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

Often a benign condition, the yellowish discolouration of the skin, sclerae, and mucous membranes in newborn infants is caused by unconjugated hyperbilirubinaemia, which may result from increased production of bilirubin, limited ability to conjugate bilirubin, and/or slow hepatic-enteric clearance of bilirubin.1 A small proportion of newborns develops extreme hyperbilirubinaemia, that is, a total serum bilirubin (TSB) level of 25 mg/dL (428 µmol/L) or more. [...]in South Asia severe hyperbilirubinaemia is the seventh leading cause of neonatal mortality.1 When timely recognised, clinically significant hyperbilirubinaemia can be treated with conventional phototherapy and in more severe cases exchange transfusion, thus reducing the risk of KSD. Low-cost and minimally invasive tools for hyperbilirubinaemia recognition including smartphone technology and point-of-care TSB quantification have emerged and may hold promise for early detection of hyperbilirubinaemia in poor-resource settings.1 Proper education of communities and healthcare providers remains essential to increase awareness of the main risk factors for severe hyperbilirubinaemia, and facilitate early recognition, timely referral for evaluation and treatment, and adequate follow-up.