Bridging Inequity via Skin Tone Inclusive Transcutaneous Bilirubinometry

Introduction:
Health inequities are rampant across the entire dominion of medicine and health care. This issue has metastasized throughout the entirety of health care and is even more deeply rooted in the fabric of society. These inequities cannot be easily solved or even succinctly described. Rather than attempting this rigorous task, this research will instead focus on a specific inequity that has already been identified. The difference between health inequality and inequity, is that a health inequity is an inequality which denotes an unjust difference in health (Arcaya et al., 2015). An example of a health inequity is race/ethnicity being a contributing factor to higher mortality and readmission rates for acute stroke victims because race/ethnicity is out of a patient's control (Langagergaard et al., 2011). Jaundice or hyperbilirubinemia is the excess of the chromophore bilirubin in the skin and blood. Hyperbilirubinemia is extremely common in neonates within the first few weeks of birth (Woodgate & Jardine, 2015). However, the current gold standard for testing total serum bilirubin is not as accurate for neonates with higher concentrations of melanin compared than those with lower concentrations. Since melanin’s absorbance spectrum overlaps with bilirubin’s, neonate with higher concentrations of melanin (especially Black Africans) have the bilirubin concentration overestimated. This leads to darker-skinned neonates being forced to undergo unnecessary treatment and be removed from their mothers for days post birth. Often just forgo testing for dark-skinned neonates and opt for a more invasive measurement using blood samples (Woodgate & Jardine, 2015).
Project Summaries:
Using spectroscopy and photo-bleaching our research has determined a specific and repeatable procedure for screening for total serum bilirubin. By combining photo-bleaching with absorbance on a small portion of neonate skin we have developed a procedure that can calculate a neonate’s total concentration of bilirubin independent of their concentration of melanin. This procedure was validated and optimized by using the mixtures of varying concentrations of chromophores to build a predictive mathematical model. We found that exposing various concentrations of bilirubin and melanin mixtures yielded different decay curves. This process did take place on a slightly longer time scale than originally predicted, on the timescale of a couple of hours rather than minutes. This procedure does allow for the concentration of bilirubin to be measured independent of the concentration of melanin. Meaning darker-skinned neonates will no longer have their bilirubin concentration overestimated. Furthermore, they will no longer undergo unnecessary treatment or be subject to repeated or more invasive testing.
Conclusion:
The idea for this novel procedure came from originally researching how health inequities broadly affect patient care. This original research led to a more deductive approach to research because systemic issues like health inequity cannot be rapidly solved. Instead, small incremental advances need to be made to slowly bridge the gap in patient care. This led to researching the dissonance in care of fairer vs darker skinned neonates. This research also documented various inequities including patient care for jaundice and pulse oximetry. Disturbingly, the inefficacy of current screening procedure for bilirubin/jaundice had led to physicians forgoing due diligence in hyperbilirubinemia diagnosis. Leading to the inspiration for the novel procedure described above. The novel approach uses the current treatment method for jaundice, photobleaching, which involves exposing a neonate to blue light to convert the bilirubin to lumirubin. Lumirubin is easier for the neonate’s liver to break down and eventually excrete from the system. By photobleaching a small area of the skin like the pinna of the ear and finding the change in absorbance of the skin over time yields a decay curve. This decay curve can be used to find the bilirubin concentration independent of the neonate’s melanin concentration. Thus, leading to more accurate measurements for darker-skinned neonates, which removes the originally researched inequity in care.