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Why is kernicterus still a major cause of death and disability in low-income and middle-income countries?
  1. Bolajoko O Olusanya1,
  2. Tinuade A Ogunlesi2,
  3. Tina M Slusher3
  1. 1Centre for Healthy Start Initiative, Ikoyi, Lagos, Nigeria
  2. 2Department of Paediatrics, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
  3. 3Department of Pediatrics, University of Minnesota & Hennepin County Medical Center, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Bolajoko O Olusanya, Centre for Healthy Start Initiative, 286A Corporation Drive, Dolphin Estate, Ikoyi, P.O. Box 75130 VI, Lagos, Nigeria; boolusanya{at}, bolajoko.olusanya{at}


Neonatal jaundice is predominantly a benign condition that affects 60%–80% of newborns worldwide but progresses to potentially harmful severe hyperbilirubinaemia in some. Despite the proven therapeutic benefits of phototherapy for preventing extreme hyperbilirubinaemia, acute bilirubin encephalopathy or kernicterus, several low-income and middle-income countries (LMIC) continue to report high rates of avoidable exchange transfusions, as well as bilirubin-induced mortality and neurodevelopmental disorders. Considering the critical role of appropriate timing in treatment effectiveness, this review set out to examine the contributory factors to the burden of severe hyperbilirubinaemia and kernicterus based on the ‘three delays model’ described by Thaddeus and Maine in the 91 most economically disadvantaged LMICs with Gross National Income per capita ≤US$6000 and median human development index of 0.525 (IQR: 0.436–0.632). Strategies for addressing these delays are proposed including the need for clinical and public health leadership to curtail the risk and burden of kernicterus in LMICs.

  • Jaundice
  • Neonatology
  • Tropical Paediatrics
  • Neurodevelopment

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