Abstract: Objective To evaluate the clinical application value of image-based bilirubin (IBB) detection of neonatal jaundice by smartphones. Methods The neonates with jaundice and birth weight > 2 500 g and without phototherapy were selected from the Neonatology Department of Suining County People's Hospital from December 2019 to April 2020.The total serum bilirubin (TSB), transcutaneous bilirubin (TcB) and IBB of infants were tested simultaneously.TSB and IBB were re-tested at the end of phototherapy and in 24 hours.The glabella of forehead was selected as detection sites of TcB and IBB.Sex, age, gestational age, birth weight, TSB and the mean value of three consecutive tests of TcB and IBB were recorded.The t test, paired t test, Pearson's correlation analysis and Bland-Altman plots consistency analysis were used. Results A total of 86 neonates were enrolled, including 46 males and 40 females.The median age was 7 days, the gestational age was (37.7±1.2) weeks, the birth weight was (3 197±396) g, and 57 cases were treated with blue light.Compared with TSB, the accuracy of IBB was similar to that of TcB [(0.32±1.11) mg/dl vs.(0.19±1.08) mg/dl, t=0.740, P=0.461].The accuracy of IBB and TcB in the subgroup with age ≤ 2 days was worse than that in the subgroup with age ＞ 2 days (t=-4.258,-3.617, P＜0.05).There was a good correlation (r=0.973) and a strong consistency (95.3% of the samples fell within the 95% consistency interval) between IBB and TSB.The accuracy of IBB at 0 hour after phototherapy was significantly inferior to that of IBB at 24 hours after phototherapy (t=-6.311, P＜0.001), and there is a moderate correlation (r=0.750) and poor consistency (only 91.2% of the samples fall within the 95% consistency interval) between IBB and TSB.At 24 hours after phototherapy, the correlation between IBB and TSB was still moderate (r=0.724), and the consistency improved (94.7% of the samples fell within the 95% consistency interval) between IBB and TSB. Conclusions The accuracy of IBB is similar to that of TcB, and there is a good correlation and a strong consistency between IBB and TcB.IBB is suitable for newborns with birth weight >2 500 g.It is a simple, quick and relatively accurate way to monitor neonatal jaundice dynamically at home after the mother is discharged from the hospital 2-3 days after delivery.

Key words: jaundice, neonates, image-based bilirubin, transcutaneous bilirubin, total serum bilirubin

摘要： 目的 评价智能手机基于图像胆红素值(IBB)检测新生儿黄疸的临床应用价值。 方法 选取2019年12月-2020年4月睢宁县人民医院新生儿科收治的出生体重>2 500 g且未经蓝光治疗的黄疸新生儿,同时检测血清总胆红素值(TSB)、经皮胆红素值(TcB)和IBB。部分患儿蓝光治疗结束时及结束后24 h复查TSB和IBB。TcB和IBB检测部位均选取额部眉间。记录性别、日龄、胎龄、出生体重、TSB、3次TcB和IBB均值。采用t检验、配对t检验、积矩相关性分析和Bland-Altman图一致性分析。 结果 共纳入86例新生儿,其中男46例、女40例。日龄中位数7 d,胎龄(37.7±1.2)周,出生体重(3 197±396) g,蓝光治疗57例。与TSB相比,IBB的准确性与TcB相似[(0.32±1.11) mg/dl vs.(0.19±1.08) mg/dl,t=0.740,P=0.461)]。日龄≤ 2 d亚组IBB和TcB的准确性均差于日龄> 2 d亚组(t=-4.258、-3.617,P<0.05)。IBB和TSB有较好的相关性(r=0.973)和较强的一致性(95.3%的样本落在95%的一致性区间内)。光疗后0 h IBB的准确性明显劣于光疗后24 h IBB的准确性(t=-6.311,P<0.001),IBB和TSB的相关性一般(r=0.750),一致性欠佳(仅有91.2 %的样本落在95%的一致性区间内)。在光疗后24 h,IBB和TSB的相关性仍一般(r=0.724),一致性好转(有94.7%的样本落在95%的一致性区间内)。 结论 IBB的准确性与TcB相似,和TSB有较好的相关性和较强的一致性。IBB适用于出生体重>2 500 g的新生儿,出生2~3 d随母亲出院后,在家中简便快捷、相对准确地动态监测新生儿黄疸。

关键词: 黄疸, 新生儿, 基于图像胆红素值, 经皮胆红素值, 血清总胆红素值