Newborn Jaundice

Newborn infant undergoing (white light) phototherapy to treat jaundice

Four-year-old Kaa cannot sit by himself. He also has a hearing problem and experiences frequent convulsion.

Kaa’s condition started when his mother noticed a change in the colour of her son’s eyes three days after delivery.

Kaa’s eyes, unlike the normal eyes of babies, had turned deep yellow in colour. His mother, on the advice of her mother, put Kaa under the morning sun for two days as a means of curing her son’s yellowish eyes.

His grandmother also provided “camelion”, a locally made string which is tied on a baby’s hand ostensibly to ward off all evil eyes (anibone) and turn every evil into good, as a cure for Kaa’s health condition.

By the seventh day, Kaa’s mother noticed that her baby had become weak and therefore took him to a nearby health facility which also referred her to a bigger hospital.

Doctors at the hospital told Kaa’s parents that their baby had jaundice but he had been brought in too late.

As a result of the delay in seeking treatment for Kaa’s health condition at the hospital, the doctors said Kaa suffered brain damage from severe newborn jaundice which would retard his development.

His parents, left frustrated due to the doctor’s diagnosis, contemplated how they would manage little Kaa’s condition which he had to live with for the rest of his life.

Kaa’s condition could have been prevented if he had been taken to the hospital earlier for medical attention.

Newborn Jaundice

Dr Hilda Mantebea Boye, a physician at the Korle Bu Child Health Department, said jaundice is not an illness in itself, but a medical condition in which too much bilirubin –a compound produced by the breakdown of haemoglobin from red blood cells –is circulating in the blood.

She said the excess bilirubin causes the skin, eyes and mucus membranes in the mouth to turn yellowish in colour.

Jaundice can occur in babies, children and adults. In newborn babies though, Dr Boye said, jaundice is common because they have extra red blood cells that begin to break down soon after they are born and their livers are often slower to process bilirubin.

“In the Child Health Outpatient 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,” she said.

Dr Hilda Mantebea Boye

Dr Hilda Mantebea Boye

Jaundice can also occur in breastfed babies. This is called “breastfeeding jaundice,” which is believed to be caused by inadequate milk intake. This type is usually not apparent until the baby is a week old and then peaks during the second or third week of life.

Dr Boye said jaundice, during the first 24 hours of life, is not considered normal and will prompt a paediatrician to do some tests on a baby to look for the cause.

She said when the jaundice is severe, the compound that causes the jaundice (bilirubin) can go into the brain and cause serious damage to the baby’s brain. It may result in cerebral palsy.

Causes of Newborn Jaundice

Dr Boye, who is also a member of the Paediatric Society of Ghana, explained that any newborn baby can get neonatal jaundice.

“It is not discriminatory,” she said, adding, “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.”

There are several conditions that cause neonatal jaundice. Examples include an infection in the baby, deficiency, and differences in blood group of the baby and mother, among others.

Breast milk jaundice is, however, caused by substances in the mother’s milk that reduce the baby’s liver’s ability to process bilirubin.

One may have to consider breast milk jaundice if tests for all other causes are negative.

Symptoms of Newborn Jaundice

“You will notice yellowing of the white portion of the eye or the skin,” Dr Ebenezer Badoe, a physician at the Child Health Department, said.

“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,” he added.

Dr Badoe also cautioned against the use of herbal medicine to treat neonatal jaundice.

He said there are a few people who try herbal medications and end up causing brain damage to their babies or even death.

Dr Ebenezer Badoe

Dr Ebenezer Badoe

“[Those babies] 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,” he added.

Dr Badoe noted that a study conducted  at 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.

Remedies

“Several tests will be done in the hospital to find the level of the jaundice (bilirubin) and the cause of the jaundice.

“This will determine whether a baby will be left alone, be put under blue light (phototherapy), have an exchange blood transfusion or undergo surgery,” he indicated.

Dr Badoe said leaving a baby under early morning sun does improve neonatal jaundice. He however added that it is not recommended because the sun also has other rays which are harmful to the baby. The baby’s condition can easily get worse and result in brain damage.

Side Bar >>>>>>>>>>>> A Note To Health Workers In Small Centres

Dr Hilda Mantebea Boye and Dr Ebenezer Badoe believe that health workers in small health facilities need to take the following into consideration when they have suspected cases of jaundice.

“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. Its complications are several, severe and preventable. No baby should therefore die or develop brain damage from newborn jaundice.

By Jamila Akweley Okertchiri

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