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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.

The bili-ruler is also being delivered in a package (called the bili-kitTM) with a portable phototherapy device, the bili-hutTM, 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.


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 bili-ruler projects, please visit our donation page or contact Thank you!

This video abstract accompanies an article appearing in the May 2019 issue of Pediatrics, published by the American Academy of Pediatrics.

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