Improving the Management of Hyperbilirubinemia in a Limited-Resource Area

Severe hyperbilirubinemia may damage the developing brain and remains more concerning in low and middle income countries (LMICs) than in high income countries (HICs). Severe hyperbilirubinemia is a preventable condition. Hence, we have to conduct novel research aiming to improve the quality of clinical practices on the diagnosis and management of jaundiced infants in Indonesia. This study found that management guidelines for jaundiced infants in Indonesia have already been developed. However, these guidelines are not uniformly applied by health workers and still based on international guidelines released by HIC countries. Our study revealed that various health care workers do not have sufficient knowledge, awareness, and adherence to hyperbilirubinemia management guidelines. Our research also investigated the utilization of non-invasive tools, i.e., a transcutaneous bilirubinometer, and a novel point of care (POC) bilirubin device targeted for jaundiced infants. This indicated that compared to TCB, the diagnostic accuracy of the POC device should be improved. The availability of such standardized tools in Indonesia is crucial to prevent severe hyperbilirubinemia . In analogy to other countries, phototherapy practices still require quality control ofapplied light irradiance. Meanwhile, a survey conducted in Indonesia found that 9 out of 17 hospitals still used phototherapy lamps with an irradiance level below the therapeutic standards, while 8 of these 17 hospitals did not have devices to measure phototherapy irradiance levels. This phenomenon could be an important contributor to the high incidence of severe hyperbilirubinemia in Indonesia. To improve adherence to the appropriate guidelines, we created a web-based application that integrates the new national guidelines for hyperbilirubinemia and socializes its usage. According to the observation before and after the introduction of this web-based app, we observed an increase in the correct management of hyperbilirubinemia