Neonatal jaundice: Why haven’t we achieved global access to phototherapy?

This blog was originally published by the Healthy Newborn Network.

By Donna Brezinski on October 1, 2014

Topics: Newborn Illnesses and ConditionsPostnatal CarePreterm Birth

Regions: AfricaAsiaEuropeLatin America and CaribbeanMiddle East

The Saving Lives at Birth Grand Challenge calls on the brightest minds across the globe to identify and scale up transformative prevention and treatment approaches for pregnant women and newborns around the time of birth. Stay tuned to the Healthy Newborn Network blog as we share a number of innovations showcased at this year's DevelopmentXchange.

In developing regions of the world, neonatal jaundice is a persistent nemesis. It stands apart from other threats to newborn health, like pneumonia, that present with clear and immediate symptoms. The very nature of jaundice, its onset and progression, expose the gaps in existing patterns of newborn health care that help to explain the residual high death and disability rates:

It is deceptive. Many of the newborns that ultimately succumb to severe neonatal jaundice are born at full term and appear healthy.

It is common. About 60% of all term newborns have some degree of jaundice. The fact that most will recover without intervention can give a false sense of security.

It is stealthy. Jaundice typically evolves over the first few days of life. It becomes symptomatic around day 3 or 4, a time when most newborns, including those delivered in health care facilities, are at home.

It is under-recognized. Some developing areas do not have sufficient resources, like adequately trained health care workers and screening programs, for identifying at-risk newborns. Warning signs, such as progressive yellowing of the skin or dehydration, may go unrecognized by family members until the infant becomes very ill.

It is time-sensitive: Often the first indicator to a mother that something is wrong is that her baby is lethargic and won’t feed. Once this happens, jaundice has progressed to the point where treatment must occur rapidly. Failure to treat rapidly can result in permanent brain injury or death.

Poor outcomes for jaundiced infants in developing countries are especially tragic because, in the context of medical therapies, the preferred treatment is a very simple one – phototherapy. Shining a bright blue light on the skin continuously for 2 to 3 days cures nearly 100% of infants, provided that the treatment is begun quickly. I have personally encountered very few treatments in my medical career that can boast of such a high success rate. If newborn babies are dying from this condition, we are failing.

Why are we failing? I believe it is because efforts have been focusing on only part of the problem. Wherever there are jaundiced babies in developing countries not receiving phototherapy treatment, the response is to provide donated devices or more affordable ones resembling those used in developed countries. Those devices are only useful in urban hospitals that have the reliable electricity and trained personnel needed to operate them. In many developing countries large segments of the population live in rural or tribal areas, far from urban hospitals. For symptomatic jaundiced newborns in those areas, receiving phototherapy treatment requires travel to the city. For some, the additional treatment delay, not to mention the stress of being transported far distances, can have devastating consequences. Others never make the trip at all.

So in addition to the list inherent characteristics associated with risk of poor outcome for neonatal jaundice, we should add another important consideration:

Access.

For years it has been stated that poor outcomes from a condition as treatable as jaundice should be a “never event.” But, as we have discovered, delivery of an intervention as simple as phototherapy in some parts of lower-income countries is still deceptively complex. Morbidity and mortality from jaundice is disproportionately high in rural and tribal regions. Fully addressing this problem will require better local access to phototherapy, as well as to preventative diagnostic interventions.

At Little Sparrows Technologies, we have designed the Bili-Hut™ phototherapy device to make jaundice treatment globally accessible. Our guiding principle is that the user is central and the design elements must address the challenges the user may face.


Our prototype meets the American Academy of Pediatrics requirements for high intensity phototherapy and can be manufactured at low cost. But most importantly, it considers the more difficult challenges faced by users in remote areas without electricity or trained health workers.


The Bili-Hut™ can operate for an extended time on a 12V battery. It weighs only 3 pounds and can be transported in a standard shipping tube. Its tent-like configuration is not only intuitive to set up and use, it also keeps the light fixed at the appropriate height from the baby so that effective treatment is guaranteed with each use.

Bringing the cure out of urban hospitals and closer to the patient means that treatment can occur earlier, and that mothers and babies need not separated. This is not only a big a win for treating jaundice, but also one for promoting breastfeeding, which has its own, significant health benefits for both the baby and the mother.

We are about to begin field studies in India to further develop the Bili-Hut™. We expect to learn what further changes the Bili-Hut™ will need to undergo to best suit this context. But we will be learning from the best teachers. As long as we look to users to guide us, we know we will get it right.

Little Sparrows Technologies LLC was the recipient of the Peer Choice Award and a Seed Grant nominee in the 2014 Saving Lives at Birth Grand Challenge.

From an applicant pool of nearly 500 proposals, Little Sparrows Technologies LLC received one of 26 seed grants at the 2014 Saving Lives at Birth Grand Challenge. Co-sponsored by USAID, the Bill and Melinda Gates Foundation, Grand Challenges Canada, the Government of Norway, and DFID(UK), these awards provide up to $250,000 to support the development and validation of ideas capable of impacting health outcomes for pregnant women and their babies in low-resource settings. In addition, their proposal for the Bili-Hut™ was the recipient of the Peer Choice Award, voted by 52 fellow finalists as the proposal having the highest potential for impact in maternal-newborn health.