Jaundice

Ok, this time I want to share some info about jaundice & also my own experience. In my case, it was prolonged jaundice.

What is jaundice?

Jaundice is the yellowish discolouration of the skin caused by an increase of bilirubin in the blood. Neonatal jaundice is jaundice that occurs within the first month of baby's life.

Jaundice menyebabkan kulit Ziqri jadik gelap. 

What is bilirubin? 

Bilirubin is a pigment produced from the breakdown of red blood cells. It is then processed in the liver before being passed out into the stools.

 

Nak check bilirubin kena amek darah. Tgn Ziqri kiri kanan yg comel itu penuh ngan bekas cucuk. Aku kira ada lar dlm 16 tanda. Bukan takat kat tgn, kat kaki pon ada. Kesian sungguh. Paling tak tahan masa dia menangis bila nurse amek darah dia kat kaki. Berkali-kali cucuk darah tak jugak keluar. Keluar pon amat lar sikit. Tak cukup utk penuhkan bekas sample. Nak kena isi 3 tiub utk anta ke lab. Sampai aku yg tgk ni pon nak keluar air mata. Lepas dah berkali2 try tak dpt jugak, nurse suruh we all balik & dtg lagi after a week to get the blood sample. Nak check kot ada penyakit lain plak sbb Ziqri kena prolonged jaundice. Bukan takat darah jer dia test. Aku kena bagi sample air kencing Ziqri skali utk test!

How common is jaundice in babies?

Jaundice is very common and occurs in 50% of babies in the first week of life.

If I'm not mistaken, Ziqri kena jaundice on his fourth day.

What causes neonatal jaundice?

1. Physiological jaundice
This is the most common cause of neonatal jaundice and is harmless to your baby. The onset of jaundice is after the first 48 hours and will subside by the end of the first week of life. It is caused by the normal breakdown of red blood cells and the immaturity of the liver.
2. Pathological jaundice
The onset of the jaundice can be in the first two days of life. There is excessive breakdown of red blood cells which could be due to :
• Incompatibility between mother's and baby's blood group (in mothers with Rhesus negative or Blood Group O blood). Aku darah O+ & Ziqri darah A+. Doc bgtau chances utk 2nd baby dpt jaundice pon high. Ni yg buat aku fobia nak preggy lagi. Especially bila kena prolonged jaundice!
• Babies with G6PD (glucose 6 phosphate dehydrogenase) deficiency in their red cells resulting in their instability on exposure to certain agents. This occurs in less than 5% of babies. All newborns are screened for G6PD deficiency at birth. (See Appendix)
• Infection in the newborn which makes the baby unwell and needs in-hospital treatment.

What causes jaundice in babies to be prolonged?

Jaundice is considered prolonged if persists for longer than 14 days in a term baby and 21 days in a preterm baby. Ziqri kena jaundice for about 21 days! This can be due to :

• Breast milk jaundice - Babies on exclusive breast feeding may have prolonged jaundice. As long as the mothers are not taking traditional herbs, the jaundice will be harmless to the babies. Mmg terkejut bila baca exclusive breast milk pon boleh kena prolonged jaundice. Masa baca nih terus aku rasa tak konfiden nak exclusively breastfeed Ziqri. Lgpon susu tak byk.
• Obstruction of bile flow from the liver into the intestine. This rare condition will result in pale coloured stools and dark coloured urine.
• Congenital hypothyroidism - This condition occurs in 1 per 4000 babies. Currently the national screening programme of newborn cord blood for congenital hypothyroidism is an ongoing programme in all government hospitals and clinics.  

What should I do if my baby has jaundice?

Consult your doctor or health nurse for a proper evaluation. Dlm kes Ziqri, disebabkan dia considered as prem baby & berat pon 2kg jer masa lahir, bila dia kena jaundice, dia dipindahkan ke NICU. Nasib baik lar aku anytime boleh visit dia dekat NICU tuh. Harus lar kan...kalo tak mcm mana nak breastfeed ;-). & nurse pon sgt baik hati tolak aku ngan wheelchair smpi tmpt Ziqri.
However, your baby is likely to be healthy in the following situations:

• Term baby with no risk factor for excessive red cell breakdown.
• Jaundice appearing after the first 48 hours of life and not increasing in severity.
• Healthy, active and feeding well.  

What are the danger signs that I should be aware of?

You need to consult your doctor urgently in any of the following situations :

• Jaundice appearing within the first 24 hours of life.
• Rapid progression of jaundice.
• If the result of the newborn screening shows G6PD deficiency.
• If previous babies in your family have severe neonatal jaundice.
• If your baby is unwell and not feeding satisfactorily.
• If there is presence of pale coloured stools or dark urine.  

What would the doctor do?

Your doctor will assess your baby clinically, proceed on to relevant investigations and then institute appropriate treatment. He will advise you on the specific situation of your baby.

What problems can jaundice cause?

In neonatal jaundice in the first week of life, the indirect bilirubin component (bilirubin not processed by the liver) is usually high and this can reach a toxic level resulting in :

• Deafness from damage to the part of the brain controlling hearing.
• Brain damage causing other neurological disability (kernicterus)  

Early intervention of babies at risk of severe jaundice will prevent this complication.
 
Mmg tak lena tido aku bila memikirkan kemungkinan2 yg jadik...Dah lar prolonged jaundice plak tuh. Tido tak tenteram nak tunggu result blood test & urine dia.  

What are the ways to treat this condition?

There are two ways to bring down the bilirubin levels to avoid brain toxicity. These are :

1. Phototherapy
Your baby will be put under a phototherapy light unit. The blue coloured component of the light can convert the indirect bilirubin to a non-toxic product. 

 

Kesian tgk Ziqri tido dgn pampers jer. Aku siap selimutkan dia ngan napkin sbb takut sejuk. Tp bila nurse nmpk dia suruh simpan napkin. Katanya kalo tutup2 lg lmbt baiknya! Ziqri masuk spital 2 kali disebabkan jaundice. 1st time dekat Sg Buloh & 2nd time dekat Selayang. Masa pegi Selayang tu siap naik ambulan lagi! Hahaha...merasa aku naik ambulan!

Note: You should not expose your baby to the morning sunlight for treatment as this is not effective and may be dangerous. Tapi aku jemur jer ;-). Tapi tak lar direct sgt ngan matahari. Bukak jer pintu & tingkap bagi cahaya masuk.

      2. Exchange transfusion

The toxic bilirubin level for term babies in the first week of life is usually taken as more than 20 mg/dL (340 umol/L). Exchange transfusion is used as a last resort to try to avoid brain toxicity due to severe neonatal jaundice. The levels for exchange transfusion will depend on many factors including the age of the baby and the cause of the jaundice. Doc ada bgtau, if jaundice teruk kena tukar darah. Mmg tak senang duduk aku bila pikirkan. Sib baek Ziqri tak kena!

Prevention

It is important to identify and monitor babies at risk of severe jaundice.
Early detection of babies with jaundice needs to be done to ensure early and appropriate intervention.

What else can be done for babies who had suffered severe jaundice?

All babies with high bilirubin level (20 mg/dL or higher) should be followed up in a paediatric clinic to check on the hearing and development. Some babies may need to be referred to the audiology department for a hearing test to exclude high tone deafness.

Brain damage due to severe jaundice (kernicterus} should be prevented. If it happens, the child should be referred to a multi-disciplinary team for rehabilitation.

Appendix

List of food, and, drugs to be avoided in a child with G6PD (Glucose 6 Phosphate Dehydrogenase) deficiency as it may lead to increase red blood cell destruction and jaundice:

• Food - e.g. Fava beans (kacang parang)
• Certain Chinese herbs
• Drugs (refer to your doctor for a complete list)
• Antibiotics such as nalidixic acid, nitrofurantoin, sulfamethazole (co-trimoxazole / bactrim)
• Chemical
• Naphthalene (ubat gegat) are not to be used on clothing
• Methylene blue local application 

Sgt lega bila blood test Ziqri ok. Meaning dia takde penyakit2 yg bahaya. And jaundice dia baik after 21 days. Lega yg amat sgt!