The term “Neonatal Jaundice” (NNJ) refers to the yellow discolouration that appears in the eyes and/or skin of a baby anytime within the first month of life. It is due to an excessive amount of BILIRUBIN in the blood. Bilirubin is a pigment formed when the red cells (RBCs) in the blood die or are destroyed. Normally it is acted upon in the liver and passed out of the body through the intestines so that its concentration in the blood is very small. If however, red blood cells are destroyed too rapidly or in excessive amounts, or if the liver is not functioning properly, or if the intestine is blocked, preventing bilirubin from leaving the body, its blood concentration may rise and jaundice results.
We worry about Neonatal Jaundice because sometimes, bilirubin (especially when the blood concentration is very high, and before it has been acted upon in the liver) can enter the brain of the baby, causing severe brain damage or even death. The importance of preventing these very distressing events is therefore obvious.
What causes Neonatal Jaundice?
Sometimes jaundice is in fact “normal” in a newborn baby. It usually appears on the third day of life. It is only mild and does not persist for more than a week. Jaundice appearing within the first 48 hours, or rising above a certain bilirubin level, or present beyond the second week of life, is not normal and, therefore, requires investigation. The cause is not always found, but the most frequent causes in our environment include:
1. Blood incompatibility:
Sometimes a baby’s blood does not “agree” with that of his mother. During her pregnancy, substances called ANTIBODIES then form in her blood and cross the placenta into the baby’s blood. These antibodies are harmful to the baby’s red blood cells, which they “attack” and destroy in excessive amount leading to Jaundice.
2. G6PD Deficiency:
G6PD is a substance normally present in red blood cells. It protects them from being destroyed too easily. In some babies (usually boys) G6PD is deficient and the red blood cells are unduly fragile. If such babies are exposed to certain chemicals such as camphor often used in preserving the baby’s clothes, the fragile red blood cells are destroyed, and jaundice results. The camphor is absorbed through the baby’s skin. Some ointments and powders used commonly in dressing the baby’s cord and navel contain menthol and have the same effect.
Newborn babies are very prone to infections because they have little or no resistance. Some of these infections may cause neonatal jaundice. Certain infections such as syphilis or German measles (Rubella) affecting the mother during pregnancy may be passed onto her unborn child and cause neonatal jaundice. Newborn babies may also suffer from hepatitis, just like adults, and become jaundiced s a result of inflammation of the liver.
If a baby is born before the usual nine (9) months , the liver may not yet have developed enough to cope with the bilirubin formed in the blood. Consequently, premature babies develop neonatal jaundice very easily.