Transcutaneous Bilirubin Meters For All

Improving Newborn Health In India
This blog has already written about the widespread problem of infant jaundice in our post on phototherapy devices like Brilliance & Firefly. The typical diagnostic approach is to look for yellowing of the skin and eyes of an infant that does not go away within 5 days of birth. If it does not, then an infant may be subjected to invasive blood tests using needles. This can be painful and dangerous to the infant, and it is often difficult to draw blood from infants.

Two devices widely used in India are able to diagnose jaundice using high-pressure liquid chromatography, the Pharos device from Rural Diagnostics and D-Rev & the Philips BiliChek system. Both are portable, low-cost, non-invasive diagnostic tools for use in monitoring the serum bilirubin levels of neonates before, during, and after phototherapy.

Philips BiliChek System

The opportunity to scale these technologies in India was enabled in part by the creation of Accredited Social Health Activists (ASHAs) by the Ministry of Health and Family Welfare in 2005, with the goal of having 250,000 ASHAs nationwide by 2012, or at least one per village. The total number of ASHAs reported in 2013 was much larger than the target at 870,089, and this widespread basic health monitoring capability enticed firms like Rural Diagnostics to equip them with bilirubin monitors for newborns.

At resale prices of ~$5,000, the Philips BiliChek device may still be out of reach for most ASHAs, so it will be up to Pharos and Rural Diagnostics to bring the price to a level that can scale the use of the technology among India's ASHA's, and ensure reliable diagnosis of neonatal jaundice to the 15 million Indian babies born outside the hospital system each year. However, an internet search does not return a current website for the Pharos product, which may have been acquired, discontinued, or changed names. If you know, please let us know in the comments section below.


Opportunity in U.S. What is currently being done?
One skilled nurse friend working at a birthing and neonatal care center in Salt Lake City recently asked a colleague about their process for diagnosing jaundice in newborns. Her colleague said that they first check bilirubin levels with a scanner as part of a standard workup; if they see a concerning reading, they will do a heel stick blood draw to verify. She also mentioned that their scanning devices 'suck,' and she wishes they had something more accurate. In this sense the technology may be parallel to old fashioned bladder scanning devices that are essentially blind and less accurate in their readings of bladder volume. In other words, the opportunity in developed healthcare markets may be sustaining innovation leading to better, more accurate bilirubin monitors, whereas the opportunity in resource-constrained markets remains disruptive innovation to make basic devices accessible to all.