This article is courtesy of Dr Cheang Hon Kit, Consultant Paediatrician/Neonatalogist of a private hospital in Penang. The hospital has a website with more information on jaundice and G6PD deficiency.
Jaundice in babies
This is a very common condition affecting over 90% of newborns born in South – east Asian region.
Newborns have a limited ability to conjugate bilirubin (yellow pigments which are breakdown products of haemaglobin) during the immediate newborn period. This transient elevated bilirubin (physiological jaundice) is of little consequence unless other factors which increase the total load of bilirubin come into play. These factors are:
1. Delay in the normal maturation of the liver function eg. In prematurity.
2. Haemolysis (excessive breakdown of red blood cells) eg. In G6PD deficiency. ABO and Rh incompatibility and drug induced
4. Persistent vomiting.
Visible yellowness of skin normally appears on the 3rd day of life. The jaundice peaks around the 5th day and subsides by 7th to 10th day. Jaundice which appear earlier or later than the 3rd day or persists beyond 2 weeks is not physiological and needs thorough investigations to rule out pathological and surgical causes.
Mild to moderate jaundice
Light therapy (phototherapy) provides an effective and reasonably safe treatment for neonatal jaudice. Blue light (wavelength 450 nm) is most effective. Phototherapy works by using light energy to change bilirubin into more water-soluble products to be excreted via the bile and urine.
What parents can do
* Make sure baby has enough nutrition and fluids. Extra fluids in the form of plain boiled water should be given liberally
* Expose baby to indirect blue skylight
* Keep appointment with the doctor during babyâ€™s first weeks of life
* Consult a doctor as soon as possible if baby is off feeds, lethargic and appears visibly more yellow.
What parents must not do
Parents must not bathe baby in herbs, alcohol etc. Babies should only be bathed with water
Nursing mothers should not eat substances which may aggravate neonatal jaundice especially in babies with G6PD deficiency. Chinese herbal drugs which can aggravate neonatal jaundice are Huan Lian, Tong Kwee, Sor Hup, Pak Poh Suah, Kow Cho Suah (terms mentioned in Hokkien dialect), etc.
Parents must not feed baby with traditional medicine. Effective treatment of Neonatal jaundice is light therapy. Severe jaundice is treated with blood exchange transfusion.
Light therapy and blood exchange transfusion
Dangers of hyperbilirubinaemia (very high levels of bilirubin in the blood). Brain damage if the unconjugated bilirubin crosses the blood-brain barrier into the brain. It stains the brain cells of the midbrain. When this happens a condition called kernicterus results. (Visit the hospital website for explanation on kernicterus)