A ‘popò’ photo on the diaper and a few simple steps with the smartphone to facilitate the early identification of neonatal cholestasis, an accumulation of bile in the liver that can have very serious effects on children’s health. The new tool available to parents is the PopòApp, conceived and developed by the Bambino Gesù Children’s Hospital in collaboration with ANIBEC – the Italian National Association of Chronic Hepatopathic Children. The application, the result of scientific research published in the Journal of Medical Screening, uses artificial intelligence algorithms and the colorimetric characterization of feces to return results with a degree of precision close to 100%.

Neonatal cholestasis is a disorder characterized by the accumulation of bile in the liver as a result of the reduction or stoppage of the normal flow of bile to the intestine. The causes of these disorders are various: metabolic problems, genetic defects, malformations, infections, but in most cases they are due to biliary atresia (progressive destruction of the biliary tract) which represents the main indication for liver transplantation in children. Cholestasis is difficult to diagnose and has a high incidence in the neonatal period (on average 1 in 2,500 newborn suffers from it). The characteristic symptoms, which generally occur during the first 2 weeks of the newborn’s life, are jaundice, dark urine and light-colored feces (hypo-acholic feces). Recognition of faecal hypoacolia through color testing (colorimetric characterization) is a method of early diagnosis of conditions of pathological neonatal cholestasis.

The Bambino Gesù app, developed with a machine learning algorithm, facilitates the early identification of cholestasis in the first weeks of children’s life by recognizing hypo-acholic feces. The system allows parents or doctors to make a colorimetric assessment by taking a photo of the poop on the diaper. The algorithm compares the color of the photo with the colorimetric card, returning an initial indication. Once the preliminary result has been received, the app allows to contact the specialized Center to take the test further by visiting or televising the child, attaching the photo taken.

PopòApp is the result of over a year of studies conducted by clinicians and researchers of the Hepato-bilio-pancreatic Surgery and liver-kidney Transplants and Hepato-gastroenterology and Nutrition of the Bambino Gesù units, coordinated by dr. Marco Spada. The results of the research on 160 sample images showed an accuracy of the app equal to 99.4%, with a positive predictive value of 98.4% and a sensitivity of 100% without false negatives, regardless of the smartphone model used. The study is published in the scientific Journal of Medical Screening.

“Given the seriousness of its consequences, cholestasis, particularly if caused by biliary atresia, must be recognized in the newborn as early as possible,” says dr. Marco Spada, head of Hepato-bilio-pancreatic Surgery and liver-kidney Transplants of Bambino Gesù. “In fact, if the disease is identified and treated early by Hepato-bilio-pancreatic surgery and Hepato-biliary specialists, almost 100% of newborns cam be effectively treated and have normal life prospects. This is the goal of the mobile app we have developed, which represents a precise and intuitive tool at the service of children’s health and medical research“.

“The application – explains prof. Giuseppe Maggiore, head of Hepato-gastroenterology and Nutrition of Bambino Gesù – 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, the use of the app is recommended to all new parents from the first days after the birth of the little ones and for the first 3 months of life“.

PopòApp, which can be downloaded free of charge on all mobile devices, was presented during a conference promoted by the Bambino Gesù Children’s Hospital aimed at health personnel who are dedicated to the care of newborns and infants, operators of birth centers and neonatology and pediatricians of choice.