Editorial: Building Evidence to Manage Newborn Jaundice Worldwide

Excerpt

Newborn jaundice is universal and usually benign; but when progressive it can be effectively managed in any population through systematic screening (prenatal and postnatal) for identifiable risk factors, any attention to optimal breast milk intake and use of prophylactic phototherapy [1, 2]. Worldwide, about 14.1 million babies (about 10.5% of live births) annually are likely to require phototherapy (Fig. 1). Though use of phototherapy is evidence-based, proven, non-intrusive and non-expensive, more than 6 million (~45%) of at-risk infants do not have access to this life-saving and effective intervention [3]. Conservatively, approximately 1.4 million infants sustain bilirubin >25 mg/dL (427 μmol/L) every year, an extreme level of over 99.9th percentile, that places them at an unacceptable high risk for the most easily preventable neonatal brain injury. At least 2.4 million (40%) infants represent those without access to phototherapy in Central and South Asia. Of these, an unknown number are candidates for exchange transfusion which, when conducted, is often delayed or life threatening. Exchange transfusion is akin to a “crash-landing” and is not a therapeutic or public health solution. In view of the narrow safety margin, a more effective proven approach is the systematic timely and efficient intervention without a need for a resort to exchange transfusion [1, 2, 4].

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