More than 14 million newborns worldwide require phototherapy for the treatment of jaundice, yet only six million have access to this treatment, making neonatal jaundice one of the 15 leading causes of neonatal deaths worldwide [1]. Jaundice is a very common symptom in newborns during the first days of life. It is usually a benign clinical expression of physiological excessive production of bilirubin in newborns. However, in rare cases, unconjugated hyperbilirubinemia in newborns can be toxic for the nervous system and requires urgent specific treatment such as exchange transfusion or phototherapy. Phototherapy effectively and safely prevents these serious medical conditions, consequences of excessive accumulation of bile pigments in the basal ganglia of the brain [2]. Without adequate treatment, neurological complications can compromise child's long term physical development (psychomotor retardation, severe physical disabilities) and even lead to immediate death [3]. Phototherapy uses special blue or green light to treat jaundice by changing bilirubin in the skin into a form that the body can more easily excrete [4,5].

Used continuously or intermittently, phototherapy significantly reduces the need for exchange transfusion, an invasive procedure which is still the only option in emergency situations where phototherapy is not available [6].

Phototherapy efficacy and indications have improved considerably since its first discovery by Cremer in 1958.4 Nowadays, there are two types of phototherapy equipment: conventional and fiber optic [7]. Countless factors may affect the potential of phototherapy, namely initial bilirubin level, birth weight, gestational age, age at the onset of jaundice, etiology of jaundice, phototherapy light intensity and spectral emission to name only few [8]. Side effects associated with intense phototherapy, such as hyperthermia, dehydration, sterility and retinopathy, have become very rare with systematic preventive measures during phototherapy sessions [2].

In resource constrained countries like Burkina Faso, routine management of neonatal jaundice using phototherapy is still a big challenge with many hurdlers: misinformation on the efficacy of phototherapy, limited laboratory capacity for rapid diagnosis of hyperbilirubinemia, high cost of phototherapy machines, irregular equipment maintenance, huge demand for phototherapy treatment in neonatal unities which are difficult to satisfy, and unreliable energy sources to ensure continuous operation of the devices.

In line with United Nations sustainable development goals, the Burkina Faso government has made a firm commitment to increase considerably resources necessary for the treatment of major newborn health conditions such as jaundice. Phototherapy machines are progressively available countrywide but the majority of the equipment is still concentrated in the capital city Ouagadougou. The objective of this survey was therefore to assess the current situation regarding the treatment of neonatal jaundice with phototherapy at the Yalgado Ouedraogo University Hospital in Ouagadougou.

It was a cross-sectional observational survey conducted from 20 October 2023 to 30 March 2024 in the pediatric department of Yalgado Ouedraogo University Hospital. Newborns who had jaundice and treated with phototherapy were included. Data collection was prospective and exhaustive. The study variables were newborns sociodemographic characteristics, jaundice characteristics on admission (onset mode, duration, associated clinical and biological signs, etiologies), techniques used for phototherapy and outcome upon discharge.

The following operational definitions and techniques were applied: jaundice was considered early onset if it began within the first three days following birth; hyperbilirubinemia was considered dangerous and phototherapy prescribed if the rate was higher than 10% of the newborn's weight or >350 umol/l regardless of weight. Protection of eyes and external male genitalia as well as sufficient hydration were applied during phototherapy. Skin color was assessed every day while bilirubinemia rate was controlled every 48 to 72 hours following the initiation of phototherapy until the newborn left hyperbilirubinemia danger zone.

Permission to collect and use the data was obtained from the authorities of the Yalgado Ouedraogo University Hospital.

Population Description

Of the 2,184 newborns admitted in inpatient ward, 168 (7.7%) had jaundice and 115 (68%) were treated with phototherapy. Among newborns treated with phototherapy; 74 ( 64.4%) were male, mean birth weight was 2,571.2 g +/- 636.01 g [extremes 1,000 g and 4,000 g]; fever was the main reason for admission in 78 (67.8%) cases and jaundice in 42 (36.5%) cases. Newborns characteristics prior to phototherapy are presented on Table1.

Table 1: Newborns characteristics prior to phototherapy at the inpatient children ward of Yalgado Ouedraogo University Hospital from 20/10/2023 to 30/03/2024 (N=115).

Jaundice Characteristics and Accompanying Symptoms/Signs

Jaundice was early onset in half of the newborns and pathological in 134 (89.6%) cases. Infection was the main cause of jaundice (Table 2). The mean rate of total bilirubinemia was 242.7 µmol/l +/- 136.4 µmol/l, with extremes of 58.7 µmol/l and 1025 µmol/l. The mean rate of unconjugated bilirubinemia was 232.6 µmol/l +/- 132.5 µmol/l, with extremes of 56 µmol/l and 1000 µmol/l.

Table 2: Jaundice characteristics and accompanying clinical signs in newborns prior to phototherapy at Yalgado Ouedraogo university hospital from 20/10/23 to 30/03/24 (N=115).

° Several causes of jaundice were possible in a newborn

Phototherapy Techniques and Equipment Used In Newborns with Hyperbilirubinemia

Conventional phototherapy was used intermittently in all patients (Figure 1).

Figure 1: Conventional phototherapy in children department of Yalgado Ouedraogo University hospital on March 2024.

Phototherapy was initiated more than 24 hours following the admission in 24 (20.9%) newborns. In 23 (20%) of them, there was at least one missing session of phototherapy per day, mainly due to malfunctioning of phototherapy devices. Table 3 shows techniques used for phototherapy in newborns. It should be noted that all patients had benefited from eye and external genitalia protection as well as hydration. The mean time of exposure to phototherapy was 5.2 days +/- 3.6 days.

Table 3: Phototherapy techniques used for treatment of jaundice at the children ward of Yalgado Ouedraogo University Hospital from 20/10/23 to 30/03/24 (N=115).

Outcomes in Newborns Treated With Phototherapy

In 97 (84, 3%) newborns, jaundice disappeared beyond three days of phototherapy. The mean length of hospital stay was 8.8 days +/- 3.4 days, with extremes of four days and 24 days. Hospital discharge modes were as follow: 110 (95.7%) recovered from the illness, three (2.6%) left without the doctor’s permission, and two (1.7%) died from complications of prematurity and birth asphyxia. None of the newborns experienced complications associated with phototherapy or hyperbilirubinemia during inpatient care.

Neonatal jaundice is a common symptom in our department. It was early onset and mostly associated with infection. The majority of newborns admitted with jaundice were treated with phototherapy. Phototherapy was initiated quite early following the admission. In all cases, it was discontinuous (every six hours) with frequent missed sessions. The duration of exposure to phototherapy necessary to leave the danger zone of hyperbilirubinemia was long.

The frequency of neonatal jaundice reported in different settings around the world depends on the sociodemographic characteristics of each population. It ranged from 4.9% in the Democratic Republic of Congo to 47% in India for exemple [9,10]. Physiological jaundice is frequent but mostly benign while pathological jaundice is typically associated with complications, hence the need for inpatient care. Jaundice is a common symptom in premature newborns hence the high rates of jaundice in studies with predominantly premature population [10]. Diagnosis of prematurity is easily made upon clinical examination unlike the majority of other causes of hyperbilirubinemia which require for confirmation sophisticated investigations. This can be very challenging for example in Yalgado Ouedraogo hospital where access to some of important laboratory tests is limited [11,12]. Therefore it is quite possible that in this survey, infections were over diagnosed while other causes of neonatal jaundice such as fetal-maternal blood incompatibility were underdiagnosed [9]. It should be highlighted that factors associated with hyperbilirubinemia such as infections must be subsequently diagnosed and managed so as to minimize the risk of complications.

As mentioned before, phototherapy efficiency depends on many factors such as the techniques and equipment used. The typical conventional phototherapy device (photo 1) widely used in resource constrained countries is effective but can be inconvenient [6]. For one thing it is restrictive, as it requires for newborns to be admitted in inpatient care and for them to be separated from their mothers during treatment sessions. On the other hand, LED lights produce intense heat which can be very uncomfortable and dangerous in hot climate environment such as that of Burkina Faso where temperatures can rise up to 45?C. As yet, our pediatric ward has a very poor ventilation system and depends heavily on air condition units which in turn are subject to frequent power shuts and misfunctioning.

Despite numerous constraints, conventional phototherapy will still remain in use in the majority of neonatal unities in Burkina Faso as it is less expensive and more available in the marketplace. It should be noted that the number of phototherapy devices in our department was very insufficient as the result the devices were often operating 24 hours nonstop hence the need for urgent actions. Providing sufficient quality phototherapy devices (energy-efficient and semi-automatic models) in neonatal unities can significantly reduce the risk of prolonged hyperbilirubinemia due to inefficient phototherapy.

Recently new phototherapy tools have been introduced in developed countries. They have the capacity to deliver the light directly to the baby's skin through optical fibers integrated into a mattress , mat, or soft blanket (billi blankets) [7]. These new devices offer many advantages: the fiber optics allow the light to be directed precisely onto a specific area of the skin, minimizing unnecessary exposure to caregivers and neighboring babies; the LEDs used produce less heat; the devices are more comfortable, allowing mother-child interaction (breastfeeding, kangaroo care, etc.) to continue [12]. In addition, they can be used in different environments (home, incubator, radiant warmer, etc.) [13,14]. Fiber optic phototherapy therefore reduce the harmful effects of prolonged exposure to high heat, especially during heat waves. In addition they can be used in the hard to reach communities provided newborns are in stable condition [14].

Apart from poor performance of equipment used in our department, the lack of treatment protocols adapted to local environment is also a big challenge although there is no clear consensus on the effectiveness of continuous phototherapy versa intermittent phototherapy [2]. Furthermore, it seems that side effects such as hyperthermia, dehydration, and ion imbalances are less frequent with intermittent phototherapy [2]. The time of exposure to phototherapy which is necessary to leave the danger zone for hyperbilirubinemia is also longer with intermittent phototherapy hence the high risk of complications in a long term and possibly longer hospital stay. However, long hospital stay (eight days) in our survey , is probably due to the co - existence of other underlying health conditions such as prematurity, birth defects and infections which require long time of care.

It is important to note that mortality rate was low in this survey. This can be explained by the small number of newborns enrolled and their relative stable condition on admission. Furthermore, newborns were followed up in a short time in the inpatient ward therefore it is possible that the rates of neurological sequelae and mortality were much higher after discharge. It is also crucial to highlight that three underlying conditions (prematurity, birth asphyxia and infections) are leading causes of neonatal mortality in Burkina Faso and elsewhere in developing countries.1 The study setting (national referral hospital) and the short period of the survey ( October - March) are also other limitations. For this, the results might not reflect the real situation of the general population in Burkina Faso.

Current phototherapy practices for newborns with hyperbilirubinemia need to be improved by introducing new effective modern equipment. Due to prolonged hyperbilirubinemia in some newborns as a consequence of inefficient phototherapy, long-term assessment of these high risk babies is essential.

1. World health organization, Newborn mortality. 2025.
2. Gottimukkala SB, Lobo L, Gautham KS, Bolisetty S, Fiander M, Schindler T. Intermittent phototherapy versus continuous phototherapy for Neonatal Jaundice. Cochrane Database Syst Rev. 2023; 3: 57.
3. Par EJ, Hughes CA, DeRico P. Neonatal Hyperbilirubinemia: Evaluation and Treatment. Am Fam Physician. 2023; 107: 525-534.
4. Cortey A, Pernel H. Efficacite des dispositifs medicaux de phototherapie dans le traitement de lhyperbilirubinemie du nouveau-ne. cite le. 2025.
5. Sender A, Cortey A. Prise en charge actuelle de lictere neonatal. J Pediatr Prat. 2019; 46.
6. Kramer LI. Phototherapy for Neonatal Jaundice. Amer J Child. 2021; 118: 454?458.
7. Mills JF, Tudehope D. Fibreoptic phototherapy for neonatal jaundice. Cochrane Database of Systematic Reviews. 2001; 1: CD002060.
8. Tan KL. Neonatal jaundice: update on phototherapy management. Ann Acad Med Singapore. 2016; 22: 225?228.
9. Mutombo JD, Kabuya MS, Kayembe CM, Luboya ON. Icteres pathologiques du nouveau-ne al hospital Bonzola de Mbuji-Mayi, Republique Democratique du Congo. Pan Afr Med J. 2023; 19: 302.
10. Dorji N, Raj Gurung M, Gyeltshen D, Singh Mongar K, Wangmoa S. Epidemiology of Neonatal Jaundice at Punakha District Hospital. Punakha, Bhutan. Int Health. 2023; 15: 505?511.
11. Rabesandratana N, Rasamimanana NG, Tatnke HT, Randaoharison P, Andrianarimanana D. Aspect epidemio-clinique des urgences medicales en neonatalogie a Mahajanga Madagascar. Rev Anesth Rea Med Urg. 2011; 3: 27?31.
12. Rasul CH, Hasan A, Yasmin F. Outcome of Neonatal Hyperbilirubinemia in a Tertiary Care Hospital in Bangladesh. Malays J Med Sci. 2010; 17: 40-44.
13. Jahan F, Parvez SM, Rahman M, Billah SKM, Yeasmin F, Jahir T, et al. Acceptability and operational feasibility of community health worker-led home phototherapy treatment for neonatal hyperbilirubinemia in rural Bangladesh Jahan . BMC Pediatrics. 2024; 24: 123.
14. Ung B, Suils H, Cohen C, Autret F, Walter-Nicolet E. Implementation of neonatal phototherapy with the BiliCocoon Bag® device in the maternity ward and impact on mother-infant separation. Arch Pediatr. 2023; 30: 283-290.
15. Niranjan T, Thangaraj A. Phototherapy for neonatal hyperbilirubinaemia: Unresolved aspects and future directions. Indian J Med Res. 2021; 153: 409-412.