Alternative Approaches for the Management of Jaundice in Infants before Birth beyond Phototherapy

Abstract

Neonatal jaundice is a prevalent condition characterised by elevated bilirubin levels resulting in yellow discolouration of the skin and sclera in newborns. While phototherapy remains the primary and most effective treatment modality, various clinical scenarios demand alternative or adjunctive management strategies, especially in cases of severe hyperbilirubinemia refractory to phototherapy, hemolytic disease, or limited access to phototherapy in resource-constrained settings. This manuscript comprehensively reviews the recent advances and evidence-based alternative approaches to managing neonatal jaundice beyond phototherapy.

Exchange transfusion continues to be a critical life-saving intervention for infants exhibiting dangerously high bilirubin levels or inadequate response to phototherapy, rapidly reducing circulating bilirubin and removing causative antibodies in hemolytic disease. Feeding optimisation through frequent breastfeeding or supplemental formula enhances bilirubin clearance by promoting stooling and reducing enterohepatic circulation. Pharmacological agents such as intravenous immunoglobulin (IVIG) have demonstrated efficacy in immune-mediated hemolysis by interrupting antibody-mediated red cell destruction. Emerging adjuvants like probiotics show promise in modulating gut flora, facilitating bilirubin metabolism, and reducing phototherapy duration.

In low-resource settings, filtered sunlight therapy offers a cost-effective, practical alternative when conventional phototherapy is unavailable, although this requires careful implementation to prevent ultraviolet damage. Additional adjunctive measures, including infant massage to promote bowel motility, have been explored, though robust clinical evidence remains limited. Traditional and herbal remedies are widely used globally but lack rigorous safety and efficacy data to recommend routine use.

The manuscript synthesises current international clinical guidelines, including those by the American Academy of Paediatrics and NICE, highlighting the critical role of universal bilirubin screening, early risk assessment, and individualised treatment plans. Continued research is necessary to validate alternative and complementary interventions, optimise outcomes, and ensure equitable neonatal care worldwide.