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WHAT  IS  JAUNDICE?

 

Jaundice is a condition in which the skin and whites of the eyes turn yellow. Jaundice is not a disease in itself. like a rash or a high temperature, it can be a sign of underlying disease. There are two distinct times when jaundice occurs: at and just after birth and later in childhood. Many newborn babies suffer from physiological jaundice, which indicates an immature liver. Haemolytic jaundice affecting newborns and jaundice in children is rare. 

What causes it?

The yellow colouring is the result of a build-up of a bile pigment called bilirubin, which is produced by the breakdown of red blood cells. The bilirubin attaches to a protein in the blood called albumin. This moves to the liver where it is metabolized. It is then excreted into the gut. Broken down, bilirubin is what makes stools a dark brown colour. However, if, for whatever reason, the bilirubin is not being disposed of by the liver, its accumulation in the blood will affect skin colour.

 

Physiological  jaundice:

Around 60 per cent of normal, healthy, full-term babies develop what is known as physiological jaundice.

 

• Suddenly the baby's liver has to struggle to get rid of the bilirubin, a job previously taken care of by the mother's placenta. 
• Newborns have to deal with a lot of red blood cells as they swap their fetal hemoglobin for adult haemoglobin. In addition, any bruising as a result of the birth will have to be broken down to bilirubin too. 
• Because of the immaturity of the liver, there is usually a small delay before its enzymes kick into action. Premature babies are particularly slow at getting rid of the bilirubin and so are more prone to physiological jaundice. 
• Physiological jaundice only ever appears on day two after birth; never within the first 24 hours. It peaks on day four and usually clears by the end of the first or second week. 

Haemolytic jaundice

A baby may develop haemolytic jaundice if his blood group is incompatible with his mother's, particularly if the mother is rhesus negative.

 

• The difference between the mother and baby's blood is often not a problem in a first pregnancy However, if the first pregnancy involves a rhesus positive baby this may sensitize the mother's blood to her baby's blood. 
• If the rhesus negative mother is not given a special injection at the time of the first birth, miscarriage or termination, the blood of the next rhesus positive baby she carries will be attacked by her immune system. 
• Such extreme situations are usually avoided as antenatal tests during a first pregnancy reveal whether the woman has a rhesus negative blood group - if she does, the required injection will be given. 
• If, for some reason, a rhesus negative woman has not been treated in this way, a blood test will check whether she might have blood cells that will attack her baby. If so, both mother and baby will be monitored closely.

Treatment

Treatment depends on the severity of the condition and how early it is picked up. A simple blood test can be taken to ascertain the bilirubin level.

 

Sunshine: for mildly jaundiced babies, a short spell each day in the sun is usually all that is needed, as light breaks down bilirubin.

 

Fluids: the baby needs plenty of fluids, by drip if he is not feeding.

 

Phototherapy: the baby will be put under a light and assessed every 24 hours.

 

Exchange transfusion: only used when the bilirubin level is rising fast and/or other measures have failed. The baby's blood is slowly removed and 'new', healthy blood - free of bilirubin - replaces it. This may be done repeatedly to ensure that the baby is out of danger from long-term injury.

 

Complications

 

If the bilirubin level is very high, it can lead to a life-threatening condition called Kernicterus. If a baby recovers, he may be left with cerebral palsy and deafness.

Symptoms include:

·        Abnormal behavior

·        Poor feeding

·        Fitting

·        Opisthotonus - a condition whereby a baby throws back his head and arches his back

 

Jaundice persisting over one week

 

As jaundice is a symptom of an underlying illness, any discolouration lasting for more than a week needs to be investigated, especially if it is associated with dark wine or pale stools. It is important that the baby is checked for liver disease or other conditions.

 

Breast-milk jaundice: this may result from infrequent feedings, starvation and dehydration, rather than from the breast milk itself. The bilirubin level does not usually rise very high and, with treatment and giving up breast-feeding for 72 hours, the jaundice soon clears up.

Biliary atresia: a rare condition in which bile fails to drain from the gall bladder in the liver into the bowels. Urgent surgery is needed before irreversible liver and brain damage occur

 

Urine or other infections or hypothydroidism (underactive thyroid gland): these may cause jaundice and may be checked for by a doctor at this stage.

Hepatitis: type A is spread by eating or drinking food infected with hepatitis A, often while abroad. Children usually have a mild illness and recover well. Types Band C are spread via blood

products (such as HIV) or the virus is given to the baby by the mother's placenta, and may cause serious long-term damage to the liver.

 

For  More  Information:  Please  consult  your  physician  on  your  next  visit.