Gabriela Jiménez-Díaz’s research while affiliated with Norwegian University of Science and Technology and other places

Objective To evaluate the performance of Picterus Jaundice Pro (Picterus JP), a mobile health device for neonatal jaundice (NNJ) screening, in Mexican newborns. Methodology A cross-sectional study was conducted from January 2023 to June 2024 at a hospital in a resource-limited setting in Mexico. The main outcomes were Picterus JP measurements and total serum bilirubin (TSB) levels. Results A total of 177 term newborns, aged 1 to 14 days, were enrolled. Picterus JP showed a significant positive Spearman’s rho correlation with TSB (ρ = .68), sensitivity of 85.7% and specificity of 80.1% to detect TSB ≥ 250 using Picterus cut off value of 202 µmol/L. However, it tended to underestimate higher bilirubin levels. Conclusion Picterus JP shows potential to be a useful tool for NNJ screening, particularly in resource-limited areas. Further validation across more diverse populations and clinical environments, alongside accuracy improvements, is necessary to enhance its utility and support wider implementation. Registered in ClinicalTrials.gov (https://clinicaltrials.gov/study/NCT06276582)

Background Neonatal jaundice is a common condition that can lead to brain damage and disabilities when severe cases go undetected. Low- and middle-income countries often lack accurate methods for detecting neonatal jaundice and rely on visual assessment, resulting in a higher incidence of adverse consequences. Picterus Jaundice Pro (Picterus JP), an easy-to-use and affordable smartphone-based screening device for the condition, has demonstrated higher accuracy than visual assessment in Norwegian, Philippine and Mexican newborns. This study aimed to identify the barriers and facilitators to implementing Picterus JP in public health services in low-income settings in Mexico by exploring the current process of neonatal jaundice detection and stakeholders’ perspectives in that context. Methods Qualitative data collection techniques, including one focus group, 15 semi-structured interviews and four observations, were employed in urban and rural health facilities in Oaxaca, Mexico. The participants included medical doctors, nurses and health administrators. The data were analysed by thematic analysis guided by the Consolidated Framework for Implementation Research. Results The analysis yielded four main themes: (I) the current state of neonatal care and NNJ detection, (II) the needs and desires for enhancing NNJ detection, (III) the barriers and facilitators to implementing Picterus JP in the health system and (IV) HCWs’ expectations of Picterus JP. The findings identify deficiencies in the current neonatal jaundice detection process and the participants’ desire for a more accurate method. Picterus JP was perceived as easy to use, useful and compatible with the work routine, but barriers to adoption were identified, including internet deficiencies and costs. Conclusions The introduction of Picterus JP as a supporting tool to screen for neonatal jaundice is promising but contextual barriers in the setting must be addressed for successful implementation. There is also an opportunity to optimise visual assessment to improve detection of neonatal jaundice.

Introduction Neonatal jaundice (NNJ) is a common and usually harmless condition, but undetected severe cases can cause brain damage and disabilities in thousands of babies each year. Low- and middle-income countries often lack accurate methods for detection and rely primarily on visual assessment (VA), resulting in a higher incidence of consequences. Norwegian researchers developed an easy-to-use and affordable smartphone app (Picterus) to detect NNJ that has shown higher accuracy than VA in Norwegian and Mexican neonates. We evaluated the feasibility of implementing Picterus in low-income settings in Mexico to improve outcomes for affected newborns. Methods Qualitative methods, including 1 focus group, 15 semi structured interviews, and 4 observations, were used in urban and rural health facilities in Oaxaca, Mexico, with medical doctors, nurses, and health authorities as participants. Results Four themes were identified through thematic analysis guided by the Consolidated Framework for Implementation Research: (1) the current process to detect NNJ, (2) participants’ needs to improve it, (3) feasibility of implementing Picterus in the health system, and (4) users’ expectations from the app. The findings indicate deficiencies in the current process of NNJ detection and a desire among participants for a more accurate tool. Picterus was perceived as an easy-to-use and useful tool compatible with the work routine; however, barriers to adoption were identified, primarily related to internet deficiencies and costs. Conclusions Picterus has the potential to improve NNJ detection but contextual barriers must be addressed for a successful implementation in the setting. Additionally, there is scope to optimize VA to strengthen NNJ detection. Key messages • Prevalence of severe consequences of NNJ is higher in LMIC compared to high-income ones reflecting an unjust but preventable health inequity with significant health, social and economic costs. • Picterus offers a reliable and accessible tool to bridge the gap in NNJ detection, potentially improving outcomes for affected newborns in all settings.