Neonatal Hyperbilirubinemia in Uganda: Mechanisms, Clinical Consequences, and Health-System Challenges

Neonatal hyperbilirubinemia is a prevalent condition characterized by elevated serum bilirubin levels, affecting approximately 50% of term and 80% of preterm infants. While mild cases often resolve without intervention, severe hyperbilirubinemia can lead to life-threatening complications such as bilirubin-induced neurological dysfunction (BIND) and kernicterus, resulting in permanent brain damage, developmental delays, and hearing impairment.

A literature review was conducted by searching PubMed, Google Scholar, and UpToDate for English-language articles published between January 2010 and March 2025 on neonatal hyperbilirubinemia. Inclusion criteria were studies on mechanisms, clinical outcomes, and interventions in low- and middle-income countries (LMICs), with a focus on Uganda. Exclusion criteria included case reports, non-English studies, and articles without primary data.

The condition arises from an imbalance between bilirubin production and elimination, influenced by immature liver function, increased red blood cell turnover, enhanced enterohepatic circulation, and genetic predisposition. In low-income countries such as Uganda, additional contributors include delayed postnatal care-seeking, limited availability of phototherapy units, and inadequate early screening programs. The low-income country has inappropriate early screening and poor treatment options, which further exacerbate the burden, contributing to preventable neonatal morbidity and mortality.

Timely screening, improved access to phototherapy and exchange transfusion, and increased awareness among healthcare providers and caregivers are essential for reducing the impact of neonatal hyperbilirubinemia. By integrating biological mechanisms, clinical consequences, and health-system challenges into a single synthesis, this review provides novel, actionable insights for policy-makers and clinicians in Uganda.