Healthy Living explores the causes of jaundice
Health experts say that the majority of babies are born with jaundice. But did you know that newborns with this health condition are at their most critical period in the days following birth? This week’s edition of Healthy Living focuses on jaundice.
Marleni Cuellar, Reporting
It is reported that sixty percent of babies are born with jaundice. While it is not an illness, per se, jaundice is the yellowing of the skin. The yellow color is caused by a build up of a chemical in the body.
Dr. Victor Rosado, Pediatrician
“What causes it is a pigment called bilirubin and bilirubin is derived from the blood in the newborn and the pigment takes on a yellow color, which leads to the yellow coloration of the skin. It’s more common in certain babies, obviously in premature babies, it is much more common. But if you take a review of all babies up to sixty percent of them will have some degree of jaundice.”
Bilirubin is made when the body breaks down old red blood cells. A normal process that that happen throughout your life; however, red blood cells have a shorter life span in babies than they do in adults, which leads to the extra bilirubin in newborn babies and explains why it is so common.
Dr. Victor Rosado
“Most babies will have mild jaundice and will recover without actually any treatment, will recover with recommendations like breastfeeding every two to three hours within the first five days of life. While I say that most children will recover from their jaundice, we do have cases where, as we have seen recently, that children can die from jaundice. The bilirubin can be very toxic if it passes a certain level. If it passes into the blood brain barrier it’s toxic to a certain area of the brain and it can cause respiratory arrest. So you can have a child dying for jaundice or you can have children suffering severe permanent brain damage a condition known as kernicterus.”
According to Dr. Rosado, the most critical time for newborns with high levels of jaundice is the first three to four days of life. In Belize we practice what is called ‘very early newborn discharge’ where newborns, except ones born by c-section, are discharged within twenty-four hours of birth.
Dr. Victor Rosado
“If the mother goes home and for some reason within the first three days sees that the level of jaundice or yellowing of the skin is increasing, then I think Belize has adequately assessable health centers so they should visit their nearest health center for a clinician to do that assessment. I really think that we have problems because we are allowing to do the decision as to when to visit the health center. Sometimes as parents, mothers are eager to return home and take unnecessary risk and return if the jaundice gets worse. Sometimes within that two days that they are at home, the jaundice grows to a level that is a huge clinical problem for the child.”
A blood test can determine the amount of bilirubin in a child system and can determine the risk associated with developing complications from jaundice.
Dr. Victor Rosado
“Most hospitals have moved towards trying to eliminate the subjectivity of assessing jaundice so we need to have established protocols whereby all newborns, be it in the first day or second day of life, need to have a serum bilirubin check because it is very subjective to just look at a child’s skin. It will vary a lot depending on the color of his skin. If you’re able to say well this child has slight jaundice, moderate jaundice or severe jaundice and so we should established protocols.”
Breastfeeding is recommended as a way of decreasing the risk of severe jaundice. A baby with high risk however, usually receives phototherapy and, in very severe cases, a blood transfusion.
Dr. Victor Rosado
“They should immediately be placed under phototherapy which are special lights in the hospital that reduces the level of jaundice and in few cases there needs to be a blood exchange transfusion. If we see the level of jaundice going up at a rapid rate within the first day or two of life, if we say it rapidly increasing by the hour then the child should receive what we can a blood exchange transfusion.”
It is common practice in Belize to sun a baby several days after birth as a home remedy for jaundice. This practice however is not without its dangers.
Dr. Victor Rosado
“Most of the established centers, including C.D.C. and the American Academy of Pediatrics, have come out against recommending sunlight as a treatment for jaundice. Again I think it’s because it’s too wide a recommendation. Parents would not know when sunlight would be an effective treatment versus when there is the need to go the hospital. The results can be catastrophic within the first three quarter days of life and so if you are relying on sunlight within the first week, you might have really bad results.”
Jaundice lasts different times for different babies and while it may be common in most, some are more at risk that others and require closer monitoring. They include: babies born before thirty-seven weeks; babies with low birth weight – under two point five kilos, babies with darker skin; babies with a family History if a sibling had jaundice; babies who were bruised at birth and babies whose mother has blood type O or RH negative.
