Data Sheet 1_Cross-cultural beliefs and practices of caregivers regarding sunlight exposure for newborn jaundice: a scoping review.pdf

Background

Neonatal jaundice affects most newborns worldwide and remains a major cause of preventable bilirubin-induced neurological injury in low-resource settings. Although most clinical guidelines recommend standardised electrically powered phototherapy and discourage sunlight exposure for newborns with jaundice due to safety concerns, uncontrolled exposure to direct sunlight remains widespread in many communities. We aimed to chart cross-cultural beliefs and practices regarding sunlight exposure for newborn jaundice to inform safer newborn care.

Methods

We conducted a scoping review using the Arksey and O’Malley methodological framework and PRISMA-ScR guidance. PubMed, Scopus, Medline, Embase, Global Health, APA PsycINFO, Allied & Complementary Medicine, and other sources were searched for studies published between January 2000 and April 2026. Eligible studies included reports on knowledge, attitudes, practices, or recommendations regarding sunlight exposure for neonatal jaundice among mothers, caregivers, healthcare workers, or within health systems. Data were extracted using a standardised charting form and synthesised descriptively by geographical region. The review protocol was registered on the Open Science Framework (OSF).

Results

Of 1,043 records, 109 studies from 30 countries met the inclusion criteria: Sub-Saharan Africa (n = 40), Middle East/North Africa (n = 25), South Asia (n = 22), East Asia/Pacific (n = 13), Europe (n = 3), North America (n = 3) and Latin America/Caribbean (n = 3); 88% were quantitative cross-sectional surveys of mothers and caregivers. Most of the included studies (87/109 or 79.8%) were identified outside the major databases. The proportion of respondents endorsing or practising unsupervised sunlight exposure ranged from 1.1 to 100% with marked regional gradients. Health-care workers were a major source of advice, with up to 84% of nurse-midwives recommending sunlight in some settings. Early-morning unfiltered exposure (08:00–10:00 h) for 15–30 min daily was the modal practice. Adverse effects, including sunburn, dehydration, hyperthermia and delayed facility presentation, were under-reported.

Conclusion

Despite safety concerns and recommendations in several clinical guidelines in high-income countries discouraging direct sunlight exposure for neonatal jaundice, unsupervised sunlight exposure for newborn jaundice remains widespread, professionally endorsed, and inadequately scrutinised for potential harm. Improving access to conventional phototherapy, strengthening caregiver education, and evaluating safe alternatives in resource-constrained settings should be prioritised to ensure optimal newborn care.