Undoubtedly, Infant jaundice remains one of the main killers of newborns in Nigeria. It is a medical condition associated with yellow discoloration of a new born baby’s skin and eyes. It is a common finding in the first week of life. It occurs in about 80% of preterm and 60% of term babies.

It occurs because the baby’s blood contains excess bilirubin, a yellow-coloured pigment of red blood cells which adversely affects the brain. The prevalence of jaundice in the newborn is variable (7-75%) in Nigeria.

Causes/Risk factors

At birth, babies have plenty of red blood cells which are in excess of what is needed in the outside world. The body therefore destroys the excess cells. Another factor that contributes to rapid red cell destruction is the relatively short life span of the red blood cells found in newborn (80 days instead of 120 days). Some factors like breastfeeding, breast milk itself, prematurity, low birth weight and blood group have also been implicated in the development of jaundice.

For the purpose of clarity, jaundice has been classified into physiological and pathological jaundice. Physiological jaundice arises in the setting of normal functioning of the body of the newborn. In other words, it is the jaundice that occurs in the absence of any infection/disease. Pathological jaundice, on the other hand, is jaundice arising from infection/disease.

Physiological jaundice becomes evident on the 2nd to 3rd day of life. It arises from excess red blood cells, short life span of red blood cells and immature handling of bilirubin by the body especially the liver.

Pathological jaundice usually begins within the first 24 hours of life. It persists more than a week. The bilirubin level rises rapidly. The baby may be pale (i.e. with low blood level). It may arise from the following:

Blood group incompatibility/iso-immunization, prematurity/low birth weight, inborn red blood cell diseases, glucose-6-phosphate dehygrogenase deficiency (G6PD).

Attack of red blood cell destruction can also be due to common household materials such as camphor, mentholatum, methylated dusting powder, heatol, robb and other balms, insecticides, salicylates, herbs e.t.c.

Conditions such as sepsis, infections, hepatitis, intestinal obstruction, bleeding into any part of the body e.g. birth injury resulting in blood collection in the baby’s scalp or into the brain, biliary atresia, choledochal cyst.

Breastfeeding and breast milk jaundice deserve some mention. Breastfeeding Jaundice is a mild form of jaundice seen in about 12% of breastfed babies. It arises around the 3rd day of life and resolves in less than 3 weeks. It is believed to be a result of dehydration from inadequate milk intake during this period.

If older sibling had jaundice or received phototherapy, the risk of jaundice is increased in the baby.

How can I tell if my baby has jaundice?

Try this quick test to check for jaundice. In a well-lit room, gently press your fingers on your baby’s nose or forehead. If there’s a yellow tinge to her skin as the pressure is released, tell your midwife or doctor. If your baby has dark skin, check for yellowness in the whites of her eyes or gums. You may also notice that your baby discharges very pale poos. Your baby’s poo is pale because no bilirubin is reaching her digestive system.

Fever, poor food intake, vomiting, pale stool and dark urine, generalized tiredness and high-pitch cry are warning signs in a baby with jaundice.

Most importantly check with your pediatrician who would carry out bilirubin test, infection screening, complete blood count, urine tests and liver function tests, blood group, hepatitis B surface antigen test and blood sugar test and others to establish the cause of the jaundice.

Complications

At a high level, unprocessed bilirubin can damage the brain. This is called kernicterus. The child is unable to suck or sucks poorly, cries with a high-pitch voice, vomits, gets tired, moves abnormally, and is irritable or become floppy or stiff. He/she may go on to convulse. Fever is also a symptom of high bilirubin level. It can result in death, deafness/hearing loss, mental retardation or cerebral palsy.

Management

In mild jaundice, the baby is carefully observed after clinical examination. In addition, laboratory follow-up is employed.

Increasing the frequency/number of feeds has been found to be helpful in increasing the rate of bilirubin removal from the body. Hence, mothers should not stop breastfeeding unless advised by the doctor.

In severe jaundice, light therapy (phototherapy) is used. A special kind of light converts the bilirubin to easily expellable/removable products. In the past, jaundiced children were placed in the sun to achieve this purpose. If life-threatening, jaundice is managed with exchange blood transfusion. The jaundiced blood is taken from the baby and replaced with new blood.

Prevention

Health education is very important, pregnant mothers should avoid over-the-counter drugs and commonly used household items or baby-care materials that can cause jaundice (listed above).

Screening is vital; blood group and rhesus type of parents should be checked to prevent ABO or rhesus incompatibility and mothers who need to be given rhogam should be educated on its importance.

Regular breastfeeding should be commenced on the day of birth. 8 to 12 feedings per day is ideal. This helps by increasing the excretion/removal rate of bilirubin. There is no need to offer water to breastfed babies. For those who cannot be breastfed, adequate formula should be given.

Monitoring of all newborns for the earliest sign of jaundice in the hospital and at home should be ensured. While it is possible to detect jaundice with the eyes, laboratory test for bilirubin is more accurate and reliable. Blood test is the routine in Nigeria. However, a device placed near the skin gives results as accurate as the blood test. It is known as the transcutaneous bilirubinometer, which measures the reflection of a special light shone through the skin.

Mild infant jaundice often disappears on its own within two or three weeks. For moderate or severe jaundice, your baby may need to stay longer in the newborn nursery or be readmitted to the hospital.

The good news however is that God not only desires that we be fruitful but also wants us to have healthy babies. Remember 3 John verse 2.

-Funke Adewoye