New AI-powered app brings infant jaundice screening home for Asian parents

Singapore, 10 January 2025 – For the first two to three weeks of their lives, infants have to undergo screening for neonatal jaundice (NNJ). It typically involves frequent clinic visits, which is not only inconvenient, but vulnerable infants could potentially be exposed to airborne diseases.

To address this issue, a team led by Singapore General Hospital (SGH), in collaboration with SingHealth Polyclinics (SHP) and national HealthTech agency Synapxe, has developed a smartphone app to enable parents to screen their babies for NNJ, in the comfort and safety of their homes. Currently, newborns are screened by means of using a light-emitting handheld gadget to measure the yellowness of the baby’s skin or a heel prick to obtain a blood sample.

The app, BiliSG^©, was named after bilirubin, a yellow pigment resulting from the natural breakdown of red blood cells that causes the yellow tint seen in jaundice. It utilises a machine learning model to predict bilirubin levels in multi-ethnic Asian newborns through skin colour analysis. By capturing images with a smartphone camera of the infant's forehead, chest, and abdomen with a specially designed colour-calibration sticker, the app’s algorithm can analyse the skin’s yellowness to accurately predict bilirubin levels.

Principal investigator Clinical Assistant Professor Alvin Ngeow, Senior Consultant, Department of Neonatal and Developmental Medicine, SGH, said, “An app to screen neonatal jaundice is not new. Most of them, however, only take a single point of reference such as the forehead to determine if the newborn has jaundice. In fact, a newborn with jaundice can have varying degree of yellowness in different parts of the body. Furthermore, the other apps were developed in other countries on babies who may have skin tones that are different from that of the local population, a factor that has bearing on accuracy. This prompted us to develop our own app, BiliSG^©.”

The study was conducted in two phases: Phase 1 from June 2022 to October 2023 focused on app development and initial machine learning model creation, while model validation was performed in Phase 2 from November 2023 to June 2024.

For Phase 2, during the iterative development of the machine learning model, SGH and SHP recruited 352 clinically stable infants born at 35 weeks of pregnancy or more and within 21 days of age. Enrolled infants underwent three forms of jaundice tests¹. For the third test, photos of the forehead, chest, and abdomen were taken with smartphone-based BiliSG©. When the machine learning model was finalised in April 2024, another 194 infants were prospectively recruited to further validate the app. The team found that the app gave similar results when compared to existing methods of NNJ testing, with 100 per cent sensitivity².

Senior author Clinical Associate Professor (Dr) Tan Ngiap Chuan, Director of Research and Primary Care Research Institute (PCRI), SHP and Vice-chair, Research, SingHealth-Duke NUS Family Medicine Academic Clinical Programme (FM ACP), added, “This novel tool will be a game changer in infant care in Singapore and beyond. It will transform the way we protect the brain health of babies by ensuring their jaundice is monitored closely by their parents in convenient setting and with the safeguard and supervision of their family doctors via telemedicine.”

Neonatal jaundice is a condition that affects 60 per cent of term and 80 per cent of pre-term infants. Some ethic groups have a higher incidence. It occurs when a baby has a high level of bilirubin in their blood as their liver may not be developed enough to remove the substance. The condition is usually self-limiting and bilirubin levels typically reach safe levels after the baby’s first two to three weeks. However, early detection and regular monitoring is recommended as severe jaundice can cause permanent brain damage, and other long-term complications, such as intellectual and motor disabilities as well as developmental delays.

Andy Ta, Chief Data Officer & Director of Data Analytics & AI, Synapxe said, "We believe that technology, particularly AI, can transform the healthcare industry. Our collaboration with our healthcare partners, such as SGH and SHP, is driven by our shared vision to innovate and enhance healthcare delivery, ultimately improving patient outcomes. While it is currently in the testing phase, the development of the BiliSG© app illustrates how we can leverage AI technologies to assist parents in monitoring their infant's jaundice from the comforts of their homes.”

Moving forward, the team is looking at conducting further validation of the app on a wider range of smartphone operating systems and camera specifications, and a pilot study to assess the app’s clinical feasibility.

The study findings were published in JAMA Network Open, a peer-reviewed medical journal, in December 2024.

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About Singapore General Hospital (SGH)

Singapore General Hospital, established in 1821, is the largest tertiary hospital in Singapore and ranked among the world’s best. It provides the most comprehensive patient-centred care with over 50 clinical specialties on its campus. As an Academic Medical Centre, it takes pride in training healthcare professionals and conducting cutting edge research to meet evolving needs of the nation as well as the region. Driven by a strong sense of purpose, SGH is committed to give of its best to heal and bring hope, as it has for over 200 years.

For more information, please visit www.sgh.com.sg

About SingHealth Polyclinics (SHP)

SingHealth Polyclinics (SHP) comprises a network of ten polyclinics that provides primary healthcare services and plays an integral role in empowering patients, their families and communities to take charge of their health and wellness. SHP practises Family Medicine, providing seamless, patient-centred treatment and preventive healthcare that is affordable and accessible to all through its network of polyclinics.

SingHealth Polyclinics is a member of Singapore Health Services (SingHealth) – an Academic Medical Centre offering over 40 clinical specialties through a network of acute hospitals, national specialty centres, community hospitals and polyclinics.

For more information, please visit polyclinic.singhealth.com.sg

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¹Total Serum Bilirubin (TSB; blood test and reference standard), Transcutaneous Bilirubinometry (TcB; non-invasive method using light waves to measure bilirubin levels through the skin), and Smartphone-predicted Bilirubin (SpB; using BiliSG^©).

²The 100 per cent sensitivity means no cases of significant jaundice were missed.