Neonatal Wearable Device Monitors Jaundice in Real Time

(Reuters Health) – Japanese researchers have developed a small, light, wearable device to measure jaundice and other vital signs in newborns, according to a new report.

More than 80% of neonates develop jaundice, but continuous monitoring systems – which could be especially useful when delivering phototherapy treatment – don’t exist, the authors write in Science Advances.

“In this study, we were able to measure jaundice continuously and non-invasively, and found the possibility of providing a better neonatal care system for medical professionals, newborns and parents,” said study coauthor Hiroki Ota, an associate professor at the Graduate School of Engineering Science at Yokohama National University.

“In addition, our device will be easily connected with phototherapy equipment that realizes the optimization of the therapeutic strategy and semi-automated treatment process,” Ota said in an email. “This leads to the prevention of side-effects (caused) by excessive and insufficient phototherapy and diminishing burden (on) neonates and medical staff. Eventually, it has potential to change the therapeutic management of neonatal jaundice.”

Neonatal jaundice usually has a good prognosis, Ota and his colleagues note in their report. “However, in severe cases, it can cause permanent neurological damage.”

Fetuses tend to have high levels of hemoglobin, which, after birth, is broken down into bilirubin. That bilirubin deposits in the skin leading to the jaundiced appearance, the authors explain. If the bilirubin levels don’t come down sufficiently, neurological damage can result.

“Abnormal hyperbilirubinemia would cause deposition of bilirubin in the basal ganglia, thus resulting in kernicterus or bilirubin-induced neurologic dysfunction (BIND),” Ota told Reuters Health. “Kernicterus causes mental retardation, athetotic cerebral palsy, sensorineural deafness, and upper gaze paralysis.”

The jaundice can be easily treated with blue light that breaks the bilirubin down. “Owing to bilirubin monitoring and phototherapy, kernicterus has been notably decreased in many countries,” Ota and his colleagues write. “Meanwhile, many neonates born in developing countries are still affected by kernicterus owing to the lack of access to medical equipment. In 2010, it was estimated that 114,000 children died, and 75,000 children were left with brain damage as a result of neonatal jaundice.”

Neonatal jaundice is one of the leading causes of neonatal death and neonatal brain damage in low- and middle-income countries, the authors note. “Even in developed countries, there is a risk of kernicterus, especially in preterm infants.”

One big problem with the light therapy is that too little, as well as too much, can be harmful to an infant, Ota said, which means bilirubin levels need to be monitored continuously. Currently bilirubin levels are measured either with a blood test or a bulky handheld bilirubinometer.

The new device was developed to help doctors find the right balance non-invasively and continuously, Ota said.

A 3-D printed rubber shell sits atop a flexible board with integrated circuits, a Bluetooth low-energy (BLE) module, LEDs (green, blue, red, and infrared) and photodiodes (PDs). The device calculates bilirubin levels via the ratio of the absorption of blue and green light. It similarly provides heart rate and oxygen saturation based on red and IR light. The device is affixed to the infant’s forehead via a silicone interface.

A test in 50 neonates found that the values generated by the new device were close to those coming from a traditional handheld unit, but the researchers say that some tweaks need to be made to improve the accuracy.

The device described in the new study is “a really interesting concept,” said Dr. Amaris Keiser, an assistant professor of pediatrics in the division of neonatology at the Johns Hopkins School of Medicine, in Baltimore. “It’s well thought out and the authors are aware of its current limitations and where it needs to be refined.”

The possibility of a wearable – which has the advantage of being wireless – device that would be able to continuously monitor babies is “really exciting,” Dr. Keiser said. It also opens up the possibility that babies could be sent home earlier, she added.

If it could reliably produce accurate values continuously, babies could be sent home with instructions to parents to call their pediatrician if the levels become too high or too low, Dr. Keiser said. That would help parents avoid trips to the pediatrician just to measure bilirubin levels, she added.

“Innovation in wearable devices in this patient population is where we are hoping technology will take us,” Dr. Keiser said.

SOURCE: Science Advances, online March 3, 2021.

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