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  • Population Study Article
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Trends of extreme hyperbilirubinemia related infant mortality in select European countries (1990–2019)

Pediatric Research volume 98, pages 121–126 (2025)Cite this article

A Correction to this article was published on 03 February 2025

This article has been updated

Abstract

Background

Limited data exist on population-level mortality outcomes related to extreme neonatal hyperbilirubinemia (EHB) and this study examines trends in annual infant mortality rate (IMR) attributed to hemolytic and perinatal jaundice among Germany, France, Italy, Portugal, Greece and Spain from 1990 to 2019.

Methods

Data on annual incident cases and disability-adjusted life years were collected from the 2019 Global Burden of Disease study. Live birth cohort data were sourced from UN World Population Prospects. We quantified temporal trends, with relative percent changes. Average annual percent changes (AAPCs) were evaluated using the Joinpoint Regression Program.

Results

EHB-related infant mortality decreased from 21.4 (95%CI: 16.1, 27.1) in 1990 to 4.2 (95%CI: 1.9, 7.6) per million live births in 2019. Germany demonstrated lowest AAPC of –3.2% (95% CI: –3.8, –2.5), while Portugal had the highest AAPC of –8.6% (95% CI –11.9, –5.1) in reducing infant mortality due to EHB. There were distinct divergences in the trajectories of declining EHB mortality among the studied countries.

Conclusion

This study highlights a significant decline in infant mortality due to extreme hyperbilirubinemia, emphasizing the need for national surveillance and tailored guidelines to prevent bilirubin induced neurological damage.

Impact

  • This cross-sectional analysis revealed a marked decline in infant mortality rates attributed to extreme hyperbilirubinemia across the selected European countries.

  • The rates of decline varied significantly between countries, demonstrating notable heterogeneity in mortality trends when stratified by age at death.

  • Implementing data-driven surveillance systems can optimize the alignment of equitable healthcare services, strengthen accountability measures, and identify critical operational inefficiencies.

  • In the European Union, country-specific hyperbilirubinemia guidelines should be reinforced to ensure effective screening and post-discharge follow-up protocols that are tailored to risk burden and available healthcare resources.

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Fig. 1: Trends of extreme hyperbilirubinemia (EHB)-related mortality in infants (0–364 days) for select countries.
Fig. 2: Segmented joinpoint trends of extreme hyperbilirubinema (EHB)-related mortality in infants (0–364 days) for select countries.

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Data availability

All raw data were openly available from the Global Burden of Disease Results Tool (https://vizhub.healthdata.org/gbd-results/), Institute of Health Metrics and Evaluation, University of Washington, USA. Derived data supporting the findings of this study are available from the corresponding author [R.V] on request.

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Author information

Authors and Affiliations

  1. Department of Neonatology, Cayuga Medical Center of Ithaca, Ithaca, NY, USA

    Ramesh Vidavalur

  2. Weill Cornell Medicine, New York, NY, USA

    Ramesh Vidavalur

  3. Childrens Hospital St. Marien gGmbH, Teaching Affiliate of the Ludwig-Maximilians University of Munich, Germany Grillparzerstreet 9, 84036, Landshut, Germany

    Karl F. Schettler

  4. Director of Neonatal Intensive Care Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy

    Carlo Dani

  5. Department of Pediatrics, University of Patras, Rio, Patras, Greece

    Sotirios Fouzas

  6. Department of Neonatology, University of Coimbra, Coimbra, Portugal

    Gabriela Mimoso

  7. Director of the Neonatology Division and NICU, Hospital General Universitario “Gregorio Marañón”, Madrid, 28009, Spain

    Manuel Sanchez-Luna

  8. Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Vinod K. Bhutani

  9. Division of Pediatrics and Neonatal Critical Care, “A. Béclère” Medical Center, Paris; Saclay University Hospital, APHP—Paris, Paris, France

    Daniele deLuca

  10. Physiopathology and Therapeutic Innovation Unit, Paris Saclay University—Paris, Paris, France

    Daniele deLuca

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Contributions

R.V., D.deL., V.K.B.: responsible for conceptualization and design of the study. D.deL.: wrote the first draft of manuscript, interpreted the findings, reviewed and revised the final draft of manuscript. R.V.: Responsible for data collection, analyzed and visualized the data, wrote the first draft of manuscript, reviewed and revised the final manuscript. V.K.B.: provided critically important inputs into content of the manuscript, provided overall supervision, reviewed the final manuscript. K.F.S., M.S.L., C.D., S.F., and G.M.: Provided valuable inputs into country-level data, revised the manuscript for critically important content and approved the final version. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. All authors accept responsibility to submit for publication.

Corresponding author

Correspondence to Ramesh Vidavalur.

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The authors declare no competing interests.

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As the study used publicly available data with no patient specific information, it was deemed exempt from Institutional Review Board review.

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Vidavalur, R., Schettler, K.F., Dani, C. et al. Trends of extreme hyperbilirubinemia related infant mortality in select European countries (1990–2019). Pediatr Res 98, 121–126 (2025). https://doi.org/10.1038/s41390-024-03695-2

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