Neonatal jaundice in Global Majority babies: A Scoping Review of diagnostic and management practices in Western healthcare systems

Rationale for scoping review vs. systematic review For the chosen research question, a systematic review may be considered inappropriate as the literature is heterogenous and potentially underdeveloped conceptually (Munn et al., 2018). Additionally, as the research question is broad and exploratory, key concepts, especially surrounding how individuals are racialised within society are not clearly established. In contrast to a systematic review, a scoping review allows researchers to examine how a topic has been studied within literature, which populations have been included and also where gaps in literature exist (Arksey and O’Malley, 2005; Peters et. al. 2020). As the aim of this literature review is not to infer causality of an intervention relative to an outcome, a scoping review is preferred, as opposed to a systematic review where evidence synthesis may be the final output. The heterogeneity of the available evidence base in terms of study design e.g. grey literature, qualitative studies, policy documents and observational research may mean that a scoping review design is preferable. This is also due to the permission of the inclusion of multiple methodologies without requiring formal quality appraisal or meta-analysis processes (Levac, Colquhoun and O’Brien, 2010). What is more, scoping reviews identify research gaps and concepts which could justify a subsequent systematic review, which could then in turn synthesise existing evidence to inform policy changes (Tricco et al., 2018). As the research question focuses on perceptions and experiences as opposed to objective outcomes alone, a scoping review is preferred and commonplace within health service research in investigating how care is delivered in different population groups (Peters et al., 2020). A systematic review may not describe the nuance of social or institutional factors affecting healthcare delivery and experiences of clinicians. Research question: How do UK clinicians approach diagnosis and management of neonatal jaundice in global majority babies? A mixed methods study. Stage 1: Identification of the research question The objectives of this scoping review are to: 1. Map the existing evidence on how neonatal jaundice is diagnosed and managed in global majority babies within Western clinical settings. 2. Identify and describe clinical approaches, tools, and guidelines used by clinicians based in Western healthcare settings when assessing and managing neonatal jaundice in global majority infants. 3. Explore clinicians’ experiences, perceptions, and decision-making related to diagnosing and managing neonatal jaundice in global majority babies. 4. Identify reported challenges, uncertainties, and inequities in the diagnosis and management of neonatal jaundice affecting global majority babies. 5. Highlight gaps in the evidence base to inform future research, clinical guidance and policy development aimed at improving equity in neonatal jaundice care. Informed by the Joanna Briggs Institute (JBI) methodology for scoping reviews, these objectives align closely with the PCC framework to ensure methodological rigour (Peters et. al., 2020). To explore concepts, contexts, varying evidence and populations, a broad research question is chosen using the PCC (Population, Concept, Context) framework to adhere to methodological consistency (Peters et. al., 2020): ‘Neonatal jaundice in Global Majority babies: A Scoping Review of diagnostic and management practices in Western healthcare systems’ PCC Framework Application Population (P) • Global majority babies/neonates (may also be described in the literature as infants from Black, Asian, and other racially minoritised groups) Concept (C) • Diagnosis and management of neonatal jaundice • Clinical approaches, assessment methods (visual assessment, transcutaneous bilirubinometry, serum bilirubin testing) and management strategies following diagnosis by a health care professional/clinician Context (C) • Western healthcare settings • Clinical settings where neonatal care is provided (e.g. labour wards, birth centres, postnatal wards, neonatal units, transitional care units, community midwifery services) • Healthcare delivered within healthcare settings in North America, Australia, Western Europe PCC Inclusion and Exclusion Criteria Population Inclusion • Neonates (≤28 days of age) described as global majority babies, including but not limited to infants identified in the literature as: o Black, Asian, African, Caribbean, Middle Eastern, Mixed groups or other racially minoritised groups • Studies involving clinicians (e.g. midwives, neonatal nurses, paediatricians, neonatologists, general practitioners) providing care to global majority neonates Exclusion • Studies exclusively involving white infants with no disaggregated data for global majority babies • Studies focused on older infants or children (>28 days) Concept Inclusion • Clinical diagnosis of neonatal jaundice, including: o Visual assessment o Transcutaneous bilirubin measurement o Serum bilirubin testing o Use of clinical guidelines or decision-making tools • Management of neonatal jaundice, including: o Phototherapy o Exchange transfusion o Monitoring, follow-up, and referral pathways • Clinicians’ knowledge, attitudes, experiences, or decision-making relating to neonatal jaundice in global majority babies • Identification of barriers, facilitators, or uncertainties in diagnosis and management Exclusion • Studies focusing solely on biochemical mechanisms, pathophysiology or genetics without clinical application • Studies addressing jaundice secondary to non-neonatal conditions (e.g. congenital liver disease beyond the neonatal period) • Intervention studies unrelated to diagnosis or management (e.g. parental education only) Context Inclusion • Studies conducted in Western healthcare settings • All Western healthcare settings providing neonatal care, including: o Neonatal units o Transitional care units o Labour wards o Birth centres o Postnatal wards o Community midwifery or health visiting services o Primary care settings Exclusion • Studies conducted outside Western healthcare settings • Non-clinical settings or care provided by non-clinicians Types of Sources Inclusion • Quantitative, qualitative and mixed methods studies • Clinical guidelines, audits and service evaluations • Grey literature (e.g. NHS reports, professional body guidance, theses, NGO reports) Exclusion • Opinion pieces without empirical or policy basis Stage 2: Identification of relevant studies A comprehensive search strategy will be adopted to capture the full scope of appropriate literature using multiple databases, grey literature sources and secondary references lists (Levac et al., 2010). As researcher familiarity with the existing literature improves, the search strategies may be refined throughout the review process, demonstrating the iterative nature of scoping reviews (Arksey and O’Malley, 2005). Searches will be conducted across databases including; MEDLINE, CINAHL, PsycINFO using terms; ‘neonatal jaundice’, ‘hyperbilirubinaemia’, ‘race’, ‘ethnicity’, ‘disparities’, ‘diagnosis’, ‘diagnostic accuracy’, ‘disparities’, ‘disparity’, ‘clinic decision making’, ‘escalation.’ Inclusion criteria for studies include; qualitative, quantitative, policies, peer-reviewed, published 2000-2025, English language, addressing behaviour of clinicians, race, ethnicity and neonatal care. Exclusion criteria include publications without racial analysis or without clinical context. Stage 3: Study selection Against the predefined inclusion and exclusion criteria, titles and abstracts will be screened, followed by a review of the full text. Due to the limitations of the Professional Doctorate, the screening will only be conducted by the primary researcher, which will minimise methodological rigour, however this is due to the small funding capabilities of the research (Peter et. al., 2020). Using the PRISMA-ScR flow diagram, the study selection processes will be clearly documented and reported (Tricco et. al., 2018). Stage 4: Charting data Key data and information are extracted systematically by data charting from the studies included within the scoping review. This can include key concepts, population characteristics, author, study design and country where the research was conducted (Arksey and O’Malley, 2005). To improve rigour, transparency and findings credibility, a data extraction form will be piloted for 5 studies from the scoping review study selection and refined iteratively by the reviewer (Levac et. al., 2010). Stage 5: Collating, summarising and reporting results Data extracted from stage 4 will be synthesised by thematic analysis to present an overview of the themes within the existing evidence and to identify gaps within the literature, as opposed to assessing methodological quality via critical appraisal tools or synthesise new evidence for example with pooled effect estimates (Arksey and O’Malley, 2005; Peters et. al., 2020). Findings will be reproducible and directly related to the research question. Stage 6: Consultation with relevant stakeholders To attempt to ensure that missing evidence is added to the scoping review or to inform the interpretation of the studies, stakeholder consultation can be added as a final optional stage if it is within the scope of a Professional Doctorate (Arksey and O’Malley, 2005). If appropriate, clinicians, patients, policymakers and families of babies racialised as belonging to Global Majority groups can be approached to consult on the scoping review (Levac et. al., 2010).