Smart Phototherapy and Bilirubin Management in Neonatal Jaundice: Emerging Technologies, Decision Support, and Equity Considerations (Published)
Neonatal jaundice is common, but delayed recognition and suboptimal treatment can still lead to acute bilirubin encephalopathy and kernicterus, particularly where bilirubin testing and effective phototherapy are inconsistently available. This narrative review critically examines recent developments in bilirubin assessment, phototherapy delivery, and digital decision support, with attention to both the promise and the limitations of current evidence. Transcutaneous bilirubin devices remain useful screening tools, and measurements from photo-protected skin sites can improve accuracy during phototherapy, although confirmatory total serum bilirubin testing remains important when management decisions are uncertain. Smartphone-based screening tools and low-cost point-of-care devices may expand access, especially after discharge and in resource-constrained settings, but external validation, calibration, and skin-tone performance remain major concerns. LED phototherapy has improved irradiance control and energy efficiency, while filtered sunlight and other context-appropriate systems may help bridge treatment gaps where electricity is unreliable. Digital nomograms and electronic follow-up pathways can support safer care, yet they should complement rather than replace clinical assessment and laboratory confirmation. Overall, smarter bilirubin management is promising, but equitable implementation requires validated devices, accurate reference standards, strong clinical governance, and careful adaptation to local resources.
Keywords: Infant, bilirubin, hyperbilirubinemia, neonatal phototherapy, newborn, point-of-care systems