Popòapp, the application that reveals if your newborn has a liver problem – time.news

by time news

2023-05-31 11:48:06

Of Elizabeth Zocchi

Created by the Bambino Gesù pediatric hospital, “Popòapp” identifies neonatal cholestasis thanks to an algorithm that analyzes the color of stools from 0 to 3 months of life on a photo of the diaper

One click with the smartphone on the diaper is enough to identify the problem early neonatal cholestasis, a difficult-to-diagnose biliary tract disorder that has a significant impact in the first few weeks of life. All thanks to an application, baptized Popular and developed by the Bambino Gesù Pediatric Hospital in Rome in collaboration with ANIBEC, the Italian National Association of Chronic Hepatopathic Children. The new tool makes it possible to evaluate the color of neonatal feces by providing an initial response, based on artificial intelligence algorithms. In real time, with a few simple steps on the mobile phone, it is possible to know if there is a suspicion and to contact the experts of the pediatric hospital via email or teleconsultation. The effectiveness of the new app is documented by research published in the Journal of Medical Screening, which highlighted the absence of false negatives and an accuracy rate of 99.4%. In short, a practically 100% reliable result.

Cholestasis: what it is and why it worries

It is an accumulation of bile in the liver, due to the reduction or obstruction of the normal flow of bile to the intestine, with potentially serious effects on the health of children. There are various upstream causes: metabolic problems, genetic defects, malformations and infections. In fact, however, cholestasis is in most cases the expression of biliary atresia, a pathology that involves the progressive destruction of the biliary tract and therefore represents the main indication for liver transplantation in the pediatric age. “Considering the seriousness of its consequences,
the cholestasis
particularly if caused by biliary atresia, must be recognized in the newborn as early as possible», says Marco Spada, head of Hepato-bilio-pancreatic Surgery and Child Jesus Liver-Kidney Transplants. «If the disease is detected and treated early by hepatobiliopancreatic surgery and hepatology specialists, almost 100% of newborns can be effectively treated and have a normal life expectancy. That’s the goal of the mobile app we’ve developed. A precise and intuitive tool at the service of children’s health and medical research”.

Early diagnosis is not easy

The problem with neonatal cholestasis lies in the difficulty of having one timely diagnosis, an essential prerequisite for the successful outcome of the treatments. Usually, these biliary disorders occur in the first two weeks of life with symptoms such as jaundice, dark urine and, of course, light stools. Technically we speak of hypocolia or faecal acolia, i.e. pigmentation defects of the faeces due to production problems or abnormal outflow of bile. Today, thanks to the new system of artificial intelligence applied to the colorimetric analysis of feces, it is finally possible to recognize faecal hypo-acolia early and therefore to place the suspicion of a pathological neonatal cholestasis for a timely diagnosis and management. This was clarified by Professor Giuseppe Maggiore, head of Hepatogastroenterology and Nutrition of the Bambino Gesu: «The new app is a tool capable of intercepting some pathological conditions of the newborn which, if diagnosed late, can seriously endanger the health of children. For this reason, its use is recommended to all new parents from the first days of birth and for the first 3 months of life”.

The time factor is of the essence

“Neonatal cholestasis involves a difficulty in discharging the bile from the liver to the intestine and can depend on various but still rare conditions, which affect a total of 1 child for every 2,500/3,000 births,” explains Spada.
“The most serious of these conditions, biliary atresia, causes about 30 new cases a year. The main treatment is surgical, and involves an operation aimed at restoring the outflow of bile in the intestine, otherwise the liver suffers irreversible damage resulting in biliary cirrhosis which requires organ transplantation. That is why early identification of the suspect of this condition is essential. And here the role of the new app comes into play to immediately pay attention to “at risk” cases. “The operation has more favorable results if performed within the first 45/60 days of life,” warns Spada. «Two, then, are the key elements in cases of atresia. First: early diagnosis. Second: quickly refer young patients to a specialized center because high-profile skills are needed that can only be found in selected structures», continues Spada. In the other conditions of cholestasis, the treatment is medical and early diagnosis remains essential for timely management by a specialized centre. “Some causes of cholestasis are really rare and achieving the goal of recognizing them as soon as possible is crucial for the treatment”, underlines Spada who continues. «In addition to biliary atresia, there are transient or metabolic pathological conditions or, again, malformations. In particular, there is a group of diseases – hypoplasia of the intrahepatic bile ducts – which can be treated with a pharmacological approach in specialized centres. And then the rare metabolic diseases linked to genetic defects, of complex management, which require the skills of the metabolist specialist. In all these cases, the rapid identification of young patients facilitates and supports the subsequent path of diagnosis, therapy and follow-up”.

Who is the new app for?

The message is clear: the use of the app should not be understood as limited to neonates who already have suspicious symptoms or abnormalities, but ideally vrecommended to all without exception. «Usually, in the presence of physiological jaundice or from breast milk, it is the pediatrician himself who suggests to the parents a careful monitoring of the evolution of the color of the feces. However, it must be said that often, after discharge, the pediatrician takes charge of it is not immediate and therefore a more or less extended period of time opens up in which the child is not followed by an expert eye», recalls the expert. «Thanks to the app, which does not formulate a diagnosis but can raise a suspicion by opening a diagnostic process, the parent is not left to himself. Furthermore, even when the stool color is normal, the app recommends repeating the test to monitor the situation over time. For now, “Popòapp” is configured to offer the possibility of contacting experts from the Bambino Gesù hospital, but the future involvement of an Italian network of specialized centers is envisaged, to which families who need it can be directed based on their place of residence.

Parents “relieved” thanks to the new app

In the past, the burden of checking the newborn’s faeces was assigned to the mothers, as was already recommended in the prenatal courses. Not to mention that in the case of physiological jaundice or from breast milk, in addition to monitoring the birth centers and general pediatricians, families were recommended to check the evolution of the color of the skin and, above all, of the faeces in the following weeks. «Suffice it to say that in countries like Japan or Taiwan, where the incidence of cholestasis is quadrupled compared to our country, screening policies are based precisely on the recognition of the color of the faeces through the delivery to the parents of a card with a scale of seven colors. It is up to them, after discharge, to evaluate the contents of the diaper day by day with respect to that parameter», says Spada. «Today, starting from the assumption that suspicion is based on a very simple element which is the stool colorour app makes the task easier for parents because it makes the comparison automatically and offers the option of immediate contact with the specialist».

Popular

It was developed with the support of ANIBEC, the Italian National Association of Chronic Hepatopathic Children, whose parents expressed their appreciation and, at the same time, regret for not having been able to have access earlier to an instrument perceived as a precious “ally”. For the families of these children, in fact, it was difficult to manage the difficulties of interpreting the symptoms, but also to reach the right center for treatment. Usually it was about children discharged with jaundice
, other times that they had presented anomalous manifestations only later. From a technical point of view, the app is designed for iOS and Android smartphones. A machine learning process was used to generate an algorithm for stool color recognition based on the seven colors of the infant stool color chart, which were considered the gold standard. Consecutive images of feces were taken by PopòApp, directly in the diapers of children younger than 6 months. The PopòApp classified the photographs as “normal”, “acholic” or “uncertain”. To validate the PopòApp, four physicians independently categorized all images and only those that all physicians agreed were included.

The future frontiers of AI in medicine

Could this experience be capitalized on for other diagnostic purposes as well? “An analogous methodology could find application spaces for other pathological conditions,” explains the expert. «The colorimetric characteristics of biological substances in general can also be studied for non-pathological disorders, such as colic, which have an impact on well-being. And it is not excluded that extensions could be investigated for chronic inflammatory bowel diseases, such as Crohn’s”. Another major line of research concerns the analysis of big data applied to rare diseases to overcome the intrinsic limit of the necessarily reduced number of cases that come to the attention of specialists and treatment centres. «In the near future, artificial intelligence will make it possible to pool all the knowledge and information on these diseases by defining more effective diagnostic algorithms and decision-making protocols thanks to the convergence of those expertise that today are shared only in the context of congresses and of the scientific debate. For this reason, the issue of the correct use of AI from an ethical point of view, the protection of privacy and data security will also be increasingly relevant, which must be tackled rigorously, even more so when it comes to minors who cannot decide in first person how to manage personal data. From this point of view, our new app was built in such a way as to acquire only indispensable information and in anonymous form, never attributable to a specific individual».

The “history” of PopòApp

To arrive at the development of PopòApp, a team coordinated by Dr. Marco Spada and made up of clinicians and researchers from the Hepato-biliary-pancreatic Surgery and Liver-Kidney Transplants and Hepatogastroenterology and Nutrition of the cell units worked for over a year. Pediatric Hospital Bambino Gesu.
How does it work, concretely? Facilitates early identification of cholestasis in the first weeks of life thanks to an algorithm that, comparing the photo of the feces
of the child with the color chart, may provide an early indication of suspicion. Based on the preliminary result, the app allows the transition to the next step which provides for thedeepening the test with an expert, even on television, attaching the photo taken. PopòApp can be downloaded free of charge on all mobile devices and, regardless of the smartphone model, it has shown an accuracy of 99.4%, with a positive predictive value of 98.4% and a sensitivity of 100% without false negatives. These data derive from a research conducted on 160 sample images and published in the scientific Journal of Medical Screening. The novelty was presented at a conference promoted by the Bambino Gesu Pediatric Hospital and aimed at health personnel dedicated to the care of newborns and infants, operators of birth centers and neonatology and paediatricians of free choice.

May 31, 2023 (change May 31, 2023 | 11:47 am)

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