Jaundice: X-raying this silent killer of infants

Imagine that you gather guests for the naming ceremony of your child ,but alas the celebration turns sour when you discover the baby is dying.  This was Halima Dangana’s experience.  She narrates. “I had my third baby normally in the hospital and we were discharged. On the seventh day, we gathered family and friends for […]

Imagine that you gather guests for the naming ceremony of your child ,but alas the celebration turns sour when you discover the baby is dying.  This was Halima Dangana’s experience. 
She narrates. “I had my third baby normally in the hospital and we were discharged. On the seventh day, we gathered family and friends for the naming. After she was named, I Iaid her on the bed to attend to some guests, but was checking on her from time to time.  It was during one of those checks that I noticed that she was gradually turning yellow. I called the attention of a nearby nurse. She examined her and advised me to take my child to the hospital immediately. Not to distract guests from the celebration, I sneaked my baby through the back door.  The hospital was about 10 kilometres away. Before I got to the hospital, her condition had worsened,” Dangana explained.
She continues. “At the emergency ward, while my husband was trying to get the baby’s hospital folder, a nurse grabbed the baby from me. They took her blood sample for a test and then took her to a particular room which had blue light. While she was there, I prayed that my baby will get better and come out alive. But that was not it.  She died. The doctor said she had jaundice that was not detected early,” she narrated.
Health experts say jaundice is a medical condition in which too much bilirubin- a compound produced by the breakdown of hemoglobin from red blood cells ,is circulating in the blood.
Dr Murjanatu Mijinyawa a public health physician at the State House Clinic, says “jaundice is the yellowish discolouration of the sclera (white part of the eye), skin and mucous. This might be observed within the first month of life. There will be yellowish colour of the eyes, which progresses to the face, and might go on to involve the whole body, including the palms and soles,”she said.
High levels of bilirubin that cause severe jaundice can result in serious complications and even death, like in the above case if not treated.
Dr Audu Lamidi, Chief Consultant Paediatrician/Neonatologist at the National Hospital, Abuja corroborates this. “As mild as it can be, jaundice is deadly. It has killed many babies and in some cases damaged the brains of babies permanently, and they become incapacitated. It is preventable and babies need not die from it. But then, in some hospitals when babies are rushed in, the phototherapy light is not working, and if the case is severe and an exchange blood transfusion is not done immediately, the child may die,” Lamidi explains.

It is estimated that six out of every ten babies develop jaundice, including eight out of ten babies born prematurely (babies born before the 37th week of pregnancy).
Nana Garba says her sister’s baby was deformed as a result of jaundice. “After the delivery of the child, they were discharged. Unknown to us, the child developed jaundice on the third day. The mother thought it was mild, so she takes the baby out and keeps her under the sun for a while. But that did not solve it. Few days later it became severe and before we took her to the hospital, they said it has affected her brain. The child survived but she is deformed. Her brain was affected, ”Garba narrates.

Experts say a baby born before 38 weeks may not be able to process bilirubin as quickly as full-term babies do. Also, he or she may feed less and have fewer bowel movements, resulting in less bilirubin eliminated through stool. So, they are more likely to get jaundiced.
 “When a child has jaundice, we don’t just jump into treatment. We must know the level of the jaundice. We have to do a blood test which will tell us the level,and show if it is mild, moderate or severe. Also, we want to know what caused it. If it is physiological, which is usually mild, we can tell the mother to go home, but if it is pathological, we must treat,” Lamidi explains.
Two ways to treat jaundice
“The most important treatment is phototherapy. It’s a specific light.  It’s a blue light with specification which we use to treat patients. However, there are some babies who despite staying under the light, jaundice will keep rising, so they will need further treatment to prevent brain damage. In that case, we do exchange blood transfusion. So you get the blood of a compatible donor which matches that of the baby and you exchange it,”Lamidi explains.
Lamidi however warns that keeping the child in the sun, as some mothers do to treat jaundice will not help. Sunlight is not clinically proven to treat jaundice.
On how many babies die as a result of Jaundice, Lamidi says it depends on where you practice.
“If you are practicing in a place like ours where some babies arrive in  a very bad state, the mortality rate is higher. For instance, if you are seeing 20 severe cases, five of them may die, 10 may survive without any problem and then five survive with some challenges. Some come in brain damaged and moribund already,” he explains.
Babies who have different blood group with their mothers are likely to be jaundiced. Also, Lamidi explains other causes of jaundice. “We tell mothers to avoid infection as much as possible. Also, camphol is very dangerous. If it touches the mothers clothe and then the baby touches it, some babies react to it and they have terrible jaundice.”
Again, if the child is dehydrated and does not feed often, it can aggravate the case of jaundice but it’s not a primary cause. Because when the child feeds well and takes water, he or she will pass stool and urine and more bilibrun will pass out. Hence, expert’s advice mothers to breastfeed their babies and feed well.
Slow progress on infant motality
In 2015, infant mortality rate in Nigeria reduced to 69 per 1,000 live births from 72 in 2014, according to data published by World bank.org. Although this shows that Nigeria is making progress in cutting down infant and under-five mortality rates, the pace still remains too slow.
A report published by UNICEF on its website,  states “More than a quarter of the estimated 1 million children who die under the age of 5 years annually in Nigeria die during the first 28 days of life (neonatal period). And it will be interesting to note that about 9 out of ten of newborn deaths are preventable.”

According to the same report, the deaths of newborn babies in Nigeria, represent a quarter of the total number of deaths of children under-five. The majority of these occur within the first week of life, mainly due to complications during pregnancy and delivery, reflecting the intimate link between newborn survival and the quality of maternal care. Main causes of neonatal deaths are birth asphyxia, severe infection including tetanus and premature birth, jaundiced amongst others.
Dr Nathaniel Adewole, a Senior Consultant Gynecologist and Obstetrician at University of Abuja Teaching Hospital, says that the rate of neonatal deaths can be reduced if the following  actions are taken
 “Parents must make sure that their babies are treated properly and promptly when they notice any ailment. The umbilical cord must be managed well after the birth of the child to prevent infection. Again, avoiding infection can greatly reduce the chances of the child having jaundice. But if the child develops jaundice, he/she must be taken quickly to the hospital. This will reduce the incidence of death,”Adewole explains.