In 1977 when I returned to Trinidad, no one bothered about jaundice in newborn babies. I often wonder what became of those babies. At the worst they became more brain-damaged Trinis, as if we didn't have enough driving around or making jokey statements once they get into government. At the best, they would have emerged from their bout of jaundice, anaemic and at risk of not developing their full potential.
We know that babies with anaemia do worse in school than their normal mates. At that time, at the Port-of-Spain General Hospital, obstetricians took care of the neonates and paediatricians were seldom asked to see them. Occasionally, we would be asked to consult on some other newborn disorder. After taking care of the problem, I would wander around the postnatal wards and marvel at all the jaundiced babies. No one cared or did anything for them.
According to public sector protocol, I was not allowed to examine newborns and you know that you must do the proper thing in the public sector, no matter how nonsensical, and follow guidelines laid down by years and years of dedicated, incompetent service. These babies were the exclusive property, medically speaking, of the Obstetrical Department and I, a paediatrician, could do nothing but beg for them to be referred to the paediatricians.
Days later some of them would turn up in Accident & Casualty, so jaundiced that they would look orange, and we would have to arrange for an emergency exchange transfusion. Over a period of years, the paediatricians were able to persuade the obstetricians that we should be informed whenever a baby was noted to be jaundiced. About 1985, we even managed to take over their care from the time they were delivered.
How times have changed. Severely jaundiced newborns are now a rarity and when parents refuse to allow doctors to treat them, the case makes newspapers. Nowadays, one is called urgently at the slightest sign of jaundice. Mothers are warned to check the skin colour on a daily basis and to "walk the baby in the sun," resulting in not a few cases of neonatal sunburn, a medical entity unknown up to a few years ago.
They are wrongly advised to stop breastfeeding, to give the baby extra water, to drink bush tea and, if of the proper tendency, to "jarre" the baby. Progress fadder! Jaundice is the name given to the yellowish colouration of the skin and sclera (the white part of the eye) and in adults it is an ominous sign, usually of liver disease. Yellow fever was named centuries ago because of the jaundice that accompanies the fever and there are a whole slew of similar appearing diseases.
In babies, however, the main cause of jaundice is destruction of red blood cells, a normal process after birth. This destruction liberates a yellow-coloured chemical, bilirubin, which in large amounts is toxic to the brain and which must be excreted by the liver into the intestine as part of bile. (Bilirubin and bile have the same root.) This is a process that continues throughout life. The yellow chemical is responsible for the yellowish-brown colour of our stools and there's a whole pathology surrounding that statement.
Because of their huge brain, human babies are really born before their time and many of their body functions are not ready for life outside the womb. This happens especially with their livers which may be unable to rid the blood stream of bilirubin. The level of the pigment rises and the excess is deposited in the skin, causing it to turn yellowish and upset mothers and inexperienced doctors and nurses.
If the level of bilirubin rises beyond the buffering power of the skin, it then begins to be deposited in certain brain cells, causing brain damage, especially to the motor part of the brain and to the auditory cells. This is permanent damage, hence the urgency to treat the jaundiced child. Treatment is either by phototherapy, a special light that helps rid the body of the bilirubin by altering it and enabling the baby to eliminate it in the urine, or by an exchange transfusion, which involves getting rid of the baby's blood and transfusing new blood into the child.
This is a life-saving procedure. Most babies become mildly jaundiced in the first week of life and there is nothing wrong with that. A touch of jaundice is actually considered healthy. Bilirubin is actually beneficial to the baby in small amounts since it is an antioxidant and protects brain cells from the damage typically caused by free radicals. Free radicals come from smoking, pollution, poisons, fried foods, and as a by-product of normal metabolism.
Free radical damage is associated with an increased risk of many chronic diseases. Antioxidants such as vitamin C, carotenes and vitamin E reduce the damage caused by free radicals. Like vitamins and governments, jaundice can either be a hero or a villain. In small amounts, good. In large amounts, bad.
THOUGHTS
Jaundice is the name given to the yellowish colouration of the skin and sclera, in adults it is a sign, usually of liver disease.
In babies, the main cause of jaundice is destruction of red blood cells. This destruction liberates a yellow-coloured chemical, bilirubin.
Treatment is by phototherapy, a special light that helps rid the body of the bilirubin by altering it and enabling the baby to eliminate it in the urine.
