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Newborn Jaundice: a preventable cause of disability and death of babies


KAA is a four year old boy who cannot sit on his own. He has a hearing problem as well as frequent convulsions. His parents expected that at his age he should be in school and are very frustrated as a result. His parents are on the verge of divorce because of KAA's current condition. His mother blames his paternal grandmother for his condition as she was told by a prophet that grandmother is the cause of the illness. KAA's mother noticed that his eyes were very yellow when he was only 3 days old. His maternal grandmother told his mother to put him under the sun in the early morning for two days. She also supplied her with camelion a locally made string which is tied on the baby's hand (It is believed to ward off all evil eyes anibone and turn every evil into good). Mother had also used that. By the 7th day mother had noticed that KAA had become weak, was refusing breastmilk and also had a weak cry.


Mother then sent KAA to a nearby Health Center which referred her to a bigger hospital in the city.
By the time they arrived in the hospital, KAA had started having repeated convulsions. The Hospital staff immediately attended to KAA and gave medicine to stop the convulsions and kept him in the hospital for some time. KAA eventually became better.


The doctors told KAA's parents that KAA had been brought in too late and that the Jaundice had gone into his brain and caused brain damage. KAA's parents had also been told that because of the brain damage, his growth would not be like other babies who had not suffered brain damage. Thus they will need repeated visits to the hospital. In summary KAA had suffered brain damage from severe newborn jaundice.

We now take a look at NEWBORN JAUNDICE.


Newborn jaundice defined:
Newborn jaundice is the yellowing of the white portion of the eye (sclera) and or skin occurring in babies less than 1 month old.
It is a common finding in newborns.
About 8 out of 10 preterm (babies born earlier than 37 weeks of pregnancy) babies develop jaundice. Also 6 out of 10 newborns who were delivered at full term (babies born at or after 37 weeks) develop jaundice.
In the Child Health Out Patients Department of the Korle Bu Teaching Hospital, no day passes without a baby coming in with neonatal jaundice. Unfortunately, some of them come in too late and end up with brain damage or even die. It leads to a condition called cerebral palsy which means the movement of the child is affected.
Every newborn baby can get neonatal jaundice. It is not discriminatory. Babies born to the rich, poor, educated, uneducated, antenatal care attendants and those who do not attend antenatal care can all develop jaundice after delivery.

You will notice yellowing of the white portion of the eye or the skin. This is always abnormal if it happens within the first day of life.

Causes of newborn/neonatal jaundice:
People often wonder if newborn jaundice is caused by hepatitis or spreads from person to person.
It is usually not caused by agents that spread  from baby to baby or baby to adults. The agents are called viruses which are contracted whilst baby is in the womb. This causes what is known as a neonatal hepatitis and is not like the adult hepatitis from an infectious source.


There are several conditions that cause neonatal jaundice. Examples include, an infection in the baby, G6PD deficiency (an inherited enzyme deficiency in the blood and fairly common in our male babies), differences in blood group of the baby and mother , Biliary atresia and Galactosemia.


Breast milk jaundice also exists. One may think of breastmilk jaundice if tests for all other causes are negative. (It may also be detected if stopping breast feeding improves the jaundice and worsens if breast feeding is restarted)

There are so many known specific causes for neonatal jaundice. Once baby is brought to hospital early for treatment, baby becomes well. Anibone (evil eyes) is not the cause of jaundice in babies.

Jaundice may be present at birth. If present at birth, it is very serious and requires immediate attention. It may also develop a few days after the baby is born. When the jaundice is severe, the compound that causes the jaundice (bilirubin) can go to the brain and cause serious damage to the baby's brain. It may result in cerebral palsy.

Other things to look out for:
The baby's stool (pupu) may become pale(almost white) which may be an indication of a very serious condition called biliary atresia. It is also important to note whether the baby is feeding poorly or has become weak. This is an indication that baby is ill and requires immediate medical attention.



A word of caution against the use of herbal medicine to treat neonatal jaundice:
There are a few people who try herbal medications and end up causing brain damage to the baby or even death. Your baby may develop brain damage which may affect their growth and development. They may not be able to grow normally. They may have hearing problems or mental retardation even if they survive. There are also some who may die from severe neonatal jaundice.
A study done  in the Child health Department of the Korle Bu Teaching Hospital found severe neonatal jaundice to be the most significant and preventable cause of cerebral palsy amongst Ghanaian children.

Tests and treatment:
Lab tests; blood samples will be taken from the baby to determine the level of the bilirubin(jaundice) in the blood and the baby's blood group. The level of the bilirubin will determine how the baby will be treated. The other causes of jaundice in babies will also be looked out for on an individual baby basis. Blood will be taken from the mother to check her blood group as well.


If the level of the bilirubin is low, baby may be asked to go home and return a few days later for reassessment.

Phototherapy: If the level of jaundice(bilirubin) is not too high the baby is put under blue light which helps to break down the bilirubin and clear the jaundice. Baby is put under the light naked with the eyes and genital area covered to protect the eyes and genitals from damage.


Exchange blood transfusion:
If the level of jaundice(bilirubin) is very high, the baby may need an exchange blood transfusion. This involves taking some of baby's blood out and giving a blood transfusion. The aim of this procedure is to bring down the level of the bilirubin quickly to avoid brain damage to the baby.


Surgery:
If a surgical cause of the jaundice is seen, surgery is performed to save the baby.

Sunbathing:
Leaving the baby under early morning sun does improve neonatal jaundice. It is however not recommended because the sun also has other rays which are harmful to the baby. The rather limited time spent under the sun in most cases will not cure the jaundice. Another reason is that, there is no monitoring by health experts thus baby can easily get worse and develop brain damage.

A note to health workers in small centers:
There are several causes of neonatal jaundice. Just looking at the baby will not reveal the cause.  Lab tests and other investigations may be necessary to make a diagnosis. If you are not trained in the management of neonatal jaundice or do not have phototherapy at your facility, prompt referral to a higher health facility for treatment is the only way to prevent disability from brain damage or death of the baby.
The intensive phototherapy unit (e.g. Firefly) in our experience is a very effective piece of equipment to manage neonatal jaundice.

In conclusion, neonatal jaundice is common. It's complications are several,severe and preventable. No baby should therefore die or develop brain damage from newborn jaundice.

Dr. Hilda Mantebea Boye.
Dr. Ebenezer Badoe.
Department of Child Health.
Korle Bu Teaching Hospital.
( Members of Paediatric Society of Ghana)