Neonatal Hyperbilirubinemia and Rhesus Disease of the Newborn: Incidence and Impairment Estimates for 2010 at Regional and Global Levels

Pediatr Res. 2013 Dec;74 Suppl 1(Suppl 1):86-100. doi: 10.1038/pr.2013.208.

Abstract

Background: Rhesus (Rh) disease and extreme hyperbilirubinemia (EHB) result in neonatal mortality and long-term neurodevelopmental impairment, yet there are no estimates of their burden.

Methods: Systematic reviews and meta-analyses were undertaken of national prevalence, mortality, and kernicterus due to Rh disease and EHB. We applied a compartmental model to estimate neonatal survivors and impairment cases for 2010.

Results: Twenty-four million (18% of 134 million live births ≥ 32 wk gestational age from 184 countries; uncertainty range: 23-26 million) were at risk for neonatal hyperbilirubinemia-related adverse outcomes. Of these, 480,700 (0.36%) had either Rh disease (373,300; uncertainty range: 271,800-477,500) or developed EHB from other causes (107,400; uncertainty range: 57,000-131,000), with a 24% risk for death (114,100; uncertainty range: 59,700-172,000), 13% for kernicterus (75,400), and 11% for stillbirths. Three-quarters of mortality occurred in sub-Saharan Africa and South Asia. Kernicterus with Rh disease ranged from 38, 28, 28, and 25/100,000 live births for Eastern Europe/Central Asian, sub-Saharan African, South Asian, and Latin American regions, respectively. More than 83% of survivors with kernicterus had one or more impairments.

Conclusion: Failure to prevent Rh sensitization and manage neonatal hyperbilirubinemia results in 114,100 avoidable neonatal deaths and many children grow up with disabilities. Proven solutions remain underused, especially in low-income countries.

Publication types

  • Historical Article
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Erythroblastosis, Fetal / epidemiology*
  • Erythroblastosis, Fetal / etiology
  • Erythroblastosis, Fetal / history
  • Global Health / statistics & numerical data*
  • History, 21st Century
  • Humans
  • Hyperbilirubinemia, Neonatal / epidemiology*
  • Hyperbilirubinemia, Neonatal / history
  • Incidence
  • Infant, Newborn
  • Models, Statistical
  • Rh Isoimmunization / complications
  • Rh Isoimmunization / epidemiology*
  • Rh Isoimmunization / history