Evaluating the Impact of Phototherapy on Serum Bilirubin Levels and Clinical Outcomes in Neonates: A Single-Center Retrospective Study in a Resource-Limited Setting in Somalia

Background: Neonatal hyperbilirubinemia is a major cause of preventable morbidity and mortality in low- and middle-income countries. Phototherapy remains the primary treatment strategy; however, its real-world effectiveness and clinical outcomes in Somalia are poorly documented. Objective: To evaluate the effectiveness of phototherapy in reducing serum bilirubin levels and to identify predictors of mortality among neonates treated for hyperbilirubinemia in a resource-limited Somali NICU. Methods: This retrospective cohort study was conducted among neonates treated with phototherapy at Mogadishu Somali–Türkiye Recep Tayyip Erdoğan Training and Research Hospital between January 2023 and December 2024. Demographic, clinical, and laboratory data were extracted from NICU records. Paired t-tests and Wilcoxon signed-rank tests were used to compare pre- and post-treatment bilirubin levels. Independent t-tests and ANOVA were used to evaluate subgroup differences, and multivariable logistic regression was performed to identify predictors of mortality. Results: A total of 110 neonates were included; 58.2% were male and 35.5% were preterm. Mean baseline total serum bilirubin(TSB) was 17.29 ± 7.91 mg/dL, which decreased to 9.10 ± 4.90 mg/dL following phototherapy(mean reduction 8.19 ± 7.09 mg/dL). Positive blood cultures were identified in 18(16.4%) cases. Effectiveness did not differ significantly by sex, gestational age group, duration of phototherapy, or feeding method. Overall all-cause in-hospital mortality was 16.4% (n=18). In multivariable analysis, only birth weight was independently associated with mortality(aOR 0.34; 95% CI: 0.12– 0.97). Baseline bilirubin level and bilirubin reduction did not independently predict death. Conclusion: Phototherapy significantly reduced serum bilirubin levels across all neonatal subgroups, supporting its effectiveness in resource-limited settings. However, mortality remained high and was primarily associated with low birth weight rather than bilirubin severity or treatment response. Strengthening neonatal intensive care services and improving early detection and management are essential to improve survival outcomes in Somalia. Keywords: neonatal jaundice, phototherapy, hyperbilirubinemia, low birth weight, mortality, Somalia