterometer and better manage care for newborns who were diagnosed with Jaundice and other newborn illnesses. Lauren Schaeffer, another member of the Brigham and Women’s Hospital team, worked closely with Save the Children Bangladesh on “mCNCP: a Mobile App for Comprehensive Newborn Care,” to help frontline health workers identify and manage severe jaundice and other illnesses. The app provided guidance and advice based on national guidelines for newborn care, photos that could be referenced when making a diagnosis, a 1-minute timer to assist in counting respiratory rates, and an electronic form that required completion of the entire examination. The app, tested in Bangladesh, led to more accurate identification of illness, along with guidance for when a patient should be referred to a higher-level health facility for treatment.

“From the start, the support from USAID and the Saving Lives at Birth team has been incredibly valuable and they have been an active partner in our work,” CC says. USAID has helped them with the long-term vision of the Icterometer to increase scale and adoption on a global level as well as connecting the team to other local and global neonatal stakeholders. The USAID team also provided numerous opportunities to present this work at global health conferences to help increase visibility, interest and potential scale up of the devices.

Brigham and Women’s recently teamed up with Donna Brezinski, founder of Little Sparrows Technologies, a fellow Saving Lives at Birth innovator, to integrate the Icterometer with their innovation, the Bilihut, a low-cost, efficacious phototherapy device. Together, they are finalists in Round 7 of Saving Lives at Birth with their proposal to evaluate their jaundice management package in Burundi. They also hope to work in partnership with Save the Children to scale-up the mobile app’s use in Bangladesh.