Can Newborn Death or Disability from Severe Jaundice Become a “Never Event” in Myanmar?

Jaundice is a killer. Not in the United States, where mortality and morbidity from severe jaundice is almost unknown, but in places like Myanmar and West Africa, where phototherapy—a simple and cost-effective light treatment—is largely unavailable.

Worldwide, 60% of newborns experience infant jaundice. Of those, one in ten will require treatment with phototherapy to prevent the possibility of serious complications, including kernicterus, a severe form of brain damage. Yet each year, 5.7 million jaundiced newborns in South Asia and Africa receive no phototherapy.

Phototherapy treatment, when available and properly administered, is amazingly effective. In a recent discussion with Dr. Priscilla Joe, Medical Director of the Neonatal Intensive Care Unit at Children’s Hospital Oakland and medical consultant to international development organization East Meets West, she noted that newborn brain injury from jaundice is so rare in the United States that the U.S. National Quality Forum lists it as a “never event,” or, in other words, “The kind of preventable and tragic outcome that should never happen in a healthcare setting. Period.” 

Yet around the globe, newborns continue to die due to complications caused by jaundice. The situation in a country like Myanmar, for instance, stands in stark contrast with the excellent outcomes in the United States.

Most hospitals in Myanmar lack a safe, robust, and inexpensive device to deliver phototherapy. An urban hospital in Yangon may have a donated phototherapy machine, but often it sits unused—broken or lacking parts that are too expensive to replace. A functioning machine intended to treat one newborn is commonly used to treat multiple sick babies simultaneously, exposing some to too little healing light and all to an increased risk of infection. If this sub-optimal treatment fails, the only intervention remaining is a blood “exchange transfusion,” with the attendant risk to the infant of transfusion reaction, blood clots, infection and shock. 

January 2014 saw a welcome change at 22 hospitals in Myanmar, as international development organization East Meets West, with support from Italian NGO Amici della Neonatologia Trentina, coordinated the delivery of specially designed, engineered and manufactured phototherapy machines that address these challenges. The device, called the Firefly is the product of an innovative collaboration among East Meets West, industrial design firm Design that Matters and medical device manufacturer MTTS Asia. (This design partnership is described in detail in The East Meets West Foundation I: Expanding Organizational Capacity,” published by the Stanford Center for Innovation in Global Health, Innovation Insight Series, June 2012.) EMW’s Breath of Life neonatal care program ensures that the machines are accompanied by trainings for clinicians and nurses in topics including machine use; early identification and management of jaundice; and parent education. Warranties, technical support, and manuals in the Burmese language all contribute to ease of use and proper maintenance of the machines.

So in January, clinicians at North Okkalapa Teaching Hospital in Yangon were able to quickly and correctly diagnose Ms. Ye Ye’s newborn with severe jaundice. The infant was then treated in a Firefly-- with just the right amount of light coming from above and below--and the newborn’s condition was monitored by nurses who had received training in using the machine and managing jaundice. A healthy baby and relieved mom left the hospital just a few days later. 

These newly installed Firefly phototherapy machines are expected to treat over 1,000 newborns per year and to have a profound impact on the speedy care of newborn jaundice, the near-elimination of the need for exchange transfusions and a reduction in kernicterus in these hospitals. 

East Meets West will conduct rigorous measurement and evaluation to track the effectiveness of the machines and the support provided by Breath of Life. As demonstrated results attract additional funding for Firefly deployment, more hospitals will have the equipment and training they need. The day may still be far off when brain damage or death caused by severe jaundice becomes a “never event” in Myanmarbut the Firefly illuminates a path forward.

Photo: A newborn with jaundice receives phototherapy treatment in a Firefly while mother looks on (January 2014 - Okkalapa Teaching Hospital in Yangon, Myanmar)