mHealth to Screen for Neonatal Jaundice in Low-resource Mexican Settings: a Randomized Controlled Feasibility Study

Background Neonatal jaundice (NNJ) affects a significant percentage of newborns (60%-80%) within the first 48 to 72 hours of life. Due to increased production and decreased elimination in the newborns, bilirubin accumulates in the blood, causing neonatal hyperbilirubinemia (NHB). While most cases resolve without consequences, severe NHB affects approximately 1.1 million infants annually, necessitating close monitoring and treatment. If undetected, NHB can lead to brain damage and conditions such as acute bilirubin encephalopathy, impaired neurologic development, long-term disabilities (including audiologic, language processing, cognitive and visual-motor disturbances) and, in the worst cases, death.

Currently, reliable detection of NNJ depends on invasive or expensive methods, such as transcutaneous bilirubinometer (TcB) devices and total serum bilirubin (TSB) blood tests, which are limited in most low- and middle-income countries (LMICs) as well as in out-of hospital settings. As a result, detection relies on using visual assessment (VA), an unreliable and inaccurate screening method that leads to a higher prevalence of severe consequences in LMICs than in high-income countries (HICs). This results in preventable health inequities with significant social and economic costs.

In response to these challenges, a Norwegian multidisciplinary research group developed an accessible, affordable mobile health (mHealth) solution called Picterus Jaundice Pro (Picterus JP) to screen for NHB. Picterus JP consists of a smartphone app to capture and upload images of the newborn's skin, a calibration card for accurate colour calibration in the images and a server for image analysis and storage. The app has undergone validation in Norwegian hospitals and in pilot studies in Mexico and the Philippines, demonstrating significant positive correlation between Picterus JP's bilirubin values and TSB levels as well as higher accuracy over VA.

Digital health technologies such as Picterus JP have immense potential to enhance healthcare in resource-constrained areas, but such innovations face implementation challenges that can hinder their adoption, leading to slow, unreliable and unsustainable outcomes, particularly in LMICs, such as Mexico.

To get insights about low-resource settings in Mexico, particularly in the state of Oaxaca, an exploratory study on the field to identify the main barriers and facilitators to implement Picterus JP in urban and rural public health facilities was recetly conducted. Through non-participants observations and interviews deficiencies in the current neonatal jaundice detection process and the participants' desire for a more accurate method were identified. Participants tested Picterus JP on a dummy perceiving the app as easy to use, useful and compatible with the work routine, but barriers to adoption were identified, including internet deficiencies and costs.