NEONATAL JAUNDICE
Jaundice is the most common condition that requires medical attention in newborns. In west Africa, neonatal jaundice is also a common pediatric problem associated with high morbidity and mortality. Incidence varies with ethnicity and geography. Incidence is higher in East Asians and American Indians and lower in Africans. Greeks living in Greece having a higher incidence than those of Greek descent living outside of Greece. The yellow coloration of the skin and sclera in newborns with Jaundice is the result of accumulation of unconjugated bilirubin.
Physiological jaundice is usually benign and occurs in almost all babies, is due to excessive bilirubin production (higher haemoglobin content and shorter red blood cell life span in newborn babies)it can be exacerbated by certain conditions such as inadequate intake, cephalophaematoma and bruises. In most infants unconjugated hyperbilirubinemia reflects a normal transitional phenomenon.
However, in some infants, serum bilirubin levels may rise excessively, which can be cause for concern because unconjugated bilirubin is neuro toxic and cause death in newborns and lifelong neurologic sequelae in infants who survive (kernicterus). For these reasons, the presence of neonatal jaundice frequently results in diagnostic evaluation. Neonates should be considered as being at increased risk of clinical significant hyperbilirubinemia if their gestational age is under 38 weeks, they have a previous sibling with neonatal jaundice that require photo therapy, or their mother intends to feed them exclusively by breast milk. These babies should be visibly examined for jaundice at every opportunity especially in their first 72 hours of life. If visible jaundice is present within the 24 hours of life their serum bilirubin concentration should be measured by the clinical laboratory within 2 hours and every 6 hours thereafter, until their bilirubin concentration is below the age dependent cut off in the treatment threshold graph. If visible jaundice develops after the first 24 hours of life and the neonates has a gestational age >35 weeks, the bilirubin should be measured with a transcutaneous bilirubinometer within 6 hours. If the bilirubin is >250 micromole per litre, or such an instrument is not available, a laboratory serum bilirubin measurement is required. Treatment of hyperbilirubinemia should be by phototherapy or exchange transfusion according to the age dependent cut offs displayed in the treatment threshold graph. Aspirin is rapidly metabolized to salicylate after ingestion, after aspirin ingestion, salicylic acid is excreted into breastmilk. Aspirin is best avoided during breastfeeding, some expert opinion indicates that low-dose (75 to 162 mg daily) aspirin may be considered as an anti platelet drug for use in breastfeeding women. If low-dose aspirin is taken, avoiding breastfeeding for 1 to 2 hours after a dose might minimize the risk of anti platelet effects in the infant. Longterm, high-dose maternal aspirin ingestion probably caused metabolic acidosis in one breastfed infant. If the neonates at increased risk of hyperbilirubinemia do not become visibly jaundiced within 72 hours of birth they can be given routine care.
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