Neonatal jaundice is extremely common in Ghana, posing a significant disease burden on health authorities.
According to the Ghana Health Service, 3 out of every 100 live births have neonatal jaundice, with 40% having an underlying medical condition. The mortality rate of neonatal jaundice is approximately 2%.
Neonatal jaundice is a medical condition that occurs shortly after birth when a baby’s blood contains a high level of bilirubin (a substance released in the blood after red blood cells break down) Neonatal jaundice usually resolves as the baby’s liver develops and the baby begins to feed. Feeding aids in the elimination of bilirubin from the blood.
According to the Ministry of Health (2018), it is estimated in Ghana that, 38% of all newborns develop Neonatal Jaundice within 72 hours after birth. This often needs quick and appropriate actions to promote early detection and treatment to prevent neonatal mortality in Ghana.
The first sign of Neonatal Jaundice is yellow discoloration of the skin or eyes, that begins within two – four days after birth and may start on the face before spreading to other parts of the body.
Danger signs of Neonatal Jaundice include fever, poor feeding, restlessness and high-pitched crying.
Risk Factors
The following categories of babies are at highest risk of developing newborn Jaundice:
- Premature babies (babies born before 37 weeks of pregnancy)
- Babies whose blood type is incompatible with mother (ABO incompatibility)
- Babies who are breast-fed poorly
- Babies with liver problems
- Babies bruised at birth or from other internal bleeding
- Babies with red blood cell enzyme deficiency
Causes of Neonatal Jaundice
During the first few days of life, babies are not able to get rid of much bilirubin, this mild type of Jaundice is normal. It is due to the breakdown of red blood cells (which release bilirubin into the blood) and the immaturity of the newborns liver to eliminate bilirubin via the gastro-intestinal system.
Normal physiologic jaundice of the newborn typically appears between 2nd and 5th day of life and clears usually within 7-14 days.
Pathological Neonatal Jaundice occurs if jaundice in the newborn persists beyond 10-14 days of life. This is usually due to underlying medical conditions such as, liver disease, ABO incompatibility, prematurity, intravascular hemolysis, sepsis (infections) as well as genetic disease (Dubin-Johnson syndrome, Gilbert’s disease).
Complications
When severe jaundice goes untreated for long, it can cause a condition called Kernicterus. Kernicterus is a type of brain damage that results from bilirubin entering the baby’s brain. It can cause cerebral palsy and hearing loss.
Dehydration is another long-term complication and can co-exist with hemolytic disease leading to sever anemia.
Treatment
The treatment of Neonatal Jaundice depends on severity. In most cases, treatment is not required.
Some treatment options are:
Phototherapy (Light therapy)
It is a treatment with a special type of light (not sunlight). It is sometimes used to treat newborn jaundice by lowering the bilirubin levels in baby’s blood through a process called photo-oxidation which adds oxygen to the bilirubin so it dissolves easily.
Exchange Transfusion
During an exchange transfusion, the baby’s blood is removed through a thin plastic tube placed in blood vessels in their umbilical cord, arms or legs. The blood is replaced from a suitable donor, someone with the same blood group. As the new blood will not contain bilirubin, the overall level of bilirubin in baby’s blood will fall quickly.
Intravenous Immunoglobulin
The immunoglobulin is a solution of antibodies (proteins produced by the immune system to fight disease) taken from healthy donors. This helps to prevent red blood cells from being destroyed, so the level of bilirubin in a baby’s blood will stop rising. It also reduces the need for a blood transfusion.
Prevention
There is a trite assertion that, prevention is better than cure but according to research, there is no real way to prevent newborn jaundice. If a baby has jaundice, inform your doctor quickly.
Make sure baby is getting enough nutrition through breastmilk. Feeding a baby 8-12 times a day for the first several days ensures that, the baby is not dehydrated which helps bilirubin pass through their body more quickly.
Seek medical care as soon as you notice jaundice in a baby. Early detection is key to preventing and managing Neonatal Jaundice in Ghana.
