BILI-RULER

Jaundice is a common newborn condition in which a baby’s skin and/or eyes may turn a yellowish color. The yellow color is due to the build-up of bilirubin, a natural break-down product of blood cells after birth. Delays in recognizing and seeking care for jaundice may result in poor outcomes. Severe jaundice can lead to complications including kernicterus (seizures and brain damage) or death. Approximately 1.1 million newborns around the world are diagnosed with severe jaundice each year, and over 114,000 babies die from jaundice-related complications.¹

The bili-ruler is a non-invasive, low-tech, easy-to-use screening tool for newborn jaundice. The bili-ruler was developed by the Global AIM Lab using advanced digital image processing and human-centered design. The bili-ruler is used by a healthcare provider to compare colors on the ruler to the color of a baby’s blanched skin; the health provider then chooses the closest color match. The bili-ruler can help determine the level of risk for the baby and identify those who may need further evaluation and management for jaundice. This type of low-tech screening option is important in settings where access to health providers is limited and/or lab testing is not available.

The Global AIM Lab conducted validation testing of the bili-ruler on 798 babies at Brigham and Women’s Hospital (Boston, MA, USA) and Sylhet Osmani Medical College (Sylhet, Bangladesh).  Bili-ruler scores on the nose were strongly correlated with transcutaneous and serum bilirubin levels (r = 0.76 and 0.78, respectively). Scores on the bili-ruler identified several different clinical thresholds of hyperbilirubinemia with high diagnostic accuracy (for example, TcB ≥13 mg/dL with 90% sensitivity and 86% specificity). Read more about the findings.

The Bili-ruler is currently being externally validated in different settings by investigators in Ghana and Peru.

Little Sparrows Technologies is working in partnership with the Global AIM Lab to manufacture and bring the bili-ruler to scale for the populations who need it most. Demand for the bili-ruler has been building both around the globe and within the US, including ambulatory practices, Indian Health Services, and a wide range of health providers including midwives and mohels. For information on obtaining the bili-ruler, visit the Little Sparrows Technologies site.

The bili-ruler is also being delivered in a package (called the bili-kit^TM) with a portable phototherapy device, the bili-hut^TM, developed by Little Sparrows Technologies, which offers a set of low-cost tools to help screen for and effectively treat cases of neonatal jaundice in resource-limited settings.

During the COVID-19 pandemic, the bili-ruler may have important and innovative applications. Access to pediatric care and laboratory visits has been limited, given the potential infection risk for caregivers and babies. The bili-ruler may play an important role in home-based jaundice screening, by which parents can directly measure and communicate bili-ruler scores, which are associated with jaundice risk, to their health providers. The Global AIM Lab is committed to innovation and creativity during these challenging times in order to help improve health outcomes.

Additionally, approximately 80,000 mothers will give birth in the next 3 months in Ukraine, and many may lack the basic equipment, and sometimes electricity, needed to care for newborns. We have been asked by the President of the Ukrainian Association of Neonatologists to donate bili-rulers and bili-huts^TM to manage newborn jaundice. We are raising funds to manufacture and get this basic equipment to Ukrainian hospitals and facilities most in need, in partnership with Little Sparrows Technologies, local physicians, hospitals, and NGOs. Visit The SUN Project page to learn more about this initiative.

We need support to bring the Bili-ruler to communities in need, both globally and at home in the US. To help us fund the COVID-19 Bili-Ruler project, please visit our donation page or contact iolson@bwh.harvard.edu. To help us fund our donation of Bili-rulers and Bili-huts to the Ukraine please visit our Support Ukrainian Newborns page. Thank you!