Infant Jaundice: Causes, Symptoms and Treatments - Volume 1
February 24, 2017
What is Neonatal Jaundice?
Neonatal jaundice (NNJ) also known as neonatal Hyperbilirubinaemia refers to the yellowish discoloration of the skin, sclera and mucus membrane. Hyperbilirubinaemia is mainly due to the breakdown of hemoglobin (portion of red blood cells).
Jaundice could be normal sometimes due to exposure of the new born infant to living outside of the mother’s womb while at other times may reflect an underlying medical condition in the child. Newborns produce bilirubin a rate per day which is twice the production rate in adults, largely due to a relatively larger red cell mass, shorter red cell life span resulting in increased red cell turn over. However, bilirubin production declines to adult levels by the tenth to the fourteenth day following delivery.
Statement of the burden
NNJ is a common problem seen in the newborn worldwide and has been identified as a cause of neonatal morbidity and mortality in sub-Saharan Africa. In some tertiary health centers jaundice has been recorded as a major cause of neonatal hospital admissions and a leading cause of irreversible brain injury and death in this age group.
Although, mortality resulting from jaundice in the developed countries is quite rare, it is a fledging problem in the developing world resulting in kernicterus with its attendant sequel which poses a great burden on the patient, the family and the society at large.
The burden of the consequences of jaundice is particularly seen more in sub-Saharan Africa. Attributable reasons include prematurity, G6PD deficiency, parental ignorance, Inefficient neonatal healthcare delivery systems, harmful traditional and social practices. These factors may occur individually or in combination. Other identifiable risks are prematurity, inadequate breast feeding, and Rhesus isoimmunization. However, in other cases an aetiologic agent is either not known or unidentifiable. Studies have shown that disease condition such as G6PD deficiency as a causative agent for jaundice in this region is unique, as not only is the incidence of the enzyme deficiency high among the population but peculiar cultural practices (such as preservation of clothes with naphthalene balls, ingestion of concussion made from naphthalene and treatment of skin conditions from naphthalene preparations)predispose both normal and enzyme deficient children to increased risk of hemolysis.
In Nigeria, neonatal jaundice constitutes between 19.4% to 45.6% of all hospital admissions into the special care baby unit around the country. These figures far underestimate the exact burden of the disease as a vast majority of babies delivered in the country (65 – 70%) are delivered outside the hospital. Recent findings have shown that babies born outside of specialized care facility or those discharged early are more prone to developing severe jaundice. Reasons attributed to this are the possibility of delay in recognizing jaundice by the caregiver, high rate of exposure of babies to icterogic agents and faulty breast feeding practices. Other peculiar reasons in Nigeria are the tendency for care givers to ‘home medicate’ ill infants with substances like juice/extracts from unripe pawpaw and leaves, glucose water, cocoa nut water and medications such as ‘Ampiclox’ and ‘ABIDEC’
Severe jaundice in a proportion of infants may progress to Acute Bilirubin encephalopathy (ABE) or kernicterus with increased risk of neonatal death. Infants who survive may acquire long term neurodevelopmental sequel such as cerebral palsy, sensoneural hearing loss, gaze disturbance, mental retardation, periodontal defects etc.
In low and medium income countries like Nigeria the challenge of managing infants with severe hyperbilirubinaemia is daunting due to its constrained resource. Early identification of at risk infants is therefore crucial to curtailing the burden of this potentially devastating disease.
How is infant jaundice diagnosed?
Doctors prescribe that infants be checked for jaundice before being released from the doctor's facility and again three to five days after birth, when bilirubin levels are most noteworthy.
There is a test you can perform yourself to check whether the baby has jaundice, despite the fact that it is not decisive. Ordinarily, when you press your finger on skin the squeezed region is marginally lighter than the ordinary skin shading. Be that as it may, if the region where you squeezed your finger looks yellow, odds are the baby has jaundice. This test is best performed under normal sunlight.
Doctors will in all likelihood analyze jaundice in view of appearance alone, although the seriousness of jaundice will be dictated by measuring levels of bilirubin in the blood. Bilirubin levels can be checked by means of a serum bilirubin (SBR) blood test or a transcutaneous bilirubinometer gadget, which measures the amount of a unique light radiates through the skin.
In the event that the newborn child's jaundice continues for more than two weeks Doctors may perform additionally blood tests and urine tests to check for hidden issue.
Infant Jaundice Treatment
Typically, treatment for mild jaundice in infants is unnecessary, as it tends to disappear on its own within two weeks.
If the infant has severe jaundice they may need to be readmitted to the hospital for treatment to lower levels of bilirubin in the bloodstream.
Some treatment choices for extreme jaundice include:
Phototherapy (light treatment) - treatment by light beams. The baby is put under a special light, secured by a plastic shield to filter out ultraviolet light, that controls the structure of bilirubin molecules so they can be excreted; some of the time it is valuable to utilize a light-radiating sleeping pad under the child also. Typically, the child is exposed, wearing just defensive eye patches.
Exchange blood transfusion- the baby's blood is repeatedly withdrawn to filter out bilirubin and then transferred back into the bloodstream. This procedure will only be considered if phototherapy does not work because the baby would need to be in an intensive care unit (ICU) for newborns.
Intravenous immunoglobulin (IVIg) - in the event that there is a distinction in blood classification, the baby can get a transfusion of immunoglobulin, a protein in the blood that can bring down levels of any residual antibodies from the mother, which may be attacking the newborn child's red platelets.
If jaundice is caused by something else, surgery or drug treatment may be required.
Complicaions that could occur from infant Jaundice
Acute bilirubin encephalopathy - a condition caused by a buildup of bilirubin in the brain (bilirubin is toxic to brain cells). Signs of acute bilirubin encephalopathy in a baby with jaundice include fever, sluggishness, high-pitched crying, poor feeding, and arching of the body or neck. Immediate treatment may prevent further damage.
Kernicterus (nuclear jaundice)- a potentially fatal syndrome that occurs if acute bilirubin encephalopathy causes permanent brain damage.
Prevention of Infant Jaundice
The most ideal method for diminish odds of a newborn child developing jaundice is to ensure they are very much fed. For the first week or so of life, breastfed children ought to be fed eight to twelve times each day, while formula-fed infants ought to be fed one to two ounces of formula every few hours say two to three hours.
1) Ogundere O. Omole
Journal of the Obafemi Awolowo University Medical Student of Ibadan
2) C.N Onyearuga, B.N Oyire and H.A.A Ugboma
Neonatal Jaundice: Prevalence and Associated factors as seen in Federal Medical Centre Abakaliki, South east Nigeria.
Journal of Clinical Medicine and Research Vol.3(3) pp 40-45, March 2011
3) Bolajoko O. Olusanya, Folasade B. Osibanjo, Tina M. Slusher
Risk factors for severe neonatal Hyperbilirubinemia in low and middle income countries: