Jaundice is the yellowish discoloration of the skin, and sclera (white part of the eye), this is due to the accumulation of a pigment called bilirubin in the blood. Jaundice occurring in the new-born (1st month of life) is neonatal jaundice.
How jaundice occurs
Firstly, Jaundice occurs because of an imbalance between bilirubin production and its removal from the bloodstream.
Bilirubin is a by-product of the breakdown of haemoglobin(a pigment in the Red blood cells)
Because new-born have more red blood cells which also have a short lifespan, as well as an immature liver, there’s usually an imbalance in the rate at which bilirubin is produced and removed from the blood stream.
Note : ( Ordinarily, as bilirubin is produced, the liver would ‘work on it’ a process called conjugation and make it leave the blood, but because the liver is still immature, it doesn’t do this at the same rate at which bilirubin is produced, and so bilirubin accumulates in the blood).
There are two forms of jaundice
The conjugated and unconjugated forms:
It is the unconjugated form that is more ‘worrisome’, as it is this form that can cross the blood-brain barrier and cause irreversible brain injury in the new-born.
Symptoms
The symptom of jaundice is the yellowish discolouration of the skin, sclera (while part of the eye), and mucous membranes (e.g., under the tongue) of the new-born.
This yellowing is usually detected between the 2nd and the 4th day of life. New-born Jaundice occurring on the first day of life is usually not physiologic. Other tests would be carried out to detect the underlying cause(s).
If yellowness is detected, the next step is to collect a sample of the baby’s blood to determine the level of the bilirubin. This will guide the doctor on the appropriate treatment option.
Treatment
Treatment options for jaundice include;
Phototherapy: Here, the new-born is put under a special light. This light acts on the excess bilirubin, converting it into a water-soluble form that can easily be excreted by the body, this water-soluble form can’t cross the blood brain barrier. Importantly, early initiation of phototherapy can go a long way to prevent the toxic effects of bilirubin to the brain. The bilirubin would be measured periodically while the patient is undergoing phototherapy to ascertain progress of treatment.
Second treatment option is – Exchange Blood Transfusion
As the name implies, the blood of the new-born is exchanged for another. In the process, it is believed that the ‘bilirubin laden” blood of the new-born is removed. It should be noted that the treatment option to be used depends on the level of the bilirubin as measured in the lab. In some cases, no intervention is required. The mother would just be counselled to go home, continue breastfeeding and come back for a recheck later.
Complication of Jaundice
The major/most worrisome complication of jaundice is kernicterus. This is irreversible (permanent) brain damage. This occurs when there are very high levels of bilirubin, some of which get to cross the blood brain barrier, causing brain injury. As such, the need for early intervention cannot be overemphasized.
Myths associated with jaundice
Sometime ago, our CEO did a post debunking some myths including those associated with jaundice. in other to emphasise, lets reiterate these myths.
A) Wearing of yellow clothes does not cause jaundice.
B) Unripe pawpaw/leaf does not cure jaundice.
C) Abidec/ampiclox drops do not cure/prevent jaundice.
In conclusion, neonatal jaundice is a common occurrence in our environment. In some cases, it is self-limiting (will disappear on its own)
while in others it might be very severe as to cause permanent brain injury. Since one as a mother/caregiver, can’t determine what the level of your child’s jaundice is.
ALWAYS follow the doctor’s recommendation when your child has jaundice. Let his/her blood sample be collected to determine the level and appropriate treatment instituted. DO NOT listen to old wives’ fables of alternate methods of ‘curing’ jaundice. Remember it’s your baby and it’s your responsibility to give him/her the best care.