LP was born at home like his elder siblings. On the fifth day of life, the white part of his eyes and skin were noticed to be yellowish in colour. The colour deepened on a daily basis. Herbal concoction was administered. He didn’t get well. He later refused breastfeeding; he began to stiffen his arms and legs. He had severe jaundice. The problem had affected his brain. He was taken late to the hospital on the tenth day. He died. His death was preventable!
What is Jaundice?
Jaundice in newborn babies is not uncommon. The white part of the eye, skin, and other membranes become yellowish in colour. This is because the breakdown product of the red blood cells, called bilirubin, is higher than what the liver can process. Excess bilirubin in the blood deposits in various parts of the body and colours them yellow. Therefore, jaundice is a warning that the health of the child needs proper evaluation.
What are the common causes of jaundice in newborn babies?
Excess bilirubin in the blood which manifests as jaundice results commonly from the following.
- Relatively excess red blood cells in children. Usually, in children, especially in the newborn, the percentage of the red blood cell component of the entire blood is higher than adults. Interestingly, these red blood cells are not as mature as those of adults. Therefore, they can get broken down to release the bilirubin that is evident as jaundice. This cause of jaundice cannot be prevented. Nature is fully in control.
- Infections: The newborn baby could have been infected in the womb or after delivery. Bacterial infection in the blood may break down the red blood cells. This will increase bilirubin production. Vaginal infection in pregnancy, premature rupture of the protective membrane around the unborn baby, or unhygienic handling of the baby after delivery are few common routes of infection. Proper use of antenatal care services may prevent this infection.
- Incompatible blood group of mother and child: Of the various blood group classes, two have been found to be involved in jaundice. They are ABO blood group class and Rhesus blood group class. In summary, in either of these two classes, if the blood group of the mother is not compatible with that of the baby, the baby’s red blood cells can get destroyed by antibodies from the mother. Bilirubin is therefore released into the blood. Jaundice resulting from the ABO blood group class cannot be prevented. Women who have Rhesus negative blood group should seek early counsel from their doctors before conception on how their babies can be prevented from having jaundice.
- Prematurity: Babies born earlier than 37 weeks of pregnancy are termed premature. The liver in premature babies is more immature than other babies to handle the bilirubin that is produced from the break down of the red cells. Also, the red blood cells in premature babies are not as mature as those of babies born after 37 weeks making their red cells get easily destroyed. The risk of infection that can destroy red cells is also higher in premature babies.
Uncommon causes of jaundice include inherited abnormalities of the red blood cells, some enzyme deficiencies that increase destruction of the red blood cells, liver disease, et cetera.
Why is jaundice in newborn babies alarming? Free bilirubin in the blood, if in excess, can cause damage to the brain, ear, et cetera. Individuals who survive severe jaundice may have developmental problems especially cerebral palsy. Others may have hearing impairment. Some may have seizure disorders. Due to all these possible complications, health personnel do not take jaundice lightly. As a result, monitoring of the blood levels of bilirubin on a daily basis and possible treatment is done until the baby is confirmed safe.
What are the options of treating jaundice in the newborn?
- Watchful waiting: Nothing is done apart from daily check of the blood levels of bilirubin to assess if there is a risk of damage to the brain and other organs. If the bilirubin level drops on its own as the liver matures, the baby is discharged home.
- Phototherapy: This involves light treatment. The baby is placed under specially arranged light bulbs. The light helps convert the excess bilirubin in the blood into a form the baby can pass out in urine or stool.
- Exchange blood transfusion: If the bilirubin level is very high and/or early evidence of damage to the brain is suspected, the bilirubin-rich blood of the baby is serially withdrawn and replaced with fresh blood from a compatible donor. This remarkably reduces the bilirubin in the blood.
- Supportive treatment: Depending on the cause of the jaundice, antibiotics, other special care of premature babies, et cetera, may be necessary.
Recommendation: Preconception counseling is essential. During pregnancy, antenatal clinics and lectures should be attended. Investigations are carried out to identify the woman with a risk of having a baby who may develop jaundice. This prepares the parents and the health personnel should jaundice develop.
Dr Ademola Orolu is a Consultant Family Physician. He holds the Fellowship of The West African College of Physicians. He is also an Associate Fellow of The National Postgraduate Medical College of Nigeria. He is in active clinical practice. He is a writer, a patient advocate, and has a passion for health education. He is the Medical Director/Chief Executive Officer of Nathaniel Health Consulting (a family hospital), Matogun, Ogun State. He is the editor-in-chief of The Family Doctors. He can be contacted via firstname.lastname@example.org