Why is jaundice a condition in newborns?

Isaac Yeboah Health Jun - 01 - 2013 , 16:52

In 21st century Ghana, newborns continue to die or suffer from severe brain injury from jaundice. Every month, we have not less than 10 newborn babies dying from or suffering severe brain damage from jaundice at the Children’s block of the Korle bu Teaching Hospital alone. Why and how can we reduce this?
Jaundice develops when red blood cells break down and bilirubin, a by-product from this breakdown, is left in high quantities in the blood.

It is normal for some red blood cells to die every day. In the womb, the mother's liver removes bilirubin for the baby, but after birth, the baby's liver must remove the bilirubin.
In some babies, the liver might not be developed enough to efficiently get rid of this bilirubin. This results in too much bilirubin building up in the blood and staining the baby's body, the skin and whites of the eyes giving the colour yellow.

This yellow colouring is what is called jaundice.

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 it gets beyond a certain level. 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 is more likely to develop 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 and blue.

Then, when the bruise begins to heal, the red blood cells die leading to the production of bilirubin.

Preterm babies: Babies born before 37 weeks, or eight and half months, of pregnancy may become jaundiced because their liver may not be fully developed to get rid of the excess bilirubin.

Besides, the newborn has a higher number of red blood cells and too many red blood cells breaking down at the same time.

Feeding difficulties: A baby who is not eating, wetting, or passing stools well in the first few days of life is more likely to get jaundice.

This results in dehydration and the jaundice, no matter how minimal it is becomes more pronounced, a phenomenon called breastfeeding jaundice.

Early jaundice: A baby who is yellow in the first 24 hours of life may get dangerously jaundiced. This is likely to be missed by the health worker if the child is discharged home soon after birth.
Hereditary: Some families inherit conditions (such as G6PD), and their babies are more likely to become jaundiced.

Blood type: Women with an O blood type or Rhesus negative blood factor might have babies with higher bilirubin levels.

Any baby with untreated jaundice is at risk of brain damage from the bilirubin, a condition called kernicterus. Kernicterus is irreversible and every attempt should be made to prevent its development.

This does not mean that every baby with yellow skin will have brain damage. Most babies with jaundice get better by themselves. If their skin is very yellow, they might need treatment.

Danger signs of jaundice to warrant hospital admission include; extensive jaundice - from the head and spread to the toes, constantly moving, not breastfeeding or refusing feeds, does not have at least four wet or dirty diapers in 24 hours, shrill cry, gasping for breath and very warm to touch.

No baby should develop brain damage from untreated jaundice. If a baby gets too jaundiced, the baby can be treated with phototherapy. That is when the baby is put under blue lights. This must be done in a hospital setting.

The blue lights do not bother the baby. They are warm and probably feel good. If the baby gets very, very jaundiced, an exchange transfusion may be done.

This is a specialised type of blood transfusion which dilutes the child’s blood as much as possible. Unfortunately, in our part of the world, a lot of children are diagnosed with this condition late and most of them die and the survivors often have complications such as developmental delays, hearing loss, mental retardation and speech impairment.

Reasons for diagnosing late are multifactorial but majority of them are cultural and a few medical. The cultural reasons are mostly what we do at home when a child is born.

Traditionally, the child is supposed to be kept in the room and brought out only after the outdooring. Thus, nobody picks the jaundice when the child starts to develop it, especially when the mother is a first time mother.

I repeat here that newborn babies must be brought out at least to observe the colour twice a day to catch any developing jaundice.

Besides this, there is this crazy idea of keeping Camphor or Naphthalene balls in the house. Some put them in clothing, water and some even put it in their drinking water.

Camphor sublimes which means it can change from solid to gas directly without going through the liquid phase.

This substance when inhaled can precipitate the breaking down of the red blood cells resulting in severe jaundice in a child with certain enzyme deficiency such as G6PD deficiency.

This enzyme deficiency is prevalent in our part of the world because of malaria. If severe, the jaundice can cross the blood brain barrier and cause the damage to the brain. This usually happens when the baby is a male child.

There are also funny ideas about the colostrums being dirty milk so some mothers refuse to breastfeed and the resultant dehydration worsens the jaundice.

Also, we need to recognise early when the child is not well and even if recognised, some of the mothers now need to wait for the father to come home to agree and release money for the child to be sent to the hospital.

These delays in seeking health care sometimes come at a huge cost when we are dealing with jaundice in the newborn. There is also this notion of putting the child in an early morning sun.

I don’t know where this idea originated from but jaundice needs to be seen and treated by a doctor and not the mother doing her own thing in the sun.

There are also medical reasons why some children develop jaundice and it is important that health workers, particularly those directly involved in delivering babies, anticipate those at risk of jaundice and educate the mothers to be on the lookout for it.

Every mother who is of blood group O is at risk of having a child who will develop jaundice, especially so if the father is of a different blood group such as group A, B or AB.

Thus, health givers should be able to anticipate and put in measures in place to treat the jaundice when they develop.

Also any rhesus negative mother is at an increased risk of having a baby who will develop jaundice, particularly when the husband is rhesus positive.

Whenever we check our blood group, it is reported as O positive or negative, B positive or negative etc. It is this positive or negative that the rhesus status refers to.

So any mother with a negative rhesus should have a certain injection called Rhogam given within 72 hours of delivery to protect subsequent pregnancies against jaundice and the child should be detained and observed for and treated when jaundice occurs.

Children of such mothers should not be discharged home after the conventional six hours if they are stable. They should be kept longer and observed.

In addition, every mother who has had a child with jaundice severe enough to be admitted and treated should have her newborn child examined by a paediatrician and treated.

Children are needlessly dying from or developing severe brain damage from jaundice- a totally preventable and treatable condition. Let us all help to reduce death from this condition.