Newborn Jaundice. A preventable cause of disability and death of babies
KAA is a four-year-old boy who cannot sit on his own, has a hearing problem and frequent convulsions. His parents are very frustrated as a result and are on the verge of divorce. His mother blames his paternal grandmother for his condition as she was told by a prophet that his grandmother is the cause of the illness.
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Kaa’s mother noticed that his eyes were very yellow when he was only three 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 to the baby’s hand (It is believed to ward off all evil eyes (ani bone) and turn every evil into good). Mother had also used that. By the seventh day, mother had noticed that Kaa had become weak and sent Kaa to a nearby health centre which referred her to a hospital in the city.
The hospital staff did everything possible to save his life.The doctors told Kaa’s parents that he had been brought in too late and that the jaundice had gone into his brain and caused brain damage. As a result, his growth would be delayed. In summary, Kaa had suffered brain damage from severe 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 one month old. It is a common finding in newborns.
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.
Any 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
There are several conditions that cause neonatal jaundice. Examples are an infection in the baby, G6PD deficiency, differences in blood group of the baby and mother, Biliary atresia and Galactosemia.
Breast milk jaundice also exists. One may think of breast milk jaundice if tests for all other causes are negative.
There are so many known specific causes for neonatal jaundice. Once the baby is brought to the hospital early for treatment, he or she becomes well. Ani bone (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 it and this 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. This is an indication that the baby 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 among Ghanaian children.
Tests and treatment
Lab tests are conducted in which 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,the 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 in order to protect them 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 the baby’s blood out and giving him or her 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.
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Sunbathing
Leaving the baby under early morning sun does tame neonatal jaundice. It is, however, not recommended because the sun also has other rays which are harmful to the baby. Baby can easily get worse and develop brain damage.
A note to health workers in small centres
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 sum, neonatal jaundice is common. Its complications are several,severe and preventable. No baby should, therefore, die or develop brain damage from newborn jaundice.
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