A woman in her mid 30s just had her first baby. It was discovered that the baby was infected with jaundice on the third day of life. She soaked unripe pawpaw in sterilised water and administered it on the child. Her mother in-law and sister also suggested to her the use of alum, ampiclox syrup and glucose.
The baby, 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....................More gist?
Newborn jaundice is also called neonatal jaundice. It happens when a new born baby (those babies who are less than 28 days old) has high levels of bilirubin in the blood.
Bilirubin is a yellow substance that the body creates when it replaces old red blood cells. The liver helps break down the substance so it can be removed from the body in the stool. A high level of bilirubin makes baby’s skin and the sclera (the white part of the eyes) look yellow. This is called jaundice.
When the baby is growing in the mother’s womb, the placenta removes bilirubin from the baby’s body. After birth, the baby’s liver starts doing this job, but due to immature nature of the liver, most newborns will have jaundice.
Most newborns have some yellowing of the skin, or jaundice. This is called “physiological jaundice.” It is harmless, and usually is worst when the baby is between two and four days old. It goes away within two weeks and doesn’t usually cause a problem.
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.
Causes
It 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 below:
•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 blue 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. Keep the light therapy on the child’s skin and feed the child every two to three hours.
•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, 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
In newborns, some degree of jaundice is normal and probably not preventable. The risk of significant jaundice can often be reduced by feeding babies at least eight to 12 times a day for the first several days and by carefully identifying infants at highest risk.
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 may also be done if the mother’s blood type is O+.
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 of newborn jaundice, while multivitamin drops also don’t cure jaundice.
These self medications listed above only increase the level of the jaundice. However, early morning sunlight for about 10-20 minutes daily has been proved to be an effective form of treatment of newborn jaundice.
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