Low- and middle-income countries need to pay urgent attention to G6PD deficiency to curtail the preventable burden of jaundice-related morbidity, mortality and disability.

Summaryobjectives To establish the incidence, correlates and hearing screening outcomes of infants with severe neonatal jaundice in Nigeria.methods Community-based study in which all infants attending Bacille Calmette-Guérin immunisation clinics in inner-city Lagos were enrolled into a universal hearing screening programme during which correlates of severe neonatal jaundice (requiring phototherapy and ⁄ or exchange blood transfusion) were explored with multivariable logistic regression.results Of the 5262 infants enrolled, only 48.7% were born in hospitals although almost all mothers (97.9%) attended antenatal clinics. 6.7% had a history of neonatal jaundice of whom 5.5% (95% CI:4.9-6.2) received phototherapy and 1.9% (95% CI:1.5-2.3) had an exchange blood transfusion. Factors independently associated with severe neonatal jaundice were maternal religion, occupation, use of herbal preparations during pregnancy, infant's gender, weight at screening, multiple gestation and place of birth. All but two infants with severe neonatal jaundice were exclusively breast-fed. Of those who failed the hearing tests, 17.3% were treated with phototherapy and 11.3% had an exchange blood transfusion. At least 8.9% of infants requiring phototherapy and 17.3% of those requiring exchange blood transfusion were at risk of sensorineural hearing loss.conclusions Severe neonatal jaundice is a significant condition associated with modifiable risk factors in this population. Policy initiatives for prevention, early detection followed by appropriate and timely intervention are urgently needed to reduce the disease burden.

BACKGROUND AND OBJECTIVE: Transcutaneous bilirubin (TcB) correlates positively with total serum bilirubin (TSB) across different racial populations. However, little is known about the pattern of divergence between TcB and TSB at individual patient-level and the relationship with TcB measuring techniques among African neonates. This study, therefore, investigates TcB-TSB discrepancies and the contribution of 2 models of transcutaneous bilirubinometers to the observed divergence in a black African population.

In line with global progress towards early detection of permanent congenital and early-onset hearing loss (PCEHL), the costs and performance of hospital-based and community-based infant hearing screening models were evaluated in Lagos, Nigeria. The protocol consisted of two-stage screening with transient-evoked otoacoustic emissions and automated auditory brainstem response followed by diagnostic evaluation for all infants referred after the second-stage screening. The main outcome measures were referral rates at screening, cost per baby screened, cost per case detected and yield for PCEHL. First-stage referrals were 32.2% for universal and 31.7% for targeted screening in the hospital, compared with 14.3% and 15.2%, respectively for the community-based programme. Second-stage referrals ranged from 3.3% under hospital-based universal screening to 4.9% under community-based targeted screening. The highest yields of 27.4 and 22.5 per 1000 were recorded under community-based targeted and universal screening, respectively. Screening cost per child was lowest (US$7.62) under community-based universal screening and highest (US$73.24) under hospital-based targeted screening. Similarly, cost per child detected with PCEHL was lowest (US$602.49) for community-based universal screening and highest (US$4631.33) for hospital-based targeted screening. Community-based universal screening of infants during routine immunisation clinics appears to be the most cost-effective model for early detection of PCEHL in low-income countries.

Filtered sunlight was noninferior to conventional phototherapy for the treatment of neonatal hyperbilirubinemia and did not result in any study withdrawals for reasons of safety. (Funded by the Thrasher Research Fund, Salt Lake City, and the National Center for Advancing Translational Sciences of the National Institutes of Health; Clinical Trials.gov number, NCT01434810.).