Global, regional, national trends and economic evaluation of neonatal hyperbilirubinemia burden, 2003-2023.

Severe neonatal hyperbilirubinemia remains a preventable cause of neonatal death and lifelong neurologic disability, yet contemporary global estimates are limited. Using Global Burden of Disease 2023 data for 204 countries, we analyzed incidence, deaths, and disability-adjusted life-years (DALYs) from extreme hyperbilirubinemia (EHB) among neonates from 2003 to 2023, applying joinpoint regression, income-stratified k-means clustering and correlation analysis, and value-per-statistical-life (VSL) and human-capital economic valuation. Globally, incident cases fell 29% (542,966-387,366) and deaths fell 66% (70,907-24,050); the mortality-to-incidence ratio halved from 13.1% to 6.2%. The average annual percent change was -1.5% for incidence and -5.0% for mortality. The Middle East and North Africa had the largest declines in cases (61%) and deaths (72%). In 2023, South Asia and Sub-Saharan Africa accounted for 68% of incident cases and 90% of deaths, lower-middle-income countries for roughly two-thirds of deaths and DALYs, and India, Pakistan, and Nigeria for about half of global mortality. Incidence and mortality were strongly correlated in low-income countries (r = 0.72) but decoupled in upper-middle-income countries (r = 0.19; P = 0.167). The 2023 burden represented $6.9-10.4 billion in VSL-based welfare losses and $13.0 billion in DALY-based human-capital losses. Progress is substantial but uneven across World Bank regions and income groups. IMPACT: Severe neonatal hyperbilirubinemia and kernicterus remain important causes of preventable neonatal death and lifelong neurologic disability. Contemporary evidence is limited on how the burden has changed across regions and income groups and whether neonatal jaundice incidence remains closely associated with mortality. Between 2003 and 2023, modeled incident cases decreased by 29%, while deaths declined by 66%. The burden was mostly concentrated in South Asia, Sub-Saharan Africa, and lower-middle-income countries. Incidence was strongly associated with mortality in low-income settings but largely decoupled from mortality in upper-middle-income settings. Future studies should link burden estimates with screening coverage, bilirubin measurement, phototherapy quality, referral capacity and long-term neurodevelopmental outcomes to identify modifiable health-system factors and guide context-specific interventions.