Another year, and the month of May is here with us. For very good reasons, the month of May has been declared by the Paediatric Society of Ghana as the “Yellow Month.”
The need to intensify this campaign is premised on the fact that despite numerous campaign messages, jaundice in the newborn continues to take the life of babies and for those fortunate to survive, get maimed for life.
In delivering the keynote address last year, Dr Isabella Sagoe-Moses highlighted that about 10,000 cases of newborns developed jaundice yearly in Ghana. It is of little or no wonder that all paediatricians and members of the Paediatric Society of Ghana continue to put the spotlight on neonatal jaundice. The myths around the newborns continue to put countless number of babies at risk of neonatal jaundice and its attendant needless deaths or damage to the brain of newborns. It is even more shocking to know that this condition is totally preventable and treatable.
Jaundice or yellowish discolouration of the skin, eyes and other body parts develops when red blood cells- the cells that carry oxygen in the blood- break down at the end of its life span. One of the by-products of this breakdown of red cells releases a substance called bilirubin into the bloodstream.
It is normal for red blood cells to die every day after they have exhausted their life span of 120 days. When a baby is in the mother’s womb, the mother's liver and placenta remove bilirubin for the baby, but after birth the baby's liver must take over the business of removing this harmful bilirubin.
In some babies, the liver might not be developed enough to efficiently get rid of this bilirubin. In some babies, even though the liver is able to work on the bilirubin, the sheer work load alone allows excess to spill in the blood stream. In some instances, an obstruction to the flow of the bile which lead to jaundice building up in the blood and staining the baby's body, the skin and sclera (whitish part of the eyes) rendering the baby colour yellow.
Jaundice usually appears first on the face and then moves to the chest, belly, arms, and legs as bilirubin levels get higher. About 60 per cent of all babies develop jaundice and not all jaundice is harmful until the bilirubin levels get beyond a certain dangerous mark. Some babies are more likely to have severe jaundice and higher bilirubin levels than others. Babies with any of the following risk factors need close monitoring and early jaundice management:
Sibling: A baby with a brother or sister that had jaundice in the newborn period is more likely to develop a severe form of jaundice.
Bruising: A baby who has bruises at birth is more likely to have jaundice. A bruise forms when blood leaks out of a blood vessel and causes the skin to look black or blue. Then, when the bruise begins to heal, the red blood cells die and are converted to bilirubin which gets into the blood and stain the body yellow.
Preterm babies: Babies born before 37 weeks, or a little above eight months of pregnancy may become jaundiced because their liver may not be fully matured to get rid of the excess bilirubin. Besides, the premature newborn has a higher number of red blood cells with reduced life span ( 80 days instead of 120 days) and too many red blood cells break down at the same time.
Feeding difficulties: A baby who is not eating, wetting nappies, or passing stools well in the first few days of life is more likely to get jaundice. This is because they need water to be able to urinate the jaundice out instead of it building up in the blood.
Early jaundice: A baby which is yellow in the first 24 hours of life may develop dangerously high levels of bilirubin and must actively be treated to prevent destruction of the brain by the jaundice in this newborn.
Hereditary factors: Some families inherit conditions that accelerate the breakdown of red cells with its resultant production of bilirubin. The most common in our part of the world is G6PD deficiency- an inheritable enzyme deficiency that is thought to confer some immunity to malaria. Babies who inherit this condition are more likely to become jaundiced when exposed to certain chemicals such as camphor and medications that contain sulphur.
Blood type: Women with blood group O type or with a negative rhesus blood factor might have babies with higher bilirubin levels. This happens when the babies have different blood group or positive rhesus status.
Infections: Babies which acquire infection at the newborn period are more likely to have accelerated production of bilirubin from accelerated breakdown of red blood cells.
Birth Trauma: Sometimes, the delivery process become complicated and traumatic and the babies bleed under the scalp just below the covering of the brain or into the brain itself. These conditions, known in medical parlance as subgaleal hematoma, cephalohematoma and intraventricular haemorrhage respectively, warrant observation for jaundice.
Any baby with untreated severe jaundice is at risk of developing brain injury.
I will continue next week.
A member of Paediatric Society of Ghana