JAUNDICE IN A NEWBORN
“How could this have Happened? No, he must pay for this. He will rot in jail! He will never practice medicine again! Useless doctor…nincompoop! People that have no business practising medicine…bunch of quacks! Useless hospital! All they want is money! They’ve killed my child for me. Oh God, they’ve destroyed my life). “I will shut this place down. They’ve messed with the wrong family”.
All these thoughts and more passed through the mind of a Man with his wife standing in excruciating pains at the hospital reception while causing a large ruckus. The 12ft by 10ft room was overturned with commotion as the loud shouts of crying and wailing were intertwined with the deep voice of the man issuing the threats. Amongst the family was a policeman who had escorted the horde to the hospital with the sole aim of arresting the doctor who had delivered their son. A son who had been perfect until the hands of that murderer touched him, a son who was now weakly crying in the arms of his almost-hysterical mother. Their family had been overjoyed with celebratory news when their bundle of joy had arrived. But that was ten days ago. Their ten-day old perfect son was now in a critical condition and by God, the person responsible was going to pay.
As the medical director of the hospital walked into the room to see what was causing the frenzy, the grandmother of the baby grabbed him by his shirt shouting, “You! You’re the one that destroyed my grandson!”. The policeman rushed to remove the woman from the doctor’s body even as she struggled with him. “Oga police, what are you waiting for? That’s the man. That’s the owner of this quack shop they call a hospital. Arrest him!”, yelled the father of the boy. The doctor recognising the man asked what the matter was. It was then that he saw the baby - weak, jaundiced, and feeble. “Are you the doctor that attended to the delivery of this baby 10 days ago?” said the policeman to the doctor. The doctor nodded as he replied, “Yes, I am”. The policeman then informed the doctor of his need to follow him to the police station for questioning regarding charges brought against him on account of negligence in the delivery and management of the baby.
The doctor realising what was going on and understanding what had really happened instructed the nurse to retrieve the baby’s case note (a case note is a folder, whether electronic or manual where the care of a patient is documented). The doctor then proceeded to show the policeman who confirmed the details of the case note to be that of the new-born. It was discovered that the doctor had noticed jaundice shortly after the baby was born (that is, yellowness of the baby’s eyes, skin, and other parts of the body). He had requested for the necessary investigations which showed that the baby had elevated levels of bilirubin in its system and would require phototherapy (that is, putting the baby under blue light to deplete the elevated levels of bilirubin in the body’s system). After two days of phototherapy, there wasn’t significant change.
However, when the doctor informed the family, the father of the child had stated that it was usually normal for them to be fair-complexioned in his family and that he was sure that the yellowness the doctor was seeing was the baby taking after the heritage of natural fairness found in his bloodline. More so, his naming ceremony was fast approaching which they had not had time to adequately prepare for because they had not been discharged yet. After much counselling, the father decided to discharge his baby against medical advice (DAMA). The entire crowd who was astonished by the new findings went mute.
The grandmother of the boy was the first to regain her wits. “Haa! So, my enemy is within my household! Temi bami.” Immediately the grandmother grabbed the father’s shirt, “So you were the culprit all along!” The policeman faced the doctor and apologised to him and announced the dismissal of the case.
Believe me, the above story is not too ridiculous to be true.
Jaundice is the yellowish discoloration of the skin, sclera, mucous membranes, and plasma, usually due to an unusually elevated level of a substance in the body called bilirubin. Bilirubin is a by-product formed from the breakdown of red blood cells in the body, with the body providing a balance between its rate of production and excretion. (O.A.) Jaundice occurs when there is an imbalance between the rate of production (in cases of increased destruction of red blood cells) and excretion (in cases of hepatobiliary obstruction) of bilirubin. It is usually noticeable clinically when blood bilirubin levels exceed 5 - 7mg/dL. (V.C.)
About 30 - 75% of newborns born in Nigeria develop jaundice, with about 6% reaching values >15mg/dL. (V.C.) A research done by Animashaun et al found that 50% of a cohort of children with cerebral palsy had severe jaundice in the first few days of their lives. (V.C.)
In new-borns, there is what can be termed ‘normal’ or ‘expected’ jaundice. In this case, there is an increase in the destruction of their red blood cells exceeding what their system can adequately metabolise and excrete. This overload leads to increased levels of bilirubin in the blood. This kind of jaundice is called physiologic jaundice, is known to begin on the second day of life, reach its peak on the fourth or fifth day (usually not exceeding 12mg/dL), and resolve on the seventh day of life. It is termed normal because it is usually not a reason for concern as it does not cause harm to the baby.
Pathologic jaundice on the other hand is abnormal, usually noticed on the first day of life and can lead to irreversible damage to the new-born’s brain, known as kernicterus. Kernicterus is the most feared complication of untreated pathologic jaundice in which the bilirubin crosses the blood-brain barrier of the new-born, permanently damaging the brain of the baby. This irreversible damage leads to poor and delayed development of the baby, seizures, inability to attain milestones, failure to thrive, in some cases cerebral palsy and extremely, death.
Therefore, this phenomenon is the main reason Jaundice in new-borns is aggressively treated. Beyond phototherapy as mentioned in the story, when the bilirubin is still markedly elevated and phototherapy is not bringing down the level, then the next lifesaving line of management for such babies is a procedure called Exchange Blood Transfusion. During this process, the blood in the body of the baby containing the high levels of bilirubin is taken out and replaced concurrently with fresh blood, usually donated by the mother.
Jaundice is a common phenomenon usually trivialized and undermined by people. So many things have been flying about or suggested to treat it, such as using pawpaw water, or placing the child under sun. As much as these are popular, they have no scientific evidence to back up their effectiveness in clearing pathologic jaundice. In conclusion, when the yellowing of a newborn or child occurs, please ensure to take such child to a healthcare facility for proper investigations and management as advised by the medical professionals.