JMIR Publications

ABSTRACT

Background:

Neonatal hyperbilirubinemia is one of the leading causes of neonatal readmission, especially severe hyperbilirubinemia and its complications, and it will influence disease burden, as well as neonatal and maternal health. Smartphones have been shown to have satisfactory accuracy in screening neonatal bilirubin levels, but the impact of this technology on neonatal health care use and maternal health outcomes is still unknown.

Objective:

To evaluate the impact of the smartphone-based out-of-hospital neonatal jaundice screening mechanism on neonatal readmission rate for jaundice and related maternal anxiety.

Methods:

This was a two-arm, unblinded, randomized controlled trial with 30 days of intervention and follow-up periods. From August 2019 to August 2020, healthy mother-infant dyads were recruited on site from three public hospitals in Hainan Province, China. Intervention group mothers used the smartphone APP to routinely monitor neonatal jaundice at home under the online guidance of paediatricians. Control group participants receive routine care. The primary study outcome was the neonatal readmission rate due to jaundice within 30 days of first hospital discharge. Secondary outcome was the maternal anxiety score associated with neonatal jaundice. The data was collected through self-assessed questionnaire. All participants were included in analysis (intention-to-treat).

Results:

1424 mother-infant dyads were recruited [maternal median age was 29.00 (IQR, 29-32) years, 712 (50.07%) male neonates] and 712 were randomly assigned to the intervention group and the control group, respectively, with a total of 1187 them completing follow-up. Compared with routine-care group, the adjusted 30-day neonatal readmission rate due to jaundice reduced 10.46% (11.74% vs 24.23%, 95%CI, -15.94% to -4.98%; OR, 0.41, 95%CI, 0.30 to 0.56, P＜.001) and the relevant maternal anxiety mean score decreased 3.61 (95%CI, -4.44 to -2.78; β, -3.64, 95% CI, -4.47 to -2.82; P < .001).

Conclusions:

The smartphone-based out-of-hospital screening method for neonatal hyperbilirubinemia decreased neonatal readmission rate within 30 days of first discharge and improved maternal mental health in some degree, thus providing benefit to the following-up in paediatric care. Clinical Trial: China Clinical Trial Registration Center, ChiCTR2100049567; http://www.chictr.org.cn/showproj.aspx?proj=64245