Sad tales of children living with cerebral palsy caused by jaundice

Dr. Emokpae explains that neonatal jaundice is a yellowish discolouration of the whites of the eyes and skin in a newborn due to high bilirubin levels. He notes that it is common in preterm babies and other symptoms may include excess sleepiness or poor feeding.

“Bilirubin is a natural occurring substance in the body of neonates, but it becomes dangerous when its concentration in the blood gets too high,” he adds.

Continuing, Emokpae said, “High concentration may cause bilirubin to accumulate in the grey matter of the central nervous system, potentially causing irreversible neurological damage that might include seizures and cerebral palsy.

The paediatrician says he is very particular about neonatal jaundice, as it can lead to devastating neurological consequences, thereby limiting children from achieving their full potential.

“If bilirubin levels in a neonate rises over five milligrams within 24 hours, I will plan to have blood transfusion, as this is one of the signs that bilirubin levels are going to reach very high levels.

“Majorly, bilirubin can damage the brain. Generally, it is assumed that children with cerebral palsy are those who don’t cry at birth, but they are unaware that jaundice in a newborn baby is capable of inflicting such lifelong disability.”

‘JAUNDICE IN A NEWBORN BABY IS CAPABLE OF INFLICTING LIFELONG DISABILITY’

The expert further explains that in older children and adults, the lifespan of red blood cells from where bilirubin is obtained takes about 120 days. But the lifespan of the neonatal erythrocyte is only 60 to 90 days, with preterm infants having an even shorter life span of 35 to 50 days, thereby making excess bilirubin available to an immature liver.

WebMD notes that high concentration of bilirubin in the blood — medically known as hyperbilirubinemia — can cause jaundice, while high bilirubin in adults is an indication of liver problem.
“Newborn babies are especially vulnerable to hyperbilirubinemia-induced neurological damage, because in the earliest days of life, the still-developing liver is heavily exercised by the breakdown of foetal haemoglobin as it is replaced with adult haemoglobin and the blood brain barrier is not as developed.

“Bilirubin levels must be carefully monitored in case they start to climb, in which case more aggressive therapy is needed, usually via light therapy but sometimes even via exchange transfusion,” Emokpae explained.

Types of jaundice in newborns

According to Dr. Emokpae, there are two types of jaundice in newborns — physiological and pathological; adding that their debilitating effects can, however, be prevented.

“Physiological jaundice usually takes a natural course and does not require treatment. It usually comes down by itself.

“It is usually very common in newborn babies and appears within 48 hours of life. It peaks on the fifth day and then declines.

‘PATHOLOGICAL JAUNDICE IS THE MOST DANGEROUS AND CAN BE CAUSED BY RHESUS DISEASE, BLOOD GROUP INCOMPATIBILITY AND G6PD DEFICIENCY’

“Almost 75 percent of babies have jaundice and it usually rises above 12 milligrams in term babies and in pre-term, 15 milligrams.

“Jaundice in the newborn baby shows at levels of seven milligrams in contrast to older children and adults at two milligrams. In most cases, treatment is not required, just light therapy (phototherapy),” Emokpae explained.

On the other hand, pathological jaundice, the expert warns, is the most dangerous and can be caused by factors that include Rhesus disease, blood group incompatibility and G6PD deficiency.

Experts say G6PD deficiency is a genetic disorder that most often affects males. It happens when the body doesn’t have enough of an enzyme called glucose-6-phosphate dehydrogenase (G6PD). G6PD helps red blood cells work. It also protects them from substances in the blood that could harm them.

Symptoms can include paleness (in darker-skinned kids, paleness is sometimes best seen in the mouth, especially on the lips or tongue); extreme tiredness or dizziness, fast heartbeat, fast breathing or shortness of breath, jaundice (the skin and eyes look yellow), an enlarged spleen and dark, tea-colored pee.

Emokpae added that pathological jaundice presents within the first 24 hours of birth, with the total serum bilirubin level rising above five milligrams within 24 hours.

“Pathological jaundice can be caused by an ABO incompatibility factor, where the mother’s blood type is O and the baby is A or B (inherited from the father).

“Group O blood carries antibodies that destroy a baby’s red blood cells in the womb, thereby leading to high levels of bilirubin.

“At birth, once the umbilical cord is separated from the mother, the baby’s immature liver is left to deal with these high levels of bilirubin. During pregnancy, this function is carried out by the mother’s liver.

Rhesus factor and severe jaundice

Consultant Haematologist at the Department of Haematology and Blood Transfusion, Lagos University Teaching Hospital, Idi-Araba, Prof. Titi Adeyemo, says rhesus disease destroys the red blood cells of the newborn babies, noting, however, that the damage might vary from mild, to severe, and fatal.

“If it is fatal, the baby will die in the womb. If it is severe, the baby will be born severely jaundiced and will require blood transfusion to manage or stop the destruction that has already started from the womb.

“Severe jaundice can damage the brain, leading to a condition known as Kernicterus that could cause cerebral palsy, among others,” she said.

Adeyemo added that, more crucially, the only way a newborn baby can be protected from jaundice is by preventing a rhesus negative woman from making the antibodies in the first place.

She says,“If a woman finds out her rhesus status early in pregnancy or before pregnancy through a simple blood test and she is Rh-Negative, she would be given the Rh immunoglobulin injection.

‘THE ONLY WAY A NEWBORN BABY CAN BE PROTECTED FROM JAUNDICE IS BY PREVENTING A RHESUS NEGATIVE WOMAN FROM MAKING THE ANTIBODIES IN THE FIRST PLACE’

“During pregnancy, an antibody screen can be done to know if an Rh-negative woman has already started making antibodies to the Rh-positive blood of her foetus. This test can also show the level of the antibodies made.

“The screening is carried out within the first trimester at 28 weeks or more often in order to monitor antibodies.

“If, at any point, it becomes too high, the baby would have to be delivered early, kept in an incubator and treated with phototherapy.”

Role of infection

Another major cause of jaundice, the physician notes is infection in the newborn. Emokpai says occasionally, congenital infection of the newborn is acquired from the mother.

“This infection does not affect the mother but is passed to the baby,” he notes.

Saving newborns from jaundice

On what could be done to avoid jaundice, the paediatric consultant notes that during pregnancy, the blood group of a mother must be ascertained.

‘ANOTHER MAJOR CAUSE OF JAUNDICE IS INFECTION IN A NEWBORN BABY’

He explains that if blood group O or rhesus negative is identified, careful monitoring of the newborn is done after birth.

“It is advised that babies should be kept for a minimum of 48 hours. If the mother has to be discharged within 24 hours, the baby should be reviewed in 48 hours.

“Unfortunately, this is not the case, as most parents and family members are in a hurry to celebrate childbirth.

“A woman will deliver a child in the morning and by evening, would insist on leaving the hospital. Yet, a mother could be fine but her infant might not be medically fit to leave, so, it is wrong to insist on being discharged.

“Otherwise, by the time they return to the hospital, it might be too late and the baby will be in crisis.

‘OTHER WAYS OF PREVENTING JAUNDICE INCLUDE BREASTFEEDING IMMEDIATELY AFTER BIRTH’

“Most mothers return with a child that is already brain damaged. We carry do blood transfusion to save the newborn. At such points, we can only save life, but they end up with a burden.

“I usually don’t like to discharge babies I take delivery of until after 48 hours. I do tell parents that they have over 25 years to spend with a child after birth, and they should give me 48 hours to ensure babies are medically fit,” he said.

Emokpae further notes that other ways of preventing jaundice include breastfeeding immediately after birth, avoiding icterogenic agents (causing or tending to cause jaundice), keeping newborn baby’s umbilical cord clean and taking delivery in a clean place.