Jaundice can damage newborn’s brain if not detected early

Many newborns are at risk of death or brain damage because of missed symptoms of jaundice.

Doctors are seeing children with kernicterus, a severe form of brain damage, days after their eyes and skin turn yellow — an early sign of jaundice.

Jaundice is caused by rapid destruction of the excess red blood cells that babies are born with.

Dr Walter Otieno, a consultant paediatrician explains that inside the womb there is less oxygen, so babies have more blood cells than adults to compensate for this. After they are born, the excess red blood cells are broken down in the liver into bilirubin.

However, some babies cannot process the excess bilirubin quickly enough either because their liver is immature or they have slightly higher levels of red blood cells than average.

‘‘This should then be flushed out of the body in the urine, causing no untoward problems,’’ Dr Otieno said.

Bilirubin which is a yellow substance builds up in the blood, causing the yellow-tinged skin and eyes. This normally starts two or three days after birth and lasts up to 10 days.

“It is either the parents are not recognising how serious jaundice can be or the health workers are not following up the children after discharge. The cases are mostly recorded on first-time mothers,” he said.

Early jaundice, Dr Otieno said can also be caused by mother and baby having a different blood type. The mother’s antibodies cross the placenta and start to destroy the baby’s red blood cells, sometimes even before birth.

“All pregnant women should be tested for blood type and unusual antibodies. When the result are such that the mother is Rh negative, the infants cord should also be tested,” he said.

Another potential cause is a deficiency in an enzyme called G6PD. This enzyme is needed for healthy red blood cells. Too little can lead to the sudden destruction of red blood cells.

“Untreated jaundice has bad effects. As it progresses it has a tranquiliser-like effect on the brain because bilirubin — which is toxic to brain cells — starts to leak into it,’’ said Dr Otieno.

Treatment involves a child being placed under phototherapy (a fluorescent light-king of incubator) which helps makes the bilirubin more soluble and therefore easier to flush out of the body.

In severe brain damage, a child lose their ability to move, may develop uncontrollable movements of the body and hearing loss, said Dr Otieno.

A Jama Paediatrics study reassured mothers that brain injury due to high bilirubin was rare and that only those infants whose levels were well above exchange transfusion guidelines developed kernicterus.

For children with dark skins, the yellowing may not be easily visible. “When a baby is dark-skinned, a mother should check the white part of the eyes, inside the mouth and palms,” the paediatrician said.

Also check for poor suckling, a high-pitched cry, yellow or orange poo and a child who is too sleepy.

“It might be difficult to detect other signs when you are a first-time mother but the yellowing of the whole body should be the first sign to tell that the child is having jaundice,” he said.