Jaundice

Jaundice In Children

Jaundice is a liver-related condition identified by yellowness of skin (not obvious in blacks), sclera of the eye and sometimes change in body fluid and stool. It is often normal in newborn and persists for only first few days of life until when the liver is well developed. It could be a medical emergency when it persists longer than a week in newborns or seen in children. Jaundice usually occur as a result of a build-up of a yellowish substance called bilirubin which is formed from the breakdown of red blood cells in the body. Normally, the rate of formation and excretion occurs and an alteration in the balance results in jaundice. Bilirubin-induced mortality is one of the top 20 cause of deaths in newborn and the 7th in Africa.

Other Symptoms:
Fever
Abdominal pain
Nausea
Fatigue
Weakness
Jaundice that is accompanied by these other symptoms are often not normal and require medical intervention.

Causes:

  • Blood type mismatched: when the mother’s blood group is different from that of the child, the child’s body tends to break down the red blood cells faster.
  • Blood cell diseases: children with sickle cell anaemia or glucose-6-phosphate dehydrogenase deficiency have red cells with a shorter lifespan and are destroyed faster than normal red cell
  • Infections: such as hepatitis A, B and C can cause inflammation of the liver and result in jaundice. Hepatitis B can be transmitted from mother to children through body fluid. Children should be vaccinated against hepatitis B. EBV (Ebstein Barr Virus) is a common infection in children that could also cause jaundice.
  • Endocrine disorders such as underactive thyroid or hypothyroidism
  • Blockage of the bile duct: the pathway that empties bilirubin into the intestine for excretion might be blocked for example in gall stones, pancreatic cancer, congenital etc.
  • Genetics e.g gilbert syndrome (often harmless), galactosemia (inability to digest galactose. Affected children will have to undergo some dietary restrictions)

Risk Factors

  • Premature birth: baby born before 38weeks are prone to jaundice because their liver is less developed
  • Breastfeeding: children who are not breastfed enough or the mother is unable to secrete breast milk may develop a condition whereby their intestine is less active and unable to excrete bilirubin as required
  • Race: some racial groups are at higher risk such as east Asian or Mediterranean
  • Bruised at birth

Complication:

Late detection of jaundice in newborns can lead to bilirubin encephalopathy, cerebral palsy, deafness and other brain damage disorders.

Prevention

Most newborn jaundice can not be prevented but early detection and treatment are important for a better outcome. Routine screening for glucose-6-phosphate deficiency, use of antiseptics to prevent infection, adequate breastfeeding right after delivery, vaccination, blood group test and use of Rh-immunoglobulin prophylaxis in case of incompatible blood group can help reduce the incidence of jaundice.

Treatment

Phototherapy e.g Filtered-sunlight phototherapy (FS-PT): a technique whereby the newborn is placed in a sunlight canopy and monitored for sunburn and dehydration. UV light helps to break down the bilirubin in the blood and allow easy excretion.

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