Bilimetrix USA uses a holistic approach to overcome critical barriers responsible for kernicterus, a preventable tragedy affecting thousands of people worldwide. Many causes of excessive bilirubin production are known and can be identified. However, the bottom-line cause of kernicterus is not the origin of jaundice but simply a delay in receiving effective treatment. Our strategy focuses on this reality.
Barriers to timely treatment
We respond to these barriers using a digital system approach. The engine that coordinates this system is a multi-purpose “Stop Kernicterus International” service.
# Failure to identify jaundice and seek care when recognized
Delays in seeking care are most often due to a lack of knowledge by parents and caregivers about risks and management of jaundice. This may be the most critical barrier to kernicterus prevention. Educating mothers about jaundice is associated with a marked decrease in kernicterus, even with home births. We advocate empowering mothers through antenatal and postnatal instruction and provide tested instructional materials to achieve this.
# Failure to evaluate severity of jaundice in primary care (and some tertiary) facilities
In most low resource communities, primary care health providers and clinics are ill equipped to evaluate the severity of jaundice and need for treatment. Using the smartphone-based BiliPic system, the plasma bilirubin level can now be measured in rural clinics. The bilirubin assay requires a single drop of blood, a test card and a smartphone camera. Results are displayed immediately.
# Failure to refer and admit patients efficiently to treatment centers
Communication between clinics and hospitals offering phototherapy and consultation for sick newborns is often deficient, sometimes forcing parents to run from hospital to hospital in search of care. Bilimetrix USA facilitates networking using two digital modalities
The BiliPic smartphone app determines plasma bilirubin using the BiliPic test cards and is linked to treatment centers.
The Stop Kernicterus International service facilitates consultations and referrals between primary and tertiary care centers and provides a platform to gather and analyze secured digital patient data. Bilirubin levels (and any manually inputted data) obtained with the BiliPic system are simultaneously presented to the user and treatment centers.
# Failure to provide quality phototherapy
Phototherapy units are either unavailable or ineffective in many treatment centers. Light intensity (irradiance) should be at least 10 µW per sq cm skin area to be effective and optimally 30 µW per sq cm in term infants. Few hospitals have irradiance meters to monitor their equipment and many fail to change fluorescent bulbs regularly. Unreliable power supply further undermines treatment. Bilimetrix USA is seeking to partner with companies that manufacture low cost battery supported LED phototherapy instruments, filtered sunlight phototherapy, and cellphone based irradiance meters.