Treating Neonatal Jaundice In A Newborn

About five per cent of Nigerian newborn would be deformed or killed by neonatal jaundice — a medical condition characterised by yellow discolouration of the covering of the skin (sclera) or the eyes. It usually occurs in a baby that is less than 28 days old. Neonatal jaundice occurs as a result of accumulation of unconjugated bilirubin, a pigment produced by the liver following a breakdown of the hemoglobin in red blood cells. ADVERTISEMENT The condition occurs in two different types — physiological jaundice, which occurs and disappears within a short period; and the pathological jaundice, which comes up about the second or third day of life and is often more severe, requiring adequate monitoring by specialists to save the child. Jaundice that appears in the first 24 hours of life is said to be pathological and will require hospital admission. During the admission, the cause will be determined through a series of tests that will be done on the baby. Case review A new mom in her mid 30s just had her first baby. It was discovered that the baby had jaundice on the third day of life. Her mother and sister advised her to administer on the child a combination of alum, Ampiclox syrup, glucose water and unripe pawpaw in sterile water. The newborn, a girl with a weight of 2.3kg, was rushed to the hospital vomiting blood-stained fluid on the eighth day of life. But it was too late. She did not make it because the acidic contents of the unripe pawpaw had caused gastric erosion (wounds and bleeding to the stomach and oesophagus). This baby was a victim of self medication. Causes of neonatal jaundice This condition may be caused variously by ABO incompatibility, rhesus incompatibility, G6PD deficiency, infections, prematurity, drug abuse, abnormality with the liver and the biliary tree, and hepatitis. Symptoms Jaundice causes a yellow colour of the skin or sclera (the white part of the eyes). The colour sometimes begins on the face and then moves down to the chest, belly area, legs, and soles of the feet. Sometimes, infants with significant jaundice have extreme tiredness and poor feeding. Treatment Some newborns need to be treated before they leave the hospital. Others may need to go back to the hospital when they are a few days old. Jaundice is an emergency if the baby has a fever, has become listless, or is not feeding well. Any infant who appears jaundiced should have bilirubin levels measured right away. This can be done with a blood test. The neonate will need treatment if the bilirubin level is too high or is rising too quickly. The treatments options are highlighted as follow: Adequate feeding: Keep the baby well hydrated with breast milk or formula. Frequent feedings (up to 12 times a day) encourage frequent bowel movements, which help remove bilirubin through the stools. Phototherapy: Sometimes, special lights are used on infants whose levels are very high. This is called phototherapy. These lights work by helping to break down bilirubin in the skin. The baby will wear only a diaper and special eye shades to protect the eyes. Exchange Blood Transfusion (EBT): In the most severe cases of jaundice, an exchange blood transfusion is required. In this procedure, the baby’s blood is replaced with fresh blood. Plasma transfusion: Treating severely jaundiced babies with fresh plasma is also effective at reducing bilirubin levels. The doctor may order additional blood tests or urine tests, abdominal ultrasound scan to rule out causes of conjugated jaundice. This type of jaundice mainly has liver-related causes and not treatable with phototherapy. Some causes of conjugated jaundice may require surgery. Complications Serious complications from high bilirubin levels include cerebral palsy, deafness, kernicterus —brain damage from very high bilirubin levels, and delayed developmental milestones (baby not able to sit, crawl, walk and talk at the appropriate age). The main reason why doctors want to admit newborns with jaundice is to prevent the bilirubin level from getting to this stage of complications. Prevention All pregnant women should be given proper antenatal care and tested for blood type and unusual antibodies. If the mother is Rh negative, follow-up testing on the infant’s cord is recommended. This column will not be complete without mentioning some myths associated with management of jaundice. Jaundice cannot be cured by giving the newborn or the mother unripe pawpaw water; it’s not caused by wearing yellow clothes for the baby; Ampiclox (an antibiotic) is not a cure for newborn jaundice, while multivitamin drops also don’t cure jaundice. Also, using dusting powder and mentholatum for a newborn could incite the breakdown of the red blood cells when there is G6PD deficiency, thereby causing jaundice. The self-medications listed above only increase the level of the jaundice. However, early morning sunlight for about 20-30 minutes daily has been proved to be an effective form of treatment of newborn jaundice. Visit my blog: http://www.doctoradesanya.blogspot.com for more details on neonatal jaundice. Source:punch