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

Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels.

Author information

  • 11] Programme for Global Paediatric Research (PGPR), Hospital for Sick Children, Toronto, Ontario, Canada [2] Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, California.
  • 2Programme for Global Paediatric Research (PGPR), Hospital for Sick Children, Toronto, Ontario, Canada.
  • 3Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
  • 4Saving Newborn Lives/Save the Children, New Delhi, India.
  • 5Keenan Research Centre, Li Ka Shing Knowledge Institute & Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario, Canada.
  • 6Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark.
  • 7Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
  • 81] Programme for Global Paediatric Research (PGPR), Hospital for Sick Children, Toronto, Ontario, Canada [2] Center for Global Pediatrics, University of Minnesota, Minneapolis, Minnesota.
  • 9Department of Pediatrics, Kasr Al Aini University, El Mounira Children's Hospital, Cairo, Egypt.
  • 10WHO Collaborating Centre for Training & Research in Newborn Care, All India Institute of Medical Sciences, New Delhi, India.
  • 11The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, The People's Republic of China.
  • 12Nigerian Society of Neonatal Medicine, Lagos, Nigeria.
  • 13Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
  • 14Center for Healthy Start Initiative, Lagos, Nigeria.
  • 15Post Graduate Institute of Medical Education and Research, Chandigarh, India.
  • 161] Centre for Maternal Reproductive & Child Health, London School of Hygiene & Tropical Medicine, London, UK [2] Saving Newborn Lives/Save the Children, Washington, DC.



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


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.


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.


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.

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