|
What are the types of jaundice and why do they occur? The main thing to remember is that jaundice is quite a common occurrence in newborn babies and need not be dangerous, though you will have to be alert to signs that it is. Jaundice affects about 50 percent of newborns. Physiological jaundice Nine in 10 cases of jaundice occur because the baby's liver is still immature. In normal circumstances, bilirubin - a yellow pigment by-product from the breakdown of old red blood cells - is removed by the liver and excreted in the bile, which goes into the intestines and gives the faeces their brown colour. In the womb, the foetus' bilirubin is cleared by the mother's liver through the placenta. But a newborn's liver is still immature and inefficient at bilirubin disposal, hence the build-up and subsequent yellowish cast of the skin. Physiological jaundice usually develops on the third or fourth day. By the seventh day, the newborn's liver will become more efficient and begin to clear off the jaundice. The bilirubin level will not reach dangerous levels. Jaundice is commonly treated with phototherapy, a light treatment that breaks down bilirubin, which is then cleared through the urine. Babies who are given phototherapy lie naked either under (in this case, their eyes will need to be covered to protect them) or over a special blue light continuously for one to several days until the jaundice has cleared up. Breastfeeding jaundice In about five to 10 percent of cases, a baby suffers jaundice because she is not getting enough breast milk. Fortunately, this type of jaundice is also usually harmless. To help prevent breastfeeding jaundice, paediatrican and lactation consultant, Dr Koe Swee Lee, advised: "A normal baby should be breastfed ten to twelve times daily on each breast." Breast milk jaundice Jaundice may occur or be prolonged because of breast milk. Breast milk contains a hormone, pregnanediol, that interferes with the body's ability to make bilirubin water- soluble and thus able to be excreted via urine. This occurs in about one in 200 mothers. Their babies may have jaundice for a longer period, for three to 10 weeks. Again, this type of jaundice is not harmful. What you can do if this is the problem is stop breastfeeding for a few days, but not permanently. The jaundice should clear up and should not return when you resume breastfeeding baby. ABO Incompetency Jaundice may result if the baby's and his mother's blood group are incompatible i.e. when the mother belongs to blood group 'O' while her baby is either from blood group 'A' or 'B'. The mother produces antibodies that enter the baby and destroy its red cells, leading to an increase in bilirubin. Jaundice will occur within 24 hours after birth. Phototherapy or blood transfusion will then be needed, depending on the severity of the baby's jaundice. Severe, prolonged jaundice This may be caused by liver disease, obstruction of the liver ducts and hepatitis. In such cases, the baby will be very pale; passes out urine that has a very dark colour, and does not grow well (underweight). Consult a doctor if in doubt. While most cases of jaundice are mild and will resolve on their own (when the baby's liver matures), in some cases, the bilirubin level increases dangerously and there is a risk that it may enter the baby's brain cells, causing permanent brain damage. This condition is called kernicterus. In extreme cases, kernicterus will result in death. Symptoms of kernicterus include very yellow skin, poor feeding, weak or shrill cry, a flaccid or stiff body and fits. The treatment for kernicterus is exchange transfusion, whereby all of the baby's blood is removed (hence removing all the bilirubin) and replaced with fresh blood, a little at a time, until all of the baby's blood has been replaced. To do this, the affected baby's umbilical cord and stump is cut off and a catheter inserted into the umbilical vein through the navel. Cause of severe jaundice The main cause of severe jaundice or kernicterus is glucose-6-phosphate dehydrogenase deficiency (G6PD). Glucose-6-phosphate dehydrogenase is an enzyme in our red blood cells. A lack of this enzyme causes red blood cells to become unstable and break down easily. A blood test can measure the level of this enzyme in the blood. Exposure to certain chemicals, antibiotics, anti-malarial drugs, fava beans and herbal preparations can also lead to a breakdown of red blood cells. Thus, cautions paediatrician Dr Hoe Tuck Sang: "Parents should exercise caution when it comes to using medical herbs on their babies as some of them contribute to an upsurge of bilirubin." Also, alert your doctor if your baby has G6PD, so he can prescribe medicine accordingly. Cupboards or drawers where your baby's things are kept should also he free from mothballs, as they also trigger jaundice in G6PD babies. |
Side Notes False jaundice You may notice that your older child's skin, palms and soles are looking yellowish. This is unlikely to be jaundice. Instead, it may be due to high levels of betacarotene in the skin, from eating large amounts of carotene-rich fruit and vegetables such as carrots, papayas and pumpkins. This condition is called hypercarotaenemia or just carotenaemia, and is reversed by cutting down on such food. It can be told apart from jaundice because in this case, the whites of the eyes remain white. Traditional beliefs Many people believe in sunning a baby to clear off jaundice. This involves putting the baby under the morning sun with his eyes covered for a few hours daily until he looses his yellow tinge. Sunning the baby as a means of getting rid of jaundice is ineffective as sunlight is made up of seven colours, and getting rid of bilirubin is only effective with continuous exposure to blue (used in phototherapy) and green light. Another popular practice is to bathe the baby with Chinese herbs to get rid of jaundice. Parents should exercise caution here. Some herbs contain chemicals that cause an upsurge of bilirubin in G6PD babies, which may lead to death. |