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March of Dimes Prematurity Research Center at Stanford University School of Medicine Bill and Melinda Gates Foundation BACKGROUND: Rhesus (Rh) disease and extreme hyperbilirubinemia (EHB) result in neonatal mortality and long-term neurodevelopmental impairment, yet there are no estimates of their burden.METHODS: Systematic reviews and meta-analyses were undertaken of national prevalence, mortality, and kernicterus due to Rh disease and EHB. We applied a compartmental model to estimate neonatal survivors and impairment cases for 2010.RESULTS: Twenty-four million (18% of 134 million live births >= 32wk gestational age from 184 countries; uncertainty range: 23-26 million) were at risk for neonatal hyperbilirubinemia-related adverse outcomes. of these, 480,700(0.36%) had either Rh disease (373,300; uncertainty range: 271,800-477,500) or developed EHB from other causes (107,400; uncertainty range: 57,000-131,000), with a 24% risk for death (114,100; uncertainty range: 59,700-172,000), 13% for kernicterus (75,400), and 11% for stillbirths. Three-quarters of mortality occurred in sub-Saharan Africa and South Asia. Kernicterus with Rh disease ranged from 38, 28, 28, and 25/100,000 live births for Eastern Europe/Central Asian, sub-Saharan African, South Asian, and Latin American regions, respectively. More than 83% of survivors with kernicterus had one or more impairments.CONCLUSION: Failure to prevent Rh sensitization and manage neonatal hyperbilirubinemia results in 114,100 avoidable neonatal deaths and many children grow up with disabilities. Proven solutions remain underused, especially in low-income countries. Hosp Sick Children, Programme Global Paediat Res, Toronto, ON M5G 1X8, Canada Stanford Univ, Dept Pediat, Div Neonatal & Dev Med, Sch Med,Lucile Packard Childrens Hosp, Stanford, CA 94305 USA London Sch Hyg & Trop Med, Fac Epidemiol & Populat Hlth, London WC1, England Saving Newborn Lives Save Children, New Delhi, India St Michaels Hosp, Keenan Res Ctr, Li Ka Shing Knowledge Inst, Toronto, ON M5B 1W8, Canada St Michaels Hosp, Dept Paediat, Toronto, ON M5B 1W8, Canada Aalborg Univ Hosp, Dept Pediat, Aalborg, Denmark Natl Ctr Child Hlth & Dev, Dept Hlth Policy, Tokyo, Japan Univ Minnesota, Ctr Global Pediat, Minneapolis, MN USA Kasr Al Aini Univ, El Mounira Childrens Hosp, Dept Pediat, Cairo, Egypt All India Inst Med Sci, WHO Collaborating Ctr Training & Res Newborn Care, New Delhi, India Zhejiang Univ, Sch Med, Childrens Hosp, Hangzhou 310003, Zhejiang, Peoples R China Nigerian Soc Neonatal Med, Lagos, Nigeria Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil Ctr Hlth Start Initiat, Lagos, Nigeria Post Grad Inst Med Educ & Res, Chandigarh, India London Sch Hyg & Trop Med, Ctr Maternal Reprod & Child Hlth, London WC1, England Saving Newborn Lives Save Children, Washington, DC USA Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil Web of Science