Context To assess the global burden of late and/or poor management of severe neonatal jaundice (SNJ), a common problem worldwide, which may result in death or irreversible brain damage with disabilities in survivors. Population-based data establishing the global burden of SNJ has not been previously reported.
Objective Determine the burden of SNJ in all WHO regions, as defined by clinical jaundice associated with clinical outcomes including acute bilirubin encephalopathy/kernicterus and/or exchange transfusion (ET) and/or jaundice-related death.
Data sources PubMed, Scopus and other health databases were searched, without language restrictions, from 1990 to 2017 for studies reporting the incidence of SNJ.
Study selection/data extraction Stratification was performed for WHO regions and results were pooled using random effects model and meta-regression.
Results Of 416 articles including at least one marker of SNJ, only 21 reported estimates from population-based studies, with 76% (16/21) of them conducted in high-income countries. The African region has the highest incidence of SNJ per 10 000 live births at 667.8 (95% CI 603.4 to 738.5), followed by Southeast Asian, Eastern Mediterranean, Western Pacific, Americas and European regions at 251.3 (132.0 to 473.2), 165.7 (114.6 to 238.9), 9.4 (0.1 to 755.9), 4.4 (1.8 to 10.5) and 3.7 (1.7 to 8.0), respectively. The incidence of ET per 10 000 live births was significantly higher for Africa and Southeast Asian regions at 186.5 (153.2 to 226.8) and 107.1 (102.0 to 112.5) and lower in Eastern Mediterranean (17.8 (5.7 to 54.9)), Americas (0.38 (0.21 to 0.67)), European (0.35 (0.20 to 0.60)) and Western Pacific regions (0.19 (0.12 to 0.31). Only 2 studies provided estimates of clear jaundice-related deaths in infants with significant jaundice [UK (2.8%) and India (30.8%).
Conclusions Limited but compelling evidence demonstrates that SNJ is associated with a significant health burden especially in low-income and middle-income countries.
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Contributors TS and BOO conceptualised and designed the study, acquired data, analysed and interpreted data, supervised the study, drafted the manuscript and conducted a critical revision of the manuscript for intellectual content and approved the manuscript as submitted. TGZ conceptualised and designed the study, and assisted with acquiring data and approved the manuscript as submitted. AMS assisted in acquiring data and approved the manuscript as submitted. EMK and JUS were responsible for acquisition of data as well as providing administrative, technical and material support and approved the manuscript as submitted. SBR was responsible for acquisition of data, analysing and interpreting data and provided administrative, technical and material support and approved the manuscript as submitted. DA, MAS and BWL analysed and interpreted the data, conducted the statistical analysis, and conducted a critical revision of the manuscript for important intellectual content and approved the manuscript as submitted. All authors had full access to all data, take responsibility for the accuracy and integrity of the data and approved the manuscript as submitted.
Funding Support for the quantitative analysis was provided in part by The Programme for Global Paediatric ReSouth-East Asianrch, Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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