title: Bilistick: a low-cost point-of-care system to measure total plasma bilirubin.
abstract: BACKGROUND
  Severe neonatal hyperbilirubinemia, with consequent encephalopathy, remains a common cause of morbidity and death in many regions of the world. Poor access to clinical laboratory resources and screening programs to measure plasma bilirubin levels is a major contributor to delayed treatment in developing countries, and the cost of existing point-of-care screening instruments precludes their dissemination.
  
  
  OBJECTIVE
  We are evaluating the accuracy of a low-cost, minimally invasive point-of-care system (Bilistick) requiring a 25-µl blood sample that could be used in low-resource environments to evaluate patients with neonatal jaundice.
  
  
  METHODS
  We compared plasma bilirubin levels in divided blood samples by clinical laboratories and by Bilistick at two medical centers serving term and near-term newborns from ethnically different populations.
  
  
  RESULTS
  118 neonates with bilirubin levels ranging from 24.8 to 501.0 µmol/l were analyzed. The mean bilirubin concentration (±SD) was 215.6 ± 85.5 µmol/l for Bilistick and 226.1 ± 86.4 µmol/l by laboratory determination. Pearson's correlation coefficient between all paired results was 0.961, and the Bland-Altman analysis showed a mean difference of 10.3 µmol/l with a 95% interval of agreement of -38.0 to 58.7 µmol/l.
  
  
  CONCLUSIONS
  Bilistick is a minimally invasive method for measuring total bilirubin concentration over a wide range of values and should provide an affordable and accurate system for pre-discharge and follow-up screening of jaundiced infants, particularly in low-resource environments.
authors.affiliation: Liver Research Centre, Italian Liver Foundation, Trieste, Italy. carlos.zabetta@csf.units.it
authors.forename: C D
authors.initials: CD
authors.lastname: Coda Zabetta
authors.forename: I F
authors.initials: IF
authors.lastname: Iskander
authors.forename: C
authors.initials: C
authors.lastname: Greco
authors.forename: C
authors.initials: C
authors.lastname: Bellarosa
authors.forename: S
authors.initials: S
authors.lastname: Demarini
authors.forename: C
authors.initials: C
authors.lastname: Tiribelli
authors.forename: R P
authors.initials: RP
authors.lastname: Wennberg
mesh_terms: D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D004534:Egypt / Q000453:epidemiology; D017721:Hospital Costs; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000097:blood / Q000175:diagnosis* / Q000191:economics / Q000208:ethnology; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D015997:Neonatal Screening / Q000191:economics / Q000295:instrumentation*; D015588:Observer Variation; D019095:Point-of-Care Systems / Q000191:economics; D011237:Predictive Value of Tests; D011934:Reagent Strips / Q000191:economics; D015203:Reproducibility of Results
chemical_list: D015415:Biomarkers; D011934:Reagent Strips; D001663:Bilirubin