Management of neonatal jaundice in low-income and middle-income countries

Neonatal jaundice (NJ) is a physiological process that occurs normally in many infants, whereas it becomes pathological and imposes an increased risk of both short-term and long-term morbidities such as hospitalisation expenses, risks of hearing loss and kernicterus, and even mortality in some cases. The challenges are especially acute in low-income and middle-income countries (LMICs), where the burden of the disease is greatest and medical facilities are least equipped to manage severe NJ. Healthcare system characteristics related to organisation, reality of the national data registries, national budget priorities, reserved budget for health effect, rate of healthcare professionals to population and availability of an insurance system have a direct effect on the problem. In addition, risk factors vary significantly in LMICs because of being very heterogeneous and having different dynamics in various aspects, such as race-related diagnosis difficulties (especially black race), religion and cultural beliefs, geographical and climate-related issues. Although the true worldwide dimension of the problem is not known, NJ is still reported as a life-threatening condition in many countries. Depending on geographical location and genetic background, NJ can result from different aetiologies which may show variation even within regions of the same country.1 2 A modelling study which was published in 2016 estimated that extreme hyperbilirubinaemia, including haemolytic aetiologies, might be responsible for a mortality rate of 1.19 over 1000 live births in LMICs in comparison to 0.01 over 1000 live births in high-income countries (HICs). The prevalence of kernicterus in sub-Saharan Africa, Latin America, Eastern Europe/Central Asia and South Asia regions was estimated as high as 0.73/1000 in comparison …