Globally, health care providers worldwide recognize that severe
neonatal jaundice is a "silent" cause of significant neonatal morbidity and mortality. Untreated
neonatal jaundice can lead to death in the neonatal period and to
kernicterus, a major cause of neurologic disability (choreo-
athetoid cerebral palsy,
deafness, language difficulty) in children who survive this largely preventable neonatal tragedy. Appropriate technologies are urgently needed. These include tools to promote and enhance visual assessment of the degree of
jaundice, such as simpler transcutaneous
bilirubin measurements and readily available serum
bilirubin measurements that could be incorporated into routine treatment and follow-up. Widespread screening for glucose-6-phoshate
dehydrogenase deficiency is needed because this is often a major cause of
neonatal jaundice and
kernicterus worldwide. Recognition and treatment of Rh hemolytic disease, another known preventable cause of
kernicterus, is critical. In addition, effective
phototherapy is crucial if we are to make
kernicterus a "never-event." Finally it is essential that we conduct appropriate population-based studies to accurately elucidate the magnitude of the problem. However, knowledge alone is not sufficient. If we are to implement these and other programs and technologies to relegate severe
neonatal jaundice and its sequelae to the history books, screening and interventions must be low cost and technologically appropriate for low and middle income nations.