智能手机软件拍照监测新生儿及早期婴儿黄疸的应用研究

Neonatal and early infantile jaundice： assessment by the use of the smartphone

目的探讨智能手机软件自动拍照检测胆红素值（automated image-based bilirubin，AIB）在新生儿及早期婴儿黄疸监测中的应用价值。方法选择2016年11月至2017年9月本院新生儿科收治或门诊就诊的黄疸新生儿（胎龄≥35周）及早期婴儿（日龄≤60 d）进行前瞻性研究。患儿在入院、光疗前、停止光疗后0 h、停止光疗后12～24 h时及门诊拟诊母乳性黄疸时查血清总胆红素（total serum bilirubin，TSB），并同时检测前胸部位经皮胆红素（transcutaneous bilirubin，TcB）和AIB。AIB检测采用＂哪吒保贝-新生儿黄疸移动监护＂智能手机应用软件。应用SPSS 20.0统计软件，采用非劣性检验、相关分析、方差分析、一致性分析及t检验进行分析。结果共纳入194例296组数据。全部数据AIB的准确性不劣于TcB（｜AIB－TSB｜与｜TcB－TSB｜差值的均值为0.77 mg/dl，95%CI为0.63～0.91 mg/dl）。男婴、女婴、足月儿、检测日龄〉2 d、TSB≤20 mg/dl等亚组的分析结果与总体结果相似，TSB〉20 mg/dl亚组AIB的准确性明显逊于TcB。全部数据AIB与TSB有较好的相关性（r＝0.824）和一致性（96.5%的样本落在95%一致性区间内）。10 mg/dl〈TSB≤20 mg/dl亚组AIB与TSB的相关性、一致性明显优于TSB≤10 mg/dl亚组及〉20 mg/dl亚组，且97.5%的新生儿TSB不超过AIB＋3.80 mg/dl。结论当患儿10 mg/dl〈TSB≤20 mg/dl时，AIB的准确性不劣于TcB，与TSB的相关性及一致性较好。＂哪吒保贝-新生儿黄疸移动监护＂手机软件适合家中动态监测新生儿及早期婴儿中度黄疸。

ObjectiveTo assess the accuracy of automated image-based bilirubin （AIB） of newborns or early infants obtained using a smartphone application called BiliScan for Newborn Jaundice.MethodJaundiced neonates （gestational age≥35 weeks） and early infants （postnatal age≤60 days） from out-patient or in-patient of our hospital during November 2016 to September 2017 were prospectively included. The total serum bilirubin （TSB）, transcutaneous bilirubin （TcB） and AIB on chest were completed simultaneously on hospitalization, pre phototherapy, 0 h and 12~24 h after cessation of phototherapy for in-patients, and after diagnosis of breast-feeding jaundice for out-patients participants. The AIB were all detected by smartphone with an application of BiliScan for Newborn Jaundice. Statistical analysis was performed by SPSS 20.0.ResultA total of 296 sets of data were enrolled from 194 neonates or infants in this study. The accuracy of AIB was not inferior to the TcB （The difference between the mean of the absolute value of AIB-TSB and the absolute value of TcB-TSB was 0.77 mg/dl, 95% confidence interval were 0.63~0.91 mg/dl）. These results of the subgroups from male and female term infants, postnatal age〉2 days and the value of TSB≤20 mg/dl were similar to the overall results. However, in the subgroup of TSB〉20 mg/dl, the accuracy of AIB was lower than that of TcB compared to TSB. There were good correlation （r=0.824） and consistency （96.5% samples lay within the 95% limits of agreement） between AIB and TSB. In the subgroup of 10 mg/dl〈TSB≤20 mg/dl, the correlation and consistency between AIB and TSB were better than those of the subgroups of TSB≤10 mg/dl and TSB〉20 mg/dl. Furthermore, TSBs of 97.5% neonates were not beyond AIB plus 3.80 mg/dl.ConclusionWhen 10 mg/dl〈TSB≤20 mg/dl, the accuracy of AIB was not inferor to TcB, and the correlation and consistency between AIB and TSB were relatively superior. The application BiliScan for Newborn Jaundice was suitable for dynamic monitoring moderate jaundice of neonates and early infants at home.