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Background: Jaundice is a common problem in neonates and the most common cause of hospitalization in Iran. The aim of this study was to compare safety and efficacy of LED and conventional photo therapy to treat hyperbilirubinemia. Materials and methods: A randomized clinical trial was conducted on 130 term and near term infants over 35 weeks. hospitalized in a neonatal care unit and who needed conventional phototherapy. Samples were randomly divided into two groups: LED and conventional phototherapy. Outcomes included the rate of fall of total serum bilirubin (TSB, ring/dL/hour) and measured duration of phototherapy. Data were analyzed by SPSS software with descriptive statistics, t-test, and analysis of variance (ANOVA). Results: TSB level was not different in the two groups before the intervention (P=0.187). LED phototherapy was more effective in reduction of the level of TSB at 6, 12, and 24 hours. (P

Objective: The objective of this study was to evaluate the effect of intravenous fluid supplementation in healthy term neonates with non-hemolytic hyperbilirubinemia receiving phototherapy. Study Design: Randomized controlled trial conducted in a tertiary level neonatal care unit of a teaching institute in North Karnataka. Methods: A total of 60 healthy term neonates with non-hemolytic hyperbilirubinemia (total serum bilirubin [TSB] >15 mg/dL [256 μmol/L]

Background: neonatal hyperbilirubinemia is a common condition in the first few days of life (1) and it can be divided into: pathological and physiological and indirect (unconjugated) and direct (conjugated) hyperbilirubinemia. Objective: This paper aimed to evaluate the effect of different types of phototherapy on serum calcium of both preterm and full-term infants with indirect hyperbilirubinemia, in either supine or prone position. Methods: data were taken from 100 newborns candidate by divided them into two groups. Blue and white light phototherapy were equally used for different infants of both groups. Results: the results showed that 31% developed hypocalcemia, 20% preterm and 11% full term infants. 38% developed hypocalcemia, where among infants who received prophylactic phototherapy 24% developed hypocalcemia. 60% of infants who received extensive phototherapy developed hypocalcemia, where 27.7% of infants who managed with single phototherapy developed hypocalcemia. Seventeen of the infants who managed in prone position and 14 infants of those who received phototherapy in supine position developed hypocalcemia. Conclusion: all in all, 19 infants developed hypocalcemia under blue light and 12 received white light phototherapy. Phototherapy induced hypocalcemia in both full term and premature infants. In addition to the common practice of monitoring the total serum bilirubin and PCV in all newborns on phototherapy, it is important to monitor the total serum calcium on daily base.

Background and Aim: Jaundice is the yellowish discoloration of the skin and mucous membranes or the visible manifestation as a result of elevated serum bilirubin. With spectroscopic tools now available, it is possible to assess the skin's condition by quantitative measures and to access information from deeper layers of skin not visible to the eye. The aim of this study was to determine the relevance of the jaundice meter in determining significant bilirubin levels in term neonates at a tertiary hospital in Lagos State using the Konica Minolta JM-103. Materials and Methods: One hundred and fifty consecutive neonates who presented at the neonatal unit of the hospital were recruited for the study after checking them with set inclusion and exclusion criteria. The transcutaneous bilirubinometry (TcB) readings of the neonates were taken on the forehead, sternum, and abdomen of the calm neonate in a supine position, and blood samples for total serum bilirubin (TSB) estimation were drawn from a peripheral vein within 10 min of TcB measurement. Pearson's correlation analysis with linear regression was done to test the relationship between TSB and TcB values as well as for TcB measurements taken at different sites. Results: The difference between the bilirubin values measured with TcB and TSB was low, with 104 neonates (69.3%) having a difference that was 12 mg/dl was 45.2% compared with 56.8% obtained by TcB. In the present study, bilirubin levels measured with the JM-103 show a good agreement with TSB levels in the study neonates. A comparison of the extent of neonatal jaundice in our study at the different body sites using the Kramer's chart showed that there were similar mean recordings for TcB and TSB, with mean values of 10.27 ± 2.90 and 10.58 ± 2.90 for involvement of the face/neck and 18.34 ± 1.61 and 18.43 ± 1.42 for hand/feet obtained by TSB and TcB, respectively. Conclusion: The excellent correlation of TcB with TSB obtained from this study even at levels of bilirubin that necessitates the initiation of phototherapy is encouraging. The JM-103 device thus appears relevant in determining significant bilirubinemia in black neonates.

Conventional phototherapy converts unconjugated bilirubin to its oxidation products and consequently causes oxidative stress with lipid peroxidation products. New devices that deliver intensive phototherapy are efficacious in treating severe hyperbilirubinemia and minimizing the need for exchange transfusions. However, the oxidative stress status when using these devices has not been explored. Therefore, we aimed to study the impact of using intensive phototherapy on the oxidant-antioxidant status in severely jaundiced neonates.This prospective case-control study included term newborns admitted with severe hyperbilirubinemia managed with intensive phototherapy. Baseline oxidant-antioxidant concentrations were compared to healthy controls and re-measured after 8 h of intensive phototherapy exposure.The study included 40 cases with severe jaundice and 40 non-jaundiced apparently normal controls. Total serum bilirubin at enrollment was 23.4 ± 4.2 mg/dl that significantly decreased after 8 h of therapy to 15.4 ± 3.4 mg/dl (p 0.001). The decline of total serum bilirubin was 1 mg/dl/h. Bilirubin: albumin ratio decreased from 3.45 ± 0.28 to 2.7 ± 0.21 (p 0.001). Total antioxidant capacity (TAC), superoxide dismutase (SOD), malondialdehyde (MDA), and total oxidative stress (TOS) concentrations were lower in cases (p 0.001, p 0.001, p = 0.049, and p 0.001 respectively) compared to controls. Following 8 h of intensive phototherapy, further decline of TAC (p = 0.016) with increased concentrations of TOS (p = 0.005) were noted. SOD and MDA did not change.Although efficacious, intensive phototherapy was associated with increased oxidative stress. The clinical correlates for harms related to such oxidative stress need further studying.

Objective To develop a statistically rigorous, hour-specific bilirubin nomogram for newborns based on a very large data set; and use it prospectively as a replacement for the 1999 Bhutani nomogram. Study design This was a retrospective analysis of first total serum bilirubin (TSB) measurements from 15 years of universal bilirubin screening during birth hospitalizations at 20 Intermountain Healthcare hospitals. Hour-specific TSB values were assembled into a nomogram by percentile, and subgroups were compared. Results The information obtained included robust data in the first 12 hours after birth (which was not included in the 1999 nomogram), general agreement with the 1999 nomogram for values in the first 60 hours, but higher 75th and 95th percentile TSB values thereafter in the new version, no difference in TSB between male and female infants, higher TSB values among earlier gestation neonates (350/7-366/7 weeks vs ≥37 weeks, P Conclusions An updated and more informative Bhutani neonatal bilirubin nomogram, based on 140 times the number of subjects included the 1999 version, is now in place in our health care system.

Introduction Acute bilirubin encephalopathy (ABE) is associated with long-term sequelae (kernicterus). It continues to be a significant issue in our region of Nigeria, accounting for much morbidity and mortality. Herein we report the outcome of neonates with ABE seen at our centre. Methodology We established a surveillance of children who had ABE and returned to follow-up from prospective cases of ABE (2012-2014). ABE was diagnosed based on a bilirubin-induced neurologic dysfunction score of ≥ 1. Kernicterus was subsequently established based on a history of developmental delays, hearing impairments and abnormal physical and neurologic examinations at follow-up age ≥3 months. Result Five hundred fifty-one neonates had hyperbilirubinaemia of whom 104 (18.8%) had ABE. Mean transcutaneous bilirubin using the Ingram icterometer was 18.3 mg/dl ± SD 1.9 [(12.5-19.1), total serum bilirubin of 18.1 ± 10.9] (range: 10.3-64 mg/dl). Sixty-five infants returned for follow-up (41 males and 24 females); mean age 9 months (22 days to 17 months). Most (58 of 65; 89.2%) had abnormal neurological findings and 15 (25.9%) had probable kernicterus. Conclusion There is a critical need for a National Kernicterus Registry to document all cases of kernicterus and formulate an effective treatment and prevention policy.

Background Phototherapy is believed to be a safe method for the management of hyperbilirubinemia. However, there are some controversial issues regarding the genotoxic effects of phototherapy on DNA. The aim of this study was to investigate morphologically both phototherapy-induced DNA double-strand breaks (DSBs) and apoptosis in lymphocytes derived from jaundiced and non-jaundiced neonates. Methods Newborns were divided into three groups, including phototherapy-treated (PT, n=30) jaundiced newborns with total serum bilirubin (TSB) levels >15 mg/dl, non-treated jaundiced newborns (C+, n=27), as positive, as well as healthy negative (C-, n=30) controls with TSB levels ranging from 10 and 15 mg/dl and less than 5 mg/dl, respectively. Lymphocytes were isolated from whole blood samples by Ficoll-isopaque density gradient centrifugation and then assessed for DNA damage and apoptosis before and 24 hours after incubation at 37°C in 5% CO2 using the neutral comet assay. Results DSB levels were significantly much higher in the PT group compared to the controls before incubation but decreased remarkably after the incubation period. As expected, no statistical differences were found between the two control groups before and after incubations. The frequency of apoptotic cells showed no significant differences among all the three groups before incubation; however, it was significantly increased in the PT group after incubation. Conclusion It seems that phototherapy in jaundiced infants is able not only to induce apoptosis in newborn lymphocytes but also to affect indirectly DNA integrity.

Transcutaneous bilirubinometry (TcB) is routinely used to monitor jaundice in term and near-term infants. However, before 35 weeks gestation, the technique has not been widely adopted.The aim of this study is to study the correlation between TcB and total serum bilirubin (TsB) before, during, and after phototherapy in preterm infants born before 35 weeks' gestation.Jaundice was monitored in infants born before 35 weeks' gestation by simultaneous measurements of TsB and TcB assessed by a Drager Jaundice Meter JM-103 (Draeger Medical, Inc., Telford, PA).About 588 pairs of measurements were recorded in 86 premature infants of 26-34 weeks, weighing 618-2400 grams. The overall correlation coefficient between TcB and TsB was 0.8 (p = .001). Subset analysis revealed lower correlation in infants born before 30 weeks. TcB was consistently estimated around 1 mg% lower than TsB. Neither the cause of the jaundice nor major neonatal morbidities significantly influenced the TcB-TsB correlation.TcB is a reliable measure of jaundice before 35 weeks' gestation with a mean under-estimation of ≈1 mg%. TcB use may reduce unnecessary invasive blood tests.

Background We tested whether direct transcutaneous bilirubin (TcB) measurement from an area unexposed to phototherapy is reliable for estimation of total serum bilirubin (TSB) in neonates during phototherapy and whether it contributes to reduction in TSB blood sampling in phototherapy decision making. Methods This was a retrospective observational study of term neonates who received phototherapy in the mother's room. TSB and TcB from the neonate's sternum were measured before and during phototherapy and compared using linear regression analysis and Bland–Altman plot, respectively. Various cut-offs of TcB for estimating TSB during phototherapy at >72 h after birth were analyzed. Results There were moderate correlations between TSB and TcB before (r = 0.56) and during (r = 0.47) phototherapy in 125 neonates. The mean difference (TSB–TcB) before and during phototherapy was 1.2 ± 1.7 mg/dL and 1.0 ± 1.7 mg/dL, respectively. The 95% limits of agreement for the difference before and during phototherapy ranged from −2.1 to 4.5 and from −2.3 to 4.3 mg/dL, respectively. For TSB ≤18 mg/dL during phototherapy, a TcB cut-off of 14 mg/dL had a specificity of 1.0; with this method, 43% of the TSB measurements could have been avoided. Conclusions Direct measurement of TcB during phototherapy using a bed-type device is a reliable method to estimate TSB in term neonates and would contribute to a reduction in blood sampling. It cannot, however, be used as a substitute for TSB measurement.

Phototherapy is an effective treatment for neonatal jaundice. Treatment indication uses total serum bilirubin (TSB), although unbound bilirubin (Bf) more accurately predicts disability risk. The goals of this investigation were to examine the response of Bf and TSB to phototherapy in preterm infants, and we hypothesized that (i) TSB and Bf respond differently; (ii) the relationship between TSB and Bf is altered; and (iii) unexpected Bf elevations are found.One hundred and seventeen preterm infants2 kg at birth and receiving (IL) were enrolled; and measurements of TSB and Bf were obtained. TSB was measured by the diazo method and Bf with a fluorescent Bf sensor BL22P1B11-Rh.Initial mean (± SD) TSB and Bf levels (41.4 ± 6.9 h) were 8.0 ± 9.0 mg/dL and 16.9 ± 12.4 nmol/L (P 0.05). The rates of rise (ROR) were 0.21 ± 0.10 mg/dL/h for TSB and 0.38 ± 0.33 nmol/L/h for Bf. Phototherapy reduced TSB from 8.0 ± 9.0 to 5.8 ± 9.4 mg/dL (P = 0.068) but Bf did not change (16.9 ± 12.4 to 14.1 ± 9.4 nmol/L P = n.s.). Bf levels were11 nmol/L in 64,17 nmol/L in 18, and22 nmol/L in 7 infants.Bf and TSB responded differently. While TSB and Bf correlated well before phototherapy, they did not correlate during phototherapy. TSB showed a trend toward a reduction with treatment, Bf did not. While TSB ROR information is not helpful, ROR Bf data can be utilized to anticipate treatment. Potentially high Bf levels existed before and after phototherapy and the mean Bf level at phototherapy termination remained elevated in a significant proportion of infants.

Introduction: Newborn jaundice is a common outpatient problem. Transcutaneous bilirubin (TcB) measurements correlate well with total serum bilirubin (SB) measurements below 15 mg/dl and are efficient and noninvasive. Some concern exists that TcB measurement may subsequently lead to an increase in the number of SB measurements performed in the outpatient setting. We aimed to implement the use of a TcB device in an outpatient clinic. By doing so, we sought to increase the number of newborns screened solely by TcB as opposed to SB, by 30%, within 12 months. Methods: We conducted plan-do-study-act cycles with targeted interventions to promote the use of TcB in an outpatient clinic for eligible newborns older than 35 weeks gestational age, aged 1–20 days, and without a history of transfusion, phototherapy, extensive bruising, or risk of hemolysis. We used statistical process control methods to measure proportions of newborns evaluated with TcB (run chart) and patients-between SB measurements (G-chart) over time in the outpatient clinic. Results: We collected preintervention data for 18-months and intervention data for 12 months. For newborns attending the outpatient clinic, the proportion of TcB measurements increased after implementation of the use of TcB measurement. There was an increase in patients-between SB measurements. At project inception, SB was drawn for every 8 eligible patients. By the end of the project, there were 98 eligible newborns between instances of SB testing. Conclusion: Implementation of a quality-improvement initiative to measure TcB in the outpatient clinic was feasible and reduced the number of SB tests.

We review the current literatures to determine whether intermittent phototherapy is more effective than continuous phototherapy in treating neonatal hyperbilirubinaemia.The systematic review is a systematic review and meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used for reporting methods and results of synthesis with meta-analysis. Synthesis Without Meta-analysis (SWIM) guidelines were used for reporting methods and results of synthesis without meta-analysis.Pubmed, Embase, Cochrane library, China National Knowledge Infrastructure, China Biology Medicine, VIP Database, and Wanfang Database.PICOS eligibility criteria were used to select original studies published from 1984 through 2019. Data were statistically extracted and evaluated using RevMan 5.3 software.A total of 416 records were identified through database searching. Four studies (three randomized studies and one retrospective study) meet the final inclusion criteria. Seven hundred and sixteen neonates were included in the meta-analysis. There was no difference in the treatment efficacy and total serum bilirubin (TSB), while there was a significant difference in phototherapy duration and side effects after treatment of intermittent phototherapy and continuous phototherapy for neonatal hyperbilirubinaemia.Intermittent phototherapy appeared to be as effective as continuous phototherapy for the treatment of neonatal hyperbilirubinaemia and is safer than continuous phototherapy. Healthcare organizations and health workers should choose intermittent phototherapy as the preferred therapy for neonatal hyperbilirubinaemia.Intermittent phototherapy is an effective, feasible, and safer treatment method for the infants with hyperbilirubinaemia in paediatric department. Healthcare organizations and health workers should choose intermittent phototherapy as the preferred therapy for neonatal hyperbilirubinaemia.目标: 我们对现有的文献作出评价,以确定间歇光疗是否比连续光疗更有效地治疗新生儿高胆红素血症。 设计: 系统性回顾指的是进行系统评价和荟萃分析。系统评价和荟萃分析的首选报告项目(PRISMA)指南用于报告带荟萃分析的综合分析方法和结果。不带荟萃分析的综合分析(SWIM)指南用于报告不带荟萃分析的综合分析方法和结果。 数据来源: 国际文献数据库(PubMed)、荷兰医学文摘数据库(Embase)、Cochrane 临床对照试验中心注册数据库、中国国家知识基础设施、中国生物医学文献数据库、维普中文科技期刊数据库、万方数据库(WANFANG)。 评价方法: 使用工艺信息和控制系统(PICOS)资格标准选择1984年至2019年发表的原创研究。使用RevMan 5.3软件对数据进行统计提取和评估。 结果: 通过数据库检索,共识别出416条记录。四项研究(三项随机研究和一项回顾性研究)符合最终入选标准。共有716例新生儿纳入荟萃分析。新生儿高胆红素血症经间歇光疗和连续光疗治疗后,疗效及血清总胆红素(TSB)无明显差别,但光疗时间和副作用存在显著性差异。 结论: 对于治疗新生儿高胆红素血症,间歇光疗和连续光疗的疗效相同,且比连续光疗更安全。因此,在治疗新生儿高胆红素血症时,应选择间歇光疗作为首选的治疗方法。 影响: 在儿科中,运用间歇光疗治疗新生儿高胆红素血症是一种有效的、可行的、安全的治疗方法。因此,在治疗新生儿高胆红素血症时,应选择间歇光疗作为首选的治疗方法。.

The absence of hyperbilirubinemia can lead to decreased suspicion of biliary rupture in dogs. This delay of suspicion and treatment can result in increased mortality rates. The objective of this retrospective, observational study was to describe ultrasound and serum bilirubin findings in a group of dogs with an ultrasonographic diagnosis of suspected biliary rupture. The records of a single institution were searched over the period of 2007-2019 for cases having ultrasound reports describing suspicion of biliary rupture. Clinical findings for each of the cases were recorded. A total of 35 dogs met inclusion criteria and, of these, 30 dogs had confirmed ruptured biliary tracts. It was found that 40% (12/30) of dogs with confirmed ruptured biliary tracts had a serum bilirubin values within the normal reference range. No statistical difference was found in serum bilirubin values between the ruptured and nonruptured biliary tracts. Leukocytosis and neutrophilia were found to be statistically significant between ruptured and nonruptured biliary tracts. Mucinous material, similar to "white bile" found in human literature, was found within the peritoneal effusion of six dogs with biliary rupture, three of which also lacked bile pigment. Findings from this study indicated that normobilirubinemia may be present in some dogs with biliary rupture, and therefore should not be used as a reason for excluding this differential diagnosis.

RESUMEN Introducción: Las pautas para prevención y tratamiento de hiperbilirrubinemia neonatal recomiendan medición de bilirrubina sérica total (BST) o bilirrubina transcutánea (BTc) para determinar el grado de ictericia antes del alta del recién nacido (RN); ésta última no invasiva, proporciona información instantánea y de calidad superior a la evaluación clínica. A pesar de ello aún no ha sido aplicada en forma sistemática en los hospitales de Paraguay. Objetivo: evaluar la aplicación en nuestro medio de la medición de bilirrubinemia transcutánea antes del alta correlancionando con la bilirrubina sérica. Materiales y Métodos: Estudio observacional, descriptivo con componente analítico, de corte transversal. Fueron incluidos RN con edad gestacional ≥ a 35 semanas, con peso ≥ a 2000 gramos, luego de las 24 hs de vida hasta los 8 días; bajo consentimiento informado de los padres, durante un año. Los datos fueron consignados en una planilla de Microsoft Excel y procesado por el software IBM SPSS Statistics ®. Resultados: De 271 RN que ingresaron al estudio, en la primera medición con el Bilirrubinómetro transcutáneo, cumplían con criterios para toma de bilirrubina sérica 90 (33,2%) de ellos. En los restantes 181 RN (66,8%), los datos emparejados no estaban disponibles debido a que siguiendo las recomendaciones de las guías actuales no fue necesario medir la bilirrubina sérica. El valor del coeficiente de correlación para la primera medición fue r = 0.574. Para la segunda medición las medidas emparejadas estaban disponibles para 131 RN. En este caso se encontró correlación positiva entre ambos métodos de 0,590. Conclusión: La bilirrubina transcutánea puede utilizarse en forma rápida, segura y válida, como un test de screening para la detección de hiperbilirrubinemia y podría evitar una proporción importante de toma de muestras sanguíneas, mejorando la seguridad del paciente. ABSTRACT Introduction: The guidelines for prevention and treatment of neonatal hyperbilirubinemia recommend measurement of total serum bilirubin (BST) or transcutaneous bilirubin (BTc) to determine the degree of jaundice before discharge of the newborn (NB); the latter non-invasive method provides instant information which is superior to the clinical evaluation. Despite this, it has not yet been systematically applied in hospitals in Paraguay. Objective: to evaluate transcutaneous measurement of bilirubin concentration as compared to serum bilirubin levels prior to discharge in our setting. Materials and Methods: This was an observational, cross-sectional, descriptive study with an analytical component. For a period of one year, we tracked NBs with a gestational age ≥ 35 weeks, weighing ≥ 2000 grams, from 24 hours of life until 8 days of life, obtaining the informed consent of the parents. The data was entered in a Microsoft Excel spreadsheet and processed by the IBM SPSS Statistics ® software. Results: Of 271 NBs who entered the study, 90 (33.2%) met criteria for measurement of serum bilirubin at their first measurement with the transcutaneous bilirubinometer. In the remaining 181 RN (66.8%), the paired data were not available as measurement of serum bilirubin was not required per the recommendations of current guidelines. The correlation coefficient value for the first measurement was r = 0.574. For the second measurement, paired measurements were available for 131 NBs. In this case, a positive correlation was found between both methods of 0.590. Conclusion: Transcutaneous bilirubin can be used quickly, safely and accurately as a screening test for the detection of hyperbilirubinemia and could avoid a significant proportion of blood sampling, improving patient safety.

To evaluate the effects of massage therapy on total serum bilirubin (TSB) levels and frequency of defecation, urination, and feeding in newborns who receive phototherapy for indirect hyperbilirubinemia.A randomized controlled clinical trial.Ankara University Cebeci Research and Training Hospital and 29 May State Hospital in Ankara, Turkey.Fifty full-term newborns with indirect hyperbilirubinemia who underwent phototherapy.The newborns were randomly allocated to an intervention group (n = 25) or a control group (n = 25). Newborns in the intervention group received massage therapy throughout the duration of phototherapy for 15 minutes twice per day; newborns in the control group received routine care during phototherapy. Every 24 hours, TSB levels were measured, and the frequencies of defecation, urination, and feeding were also calculated for each newborn.We found no differences in the characteristics of the newborns or in TSB levels between groups at enrollment. After treatment, TSB levels were lower in the intervention group (p .001). Frequencies of defecation, urination, and feeding were significantly greater in the intervention group than in the control group.Massage therapy had significant effects on TSB levels, feeding, breastfeeding, defecation, and urination in newborns who received phototherapy for indirect hyperbilirubinemia. Massage therapy can be added as routine care for full-term newborns with hyperbilirubinemia under phototherapy and may be an effective supplementary intervention.

Background: A common procedure for the diagnosis of hyperbilirubinemia is the total investigation of total serum bilirubin (TSB); however, this procedure is invasive for neonates. For two decades, transcutaneous bilirubin (TCB) was used as a non-invasive and painless method to assess bilirubin. Objectives: This study aimed to compare the accuracy of TCB versus TSB before and after phototherapy. Methods: This descriptive-analytical study included 85 neonates. Neonates were selected by convenience sampling methods. Neonates had a normal birth weight and physiological jaundice; having no need for blood transfusions. Data were collected using a BiliChek device (APEL, Japan). The researcher, before phototherapy and simultaneously by checking the TSB, pressed the BiliChek three consecutive times in the middle of the neonate’s forehead and then, recorded the results. The correlation between TCB and TSB were determined before and after phototherapy. Pearson, t-test, and ROC were used by SPSS v.18 for analysis data. Results: There was a strong correlation between the TCB and the TSB in neonates weighing 3001 to 4000g before phototherapy (r = 0.74, P 0.05), the cut-off value of bilirubin was 6 - 8 mg/dL. The sensitivity was (100%) and specificity was 90% for bilirubin at the levels of 6.7 mg/dL. Conclusions: TCB procedure can be a reliable alternative to the TSB, especially in the initiation of phototherapy with bilirubin levels of 6 - 8 mg/dL. However, it is not a device with a high accuracy after phototherapy.

Objective To characterize home phototherapy treatment for neonatal hyperbilirubinemia and assess the risk factors associated with the need for hospital admission during or after home phototherapy. Study design This was a retrospective study of newborn infants born at ≥35 weeks of gestation who underwent comprehensive home phototherapy (that included daily in-home lactation support and blood draws) over an 18-month period. We excluded infants who lacked a recorded birth date or time, started treatment at age >14 days, or had a conjugated serum bilirubin level of ≥2 mg/dL (≥34.2 μmol/L). The primary study outcome was any hospital admission during or within 24 hours after completion of home phototherapy. Logistic regression was used to identify risk factors for hospitalization. Results Of the cohort of 1385 infants, 1324 met the inclusion criteria. At the time home phototherapy was initiated, 376 infants (28%) were at or above the American Academy of Pediatrics phototherapy threshold. Twenty-five infants required hospitalization (1.9%; 95% CI, 1.3%-2.8%). Hospital admission was associated with a younger age at phototherapy initiation (OR, 0.63 for each day older in age; 95% CI, 0.44-0.91) and a higher total serum bilirubin level relative to the treatment threshold at phototherapy initiation (OR, 1.71 for each 1 mg/dL above the treatment threshold; 95% CI, 1.40-2.08). Conclusions Comprehensive home phototherapy successfully treated hyperbilirubinemia in the vast majority of the infants in this cohort.

OBJECTIVES: To evaluate medial olivocochlear efferent system of babies with hyperbilirubinemia with normal auditory brain stem responses. MATERIALS AND METHODS: This was a prospective study in a tertiary referral hospital. The study involved 40 hyperbilirubinemic and 44 healthy newborns. Cochlear and auditory activity of participants was evaluated by transient otoacoustic emissions (TOAEs) and brainstem auditory evoked response components (BAER). Medial olivocochlear (MOC) reflex was evoked with contralateral acoustic stimulation and recorded with TOAEs. RESULTS: A comparison of the MOC reflex activity between two groups with Mann Whitney U test revealed that MOC reflex activity were significantly decreased in the hyberbilirubinemic group for both ears (p

Jaundice is a major cause of mortality and morbidity in the newborn. Globally, early identification and home monitoring are significant challenges in reducing the incidence of jaundice-related neurological damage. Smartphone cameras are promising as colour-based screening tools as they are low-cost, objective and ubiquitous. We propose a novel smartphone method and app called neoSCB to screen for neonatal jaundice by imaging the sclera. It does not rely on colour calibration cards or accessories, which may facilitate its adoption at scale and in less economically developed regions. Our approach is to explicitly address three confounding factors in relating colour to jaundice: (1) skin pigmentation, (2) ambient light, and (3) camera spectral response. (1) The variation in skin pigmentation is avoided by imaging the sclera. (2) With the smartphone screen acting as an illuminating flash, a flash/ no-flash image pair is captured using the front-facing camera. The contribution of ambient light is subtracted. (3) This permits a device-and ambient-independent measure of sclera chromaticity following a one-time calibration. We introduce the concept of Scleral-Conjunctival Bilirubin (SCB), in analogy with Transcutaneous Bilirubin (TcB). The scleral chromaticity is mapped to an SCB value. A pilot study was conducted in the UCL Hospital Neonatal Care Unit. 51 neonates were imaged using the neoSCB app and had a blood test for total serum bilirubin (TSB). The better of two models for SCB based on ambient-subtracted sclera chromaticity achieved r = 0.75 (p250μmol/L (area under receiver operating characteristic curve, AUROC, 0.86), and 92% (specificity 67%) in identifying newborns with TSB>205μmol/L (AUROC 0.85). These results are comparable to modern transcutaneous bilirubinometers.

Background: Phototherapy with radiation of 460–490 nm wavelengths provides the most potent therapeutic effect for neonatal jaundice. However, the efficacy of phototherapy has been estimated using single-wavelength detectors with sensitivity at approximately 460 nm. Cyclobilirubin formation capacity (CFC), which comprises the sum of the irradiance values from three wavelengths multiplied by their specific coefficients, has been proposed as an alternative marker to evaluate the efficacy of phototherapy. This study aimed to test whether two types of phototherapy devices with distinct spectral characteristics provide similar therapeutic effects on adjustment of device-to-patient distances to deliver similar CFCs. Methods: Using a three-wavelength spectroradiometer, CFCs and footprints of the light-emitting diode and fluorescent tube devices were assessed. Having determined the device-specific distances that ensured similar CFCs, 32 newborn infants, requiring phototherapy for hyperbilirubinemia, were randomized into the light-emitting diode and fluorescent tube groups. The total serum bilirubin levels before and after phototherapy were assessed. Results: The light-emitting diode and fluorescent tube devices had comparable CFCs at distances of 60 and 50 cm, respectively. Phototherapy reduced the total serum bilirubin levels from 18.1 to 14.6 mg/dL and from 19.1 to 15.1 mg/dL in the light-emitting diode and fluorescent tube groups, respectively. The two groups did not differ significantly with respect to the patients' clinical backgrounds, serum bilirubin levels, or changes before and after phototherapy. Conclusion: At similar CFCs, the two phototherapy devices reduced the total serum bilirubin levels by comparable amounts. Hence, determining CFCs may help predict phototherapy efficacy. This may ensure better safety and greater efficacy of the treatment for newborn infants. Key Words: bilirubin, cyclobilirubin, irradiance, light-emitting diode, spectroradiometer

Introduction Both benign and malignant diseases of common bile ducts (CBD) become the reason of obstruction. The aim of the study was to determine the optimal duration of percutaneous transhepatic cholangiodrainage (PTCD) depending on the duration of obstructive jaundice (OJ) and the initial level of total serum bilirubin. Methods The experience of using PTCD in 88 patients with diseases of CBD complicated by OJ for the period 2011-2017 were divided into three groups: the first (1) - 15 (17.1%) patients with benign diseases of CBD, the second (2) - 11 (12.5%) patients with resectable cholangiocarcinomas, and the third (3) - 62, 4%) patients with unresectable cholangiocarcinomas. Causes of OJ: choledocholithiasis in 6 (6.8%), strictures of CBD in 2 (2.3%) and cholangiocarcinomas of different localization in 73 (82.9%) patients. The optimal timing of biliary decompression was determined by PTCD, the Poisson process (poisson) was used, and more precisely as the quasipoisson distribution (quasipoisson), which reflects the process of reducing total serum bilirubin. Results It was determined that the fastest decrease in total bilirubin occurs in patients of group 3, enough 7-8 days to reduce total bilirubin to 50 μmol/L. In patients of group 1, the duration of biliary decompression is 10-12 days. For patients in group 2, biliary decompression requires at least 12. Conclusions Using the Poisson process (poisson), or more precisely the quasi-Poisson distribution (quasipoisson), it was possible to determine the optimal duration of biliary decompression by PTCD depending on the duration of OJ and the initial level of total serum bilirubin.

Background: For determining hyperbilirubinemia in a neonate, clinical evaluation, serum bilirubin estimation and trans cutaneous bilirubin estimation are the modalities available. Transcutaneous bilirubinometry (TcB) is routinely used to monitor jaundice in term and near-term infants. Literature shows a positive correlation observed between TcB and total serum bilirubin (TSB). The present study was conducted determine the correlation of TcB with TSB in neonates with hyperbilirubinemia admitted at a tertiary care hospital, ChennaiMethods: A cross sectional study was conducted at a tertiary care hospital, Chennai where 350 neonates who have clinical jaundice and require estimation of serum bilirubin who are admitted to the tertiary care centre, Chennai during December 2020-March 2021 were included in the study. The ROCHE INTEGRA-e 411+ autoanalyzer was used to estimate TSB (mg/dl) using a modified diazo method. The Jaundice Meter JM-103 to measure TcB, (Manufactured by Draeger medical systems, Germany). Pearson corelation coefficient was used to find the correlation between the two variables. P

Background: In some hospitals in low/middle-income countries, methods to determine the bilirubin level in newborn infants are unavailable and based on a clinical evaluation, namely a clinical score designed by Kramer. In this study, we evaluated if this score can be used to identify those infants that need phototherapy. Method: Infants admitted between November 2018 and June 2019 to three hospitals in Surabaya, Indonesia were included. The jaundice intensity was scored using the Kramer score. Blood was sampled for total serum bilirubin (TSB) measurement. The infants were categorized into Treatment Needed (TN) group when treatment with phototherapy was indicated and the No Treatment Needed (NTN) group when phototherapy was not indicated, based on the Indonesian Guideline for hyperbilirubinemia. Result: A total of 280 infants with a mean birth weight of 2744.6 ± 685.8 g and a gestational age of 37.3 ± 2.3 weeks were included. Twenty-seven of 113 (24%) infants with Kramer score 2 needed phototherapy, compared with 41 of 90 (46%) infants with score 3 and 20 of 28 (71%) of infants with score 4. The percentage of infants that needed phototherapy was higher with decreasing gestational age. Conclusion: The Kramer score is an invalid method to distinguish between those infants needing phototherapy and those infants where this treatment is not indicated.

Introduction and importance Increased total serum bilirubin rarely reported in mild COVID-19 patients. It occurs mostly in severe cases, particularly in those who have liver diseases and admitted to an intensive care unit. The main cause of increased liver biochemistries in Covid-19 patients related to used drugs, the presence of the ACE2 receptor in the liver, and robust inflammatory response. However, limited studies available regarding to jaundice in COVID19 patients. Case presentation Here we present a case of hyperbilirubinemia in a mild asymptomatic COVID-19 patient, the patient was diagnosed by RT-PCR three days prior to presentation fever, dark urine, and of acute onset of jaundice. The patient was diagnosed by physical examination and laboratory findings, and treated successfully by high-quality natural honey. Clinical discussion A recent studies of COVID-19 increased total serum bilirubin have been reported, mostly after the appearance of the COVID-19 symptoms. The case in the current study was a 48-year-old male patient who was diagnosed with mild COVID-19 three days prior to presentation. After 2 days increased total serum bilirubin. Conclusion Honey is a natural medicine to treat Jaundice in mild COVID-19 patients. However, significant data on larger studies are still lacking to decide. Our case guides for the clinical treatment of conjunctival icterus in mild COVID-19 patients.

Hyperbilirubinemia in the newborn occurs more frequently in Indonesia. Therefore, it is important that pediatric residents in Indonesia acquire adequate knowledge of hyperbilirubinemia management. This study aims to determine the pediatric residents' knowledge on hyperbilirubinemia management, whether they follow recommended guidelines, and whether differences exist between five large Indonesian teaching hospitals. We handed out a 25-question questionnaire on hyperbilirubinemia management to pediatric residents at five teaching hospitals. A total of 250 questionnaires were filled in completely, ranging from 14 to 113 respondents per hospital. Approximately 76% of the respondents used the Kramer score to recognize neonatal jaundice. Twenty-four percent correctly plotted the total serum bilirubin levels (TSB) on the phototherapy (PT) nomograms provided by the American Academy of Pediatrics (AAP) and the National Institute for Health and Care Excellence (NICE) for full-term and nearly full-term infants. Regarding preterm infants, Hyperbilirubinemia, newborn infants, knowledge, residents, guidelines.

Background The gold standard for diagnosis of neonatal jaundice is total serum bilirubin (TSB) measurement. This method, however, is invasive, painful, and costly in terms of workload, time, and money. Moreover, repeated blood sampling may lead to significant blood loss, which is of particular concern in preterm infants. To overcome these drawbacks, non-invasive methods of bilirubin measurement have been proposed. Transcutaneous bilirubinometry (TcB) determines the yellowness of the subcutaneous tissue of a newborn infant by measuring the difference between optical densities for light in the blue and green wavelength regions.Objective To evaluate the accuracy of transcutaneous bilirubinometry for estimating TSB levels in neonatal jaundice.Methods Subjects were infants aged < 28 days with jaundice who had never been treated with phototherapy or exchange transfusion. The study was done from February to July 2016 in Mohammad Hoesin Hospital. Subjects underwent transcutaneous bilirubin (TcB) and TSB assays, with a maximum interval of 15 minutes between tests.Results One hundred fifty patients were included in this study. The TcB values > 5 mg/dL were correlated to TSB > 5 mg/dL, with 100% sensitivity and 83.3% specificity. This cut-off point was obtained from a receiver-operator characteristic (ROC) curve with AUC 99.3% (95%CI 97.9 to 100%; P< 0.001).The correlation coefficients (r) for TSB and TcB measurements on the forehead were 0.897 (P

Background: Routine and timely determination of total serum bilirubin (TSB) remains a challenge in many resource-limited countries with substantial burden of severe neonatal hyperbilirubinemia. Limited evidence exists on the potential usefulness of transcutaneous bilirubin (TcB) to identify infants who may require phototherapy based on possible treatment criteria in such settings. Objective: To compare the number of infants requiring phototherapy across different TSB criteria and determine the predictive performance of TcB under each criterion. Methods: Infants with paired TcB and TSB measurements in a maternity hospital in Lagos, Nigeria, were assessed for phototherapy based on TSB criteria by the American Academy of Pediatrics (AAP), National Institute for Health and Clinical Excellence (NICE) UK, and World Health Organization (WHO), and an absolute threshold of ≥12 mg/dL. The predictive performance of TcB across treatment criteria was evaluated with receiver operating curve analysis. Results: A total of 1,011 infants with a mean TcB of 10.54 ± 3.19 (range: 2.7-19.9) mg/dL and TSB of 9.63 ± 2.61 (range: 0.3-19.5) mg/dL were assessed. Some 60 (5.9%) infants required phototherapy by 1 or more TSB criteria, with TSB ≥12 mg/dL identifying 55 (91.7%) and AAP 27 (45%) of these infants. All infants identified by the NICE and WHO criteria were equally detected by the AAP criterion. TcB showed negative predictive values of 99.0-99.9%, and positive predictive values of 7.7-15.5% across all criteria. Conclusions: The number of infants requiring phototherapy varies significantly across treatment criteria. TcB may be useful in identifying infants who do not require phototherapy, but may also identify a high proportion of false positives that is burdensome in resource-limited settings.

Objective An elevated total serum bilirubin level has been demonstrated to be protective against cardiovascular disease with the majority of evidence limited to males. We assessed the hypothesis th...

Background: Universal pre-discharge assessment of risk for neonatal hyperbilirubinaemia is recommended by the American Academy of Pediatrics. A common algorithm is universal transcutaneous bilirubin (TcB) screening, followed by confirmatory total serum bilirubin (TSB) testing for results which cause concern. There is a paucity of data on the feasibility of TcB screening in low-income settings.Objectives: To evaluate the acceptability and feasibility of implementing universal TcB screening at a resource-limited hospital in rural India, and to determine if it was associated with increased recognition of high-risk hyperbilirubinaemia.Methods: In December 2012 at Vivekananda Memorial Hospital, Karnataka, India, universal TcB screening at 24–48 hours of life was implemented, with TSB estimated if TcB was >75th percentile for age. The proportion of families that provided consent and the proportion of infants who underwent TcB and TSB testing were calculated. The rates of phototherapy pre- and post-implementatio...

The study was conducted on Full term neonates with birth weight > 2.5 kg born in KIMS, Hubballi with an objective to determine the first day Total Serum Bilirubin (TSB) value so as to predict subsequent development of significant hyperbilirubinemia in term neonates. All enrolled neonates were sampled for TSB and blood group on Day 1 at 20 ± 4 h and then followed up clinically by Kramer’s rule and when the clinical jaundice by Kramer’s rule was >10 mg/dl, TSB levels were repeated. A total of 180 newborns were enrolled for the study and 165 babies completed the study. Out of these, 17(10.3%) babies had significant hyperbilirubinemia by day 5 of life. Using Receiver Operating Characteristic (ROC) Curve, a cut off TSB value of 6.15 mg/dl was determined with sensitivity of 82.4%, specificity of 81.8%, positive predictive value of 32.8%, negative predictive value 97.6%. In term neonates, the first day total bilirubin level at 20 ± 4 h of life

Objective The aim was to compare between total bilirubin levels measured via blood vs skin in neonates. Background Neonatal jaundice is a common clinical problem. total serum bilirubin (TSB) with transcutaneous bilirubin (TCB) measurement can be used for evaluating bilirubin levels in neonates. Patients and methods This cross-sectional study was conducted on 200 jaundiced neonates with indirect hyperbilirubinemia, in the neonatal intensive care unit of Menoufia University Hospital, and they were randomly divided into three groups: group 1 (n = 100) included full-term neonates with gestational age ranged from 37 to 42 weeks; group 2 (n = 35) included late preterm neonates with gestational age ranged from 34 to 36 weeks; and group 3 (n = 65) included early preterm neonates with gestational age ranged from 30 to 33 weeks. Complete blood count with reticulocyte count was obtained along with TSB, Rhesus factor, and ABO blood groups for both mothers and neonates. Results There was a strong positive significant correlation between TSB and TCB, but the correlation decreased as both levels advanced [Pearson correlation (r)=0.983]. The correlation was better in full tem with TSB-TCB difference of 1.88 ± 0.39 in comparison with late and early preterm, which was 2.27 ± 1.99 and 2.55 ± 0.64, respectively. There was a strong positive correlation between TSB and TCB regarding weight, gestational age, and postnatal ages, with Pearson correlation of 0.08, 0.404, and 0.505, respectively, for TSB and 0.477, 0.489, and 0.558, respectively, for TCB. TSB always overestimates TCB. Conclusion TCB is a reliable method in screening of neonatal jaundice in full-term babies, reducing the need for TSB, which is expensive and invasive. Reliability is lesser for the preterm.

Purpose: The aim of this work was to study Kayser-Fleischer [KF]-like rings in patients with hepatic or cholestatic liver disease and to find out the relation between serum bilirubin level and the presence of KF like ring in these patients. Methods: In this study, we evaluated patients with hepatic and cholestatic liver diseases with total Serum bilirubin levels >10 mg/dl. These patients were evaluated for the presence or absence of KF like ring. Results: A total of 67 patients with total bilirubin >10 mg/dl were included in the study. Patients were divided into 3 groups based on total S. bilirubin level: Group 1 with S. bilirubin >30 mg/dl, Group 2 with S. bilirubin >20 - 10 - 20 mg/dl, Group 2- >10

Background Transcutaneous (TcB) meters support clinical decision making at point-of-care, reduces nurses’ time to screen, decreases the frequency of painful blood draws and minimizes health care costs. Best practice for TcB screening is unknown and international guidelines vary. Meter bias may result in over- or underestimation of TSB in a Canadian population. The Canadian Paediatric Society suggests screening between 24 and by 72 hours of age and reducing total serum bilirubin (TSB) action thresholds by the 95th confidence interval of the meter. To support point-of-care decision making, a tertiary center and community follow-up program uses universal screening and follow-up protocols. ​ Objectives The aim of this analysis is to develop a locally validated TcB nomogram with action thresholds based on age and risk for clinical use at point-of-care. ​ Design/Methods This prospective cross-sectional study includes newborns ≥35 weeks gestation Results The study population includes 498 newborns that received 620 visits and 705 meter readings with thirteen JM-105 with mean birth weight 3.38 kilograms (SD=0.51) with thirteen JM-105. Along with the clinical screening protocol, nomograms for newborns 35-37 weeks gestation (high and medium risk thresholds) and 38+ weeks gestation medium and low risk thresholds) are presented. Newborns with TcB that plots in a potential treatment range will receive a TSB to determine if intensive phototherapy is required. Conclusion To support point-of-care decision making, a tertiary center and community follow-up program uses universal screening and follow-up protocols. TcB nomograms with action thresholds based on age and risk support point-of-care decision making.

ObjectiveTo examine the accuracy of transcutaneous bilirubinometry (TCB) measurements during and after phototherapy (PT) in preterm infants.DesignProspective observational cohort study.SettingLevel III neonatal centre.PatientsPreterm infants (from 23+0 to 36+6 weeks of gestation) born between June 2017 and May 2018 requiring PT.InterventionsTCB was measured from an exposed area of the skin (the sternum; TCBU) and the covered area of the skin under the nappy (the bony part of the upper outer quadrant of the buttock; TCBC) within an hour of obtaining total serum bilirubin (TSB).Main outcome measuresCorrelation and agreement between TCB (TCBU and TCBC) and TSB during and after PT.ResultsWe have enrolled 196 preterm infants. There was a significant correlation between TSB and TCB during PT (r=0.72, 95% CI 0.66 to 0.77 in covered area; r=0.75, 95% CI 0.70 to 0.80 in uncovered area) and after PT (r=0.87, 95% CI 0.83 to 0.91). TCB underestimated TSB level during PT, with a mean TCBC–TSB difference of −25±43 (95% agreement limits of 62 to −112) and a mean TCBU–TSB difference of −48±46 (95% agreement limits of 45 to −140). The agreement between TCB and TSB after cessation of PT improved, with TCB underestimating TSB by a mean TCB–TSB difference of −10±31 (95% agreement limits of 52 to −72).ConclusionTCB measurements correlated strongly with TSB levels during and after PT. However, there was a wide and clinically relevant disagreement between TCB and TSB measurements during the PT phase, improving significantly after PT.

Background: Neurologic dysfunctions, specifically hearing impairments due to hyperbilirubinemia are ranked among the main concerns in medicine. Objectives: This study evaluates the prevalence of acute auditory neuropathy (AN) disorders in term neonates with mild to moderate hyperbilirubinemia and low bilirubin-induced neurological dysfunction (BIND) score and the roll of early treatment on reducing their incidence. Methods: Fifty one term jaundice neonates with normal newborn exam and total serum bilirubin (TSB) ≥ 15 mg/dL after the third day of birth with normal otoacoustic emission (OAE) test were enrolled. The BIND score assessment for severity of neurologic dysfunction was done. Neonates with low BIND score were divided into two groups based on their TSB levels at the time of admission (15 - 18 mg/dL: Mild-moderate hyperbilirubinemia and ≥ 19 mg/dL: Severe hyperbilirubinemia). ABR was performed within the first 12 hours of their admission and the second ABR was performed before discharge. Results: The 30.60% of neonates with TSB < 19 mg/dl had abnormal ABR. Latency of V, III waves and interpeak interval latency of I-III, I-V waves were detected. Mean latency of wave V and I-V interpeak latency after phototherapy were significantly decreased compared to pre-treatment (P < 0.001). Conclusions: With the prevalence of auditory neuropathy (AN) at lower TSB concentrations (that have traditionally been considered safe) it can be concluded that more attention should be given to this group despite the absence of neurologic signs, and it also shows the sensitivity of early phototherapy to lower bilirubin level.

Background Severe neonatal jaundice (SNJ) and associated long term health sequelae are a significant problem in low income countries (LIC) where measurement of total serum bilirubin (TSB) is often unavailable. Transcutaneous bilirubinometry (TcB) provides opportunity for non-invasive, point-of-care monitoring. Few studies have evaluated its agreement with TSB levels during phototherapy in LICs. Aim To determine agreement between TcB and TSB during phototherapy in a Haiti newborn population, and to establish if TcB can be safely used to guide treatment during photother-apy when TSB is unavailable. Methods A single centre prospective study (February-May 2017) in Cap Haïtien, northern Haiti was conducted. Newborns with clinically detected jaundice, 250 µmol/L), TcB tended to underestimate bilirubin in comparison to TSB and the magnitude of the differ-ence increased. Conclusion In a LIC setting where serum bilirubin testing is not commonly available, TcB demon-strates good agreement with TSB and can be safely used to guide jaundice treatment dur-ing phototherapy but may lead to overtreatment at lower bilirubin levels and are more in-accurate at higher levels. For TcB levels >250µmol, confirmation with serum bilirubin should be performed if available to avoid underestimation.

Background: Neonatal jaundice resulting from raised blood bilirubin levels is one of the most common clinical conditions that needs medical attention. To initiate appropriate management that can both prevent and treat severe neonatal jaundice, screening methods that measure bilirubin level are warranted. Methods: In this study, we present an Android OS-based application for detecting neonatal jaundice. We used the application to detect jaundice in 113 neonates. Our smartphone-based estimation of bilirubin levels depends on a smartphone, a color calibration card, and a 100X zoom microscope clip. Our application was designed to acquire images of the newborn’s forehead skin in a standardized manner, estimate the average R, G, B scores of the images that have been taken from the forehead skin and calibration card, and then convert them to hue, saturation, intensity (HSI) parameters. All these are performed offline; in this application, we used offline machine learning and regression techniques for analysis Results: Our smartphone-based estimation of bilirubin levels had a sensitivity of 68% and specificity of 92.3% for estimating the bilirubin levels of less than 10 mg/dL and sensitivity of 82.1% and specificity of 100% for estimating the bilirubin levels of less than 15 mg/dL. Our application-based estimation of bilirubin levels had the correlation of 0.479 with the total serum bilirubin values. Conclusions: Our results suggest that our smartphone-based application can serve as a promising screening tool for neonatal jaundice, and it can aid in determining neonates requiring a blood draw for measuring total serum bilirubin level.