Evaluation of A Mobile Application Tool (BiliNorm) To Improve Care for Newborns with Hyperbilirubinemia in Indonesia

Abstract

Background: Hyperbilirubinemia is more frequently seen in low- and middle-income countries such as Indonesia than in high-income countries. A lack of adherence to existing guidelines for the diagnosis and treatment of hyperbilirubinemia might be one of the factors contributing to this difference. In Indonesia, we developed a new national guideline for hyperbilirubinemia. To assist healthcare workers in the use of this guideline, we developed a web-based app (BiliNorm) to be used on a smartphone. It shows the bilirubin level of the patient on the nomogram and advises which treatment should be started. We evaluated whether this app was helpful and whether it improved care for infants with hyperbilirubinemia.Methods: Health care workers from two teaching hospitals in East Java, Indonesia, were trained in the use of the BiliNorm app. Six months after the introduction of the app, a questionnaire was sent to those who worked with the app asking about their experiences. A chart review of infants with hyperbilirubinemia at these two hospitals was then performed for two time epochs. Hyperbilirubinemia management in the six-month period before the introduction of the app was compared with that in the seven-month period after its introduction.Results: Forty-three participants completed the questionnaire. The majority (72%) of the respondents indicated that the BiliNorm app was well received and easy to use; 84% of respondents indicated that the BiliNorm app was helpful in the decision to start phototherapy. The chart review of 255 infants before and 181 infants after the introduction of the app indicated that significantly more infants received treatment according to the guidelines (38% vs 51%, p=0.006). After the introduction of the app fewer infants received phototherapy, without a bilirubin measurement (14% vs 7%, p=0.024). The percentages of infants that were over- and undertreated were not different (34% vs 32% and 14% vs 10%, respectively)Conclusions: The web-based decision tool BiliNorm seems to be a valuable app. It is easy for healthcare workers to use, and it helps them adhere to guidelines. BiliNorm improves care for infants with hyperbilirubinemia and may help to reduce the incidence of severe hyperbilirubinemia in Indonesia.