Challenges to Newborn Care In Ghana: Newborn with Jaundice

CHALLENGES TO NEWBORN CARE IN GHANA – STORIES FROM THE MBU: A NEWBORN WITH JAUNDICE

It’s another day in the Mother Baby Unit, (MBU) which is the newborn care unit of the Komfo Anokye Teaching Hospital (KATH) where babies below 2 months are admitted when they fall ill.

A young mother had just “rushed” in her 5 day old baby boy. I say “rushed” but the reality was that it took about 6 hours for the grandmother to organise the money for the journey (the father of the baby had denied responsibility for the pregnancy…) and another hour to be seen at the Health Post from which she was referred to Komfo Anokye Teaching Hospital (KATH). It had taken her another hour or so of wandering around KATH, starting from the Accident and Emergency block. There she was told to go to the Paediatric Emergency Unit where she was told that her baby was too young to be seen there and a Health Care Assistant was asked to bring her to MBU.

Big hospitals can be very confusing, especially when you cannot read and therefore cannot easily follow the sign posting…

She finally did turn up on MBU and this was her story.

She had given birth 5 days before to a healthy baby boy whom she had called Kofi, as he was born on a Friday. Like many mothers, she was worried about people with “evil eyes” looking at her baby and making the baby sick. Because of this fear her mother had insisted that she stay indoors with the baby and keep the doors and the windows closed until the baby was at least a week old. The room was dark and she couldn’t really see the baby very well. Everything seemed to be going well until the morning of the 5^th day when she woke up very early as usual. She had had a good sleep but was surprised that her little son had not woken up and cried 3 or 4 times during the night as he usually did. She had actually got up once at midnight to look at him but he was asleep and as she was very tired herself and the weather was cold, so… she went back to sleep. His grandmother bathed the little boy and commented that he seemed a bit weak and did not protest loudly as he usually did. “Maybe he is just hungry” she said. His mother decided to quickly feed him and she put him to breast but this time he did not grab the nipple and suckle vigorously as he usually did. He seemed very still…

So for the first time since the baby was born, she decided to take him outside into the bright morning sun and have a good look at him. It was then that she realised how yellow his eyes and body had become. She also realised that she could not see the black part of his eyes and he looked very sick…

At MBU, we made a diagnosis of severe Newborn Jaundice. The level of the yellow pigment in the baby’s blood which caused the jaundice was so dangerously high that the only way to bring it down quickly was to wash it out with blood donated by another person, a procedure called an “exchange blood transfusion”. The baby’s inability to feed or cry well was evidence that the yellow pigment which we call “Bilirubin” (long name!) had started entering into his brain and destroying it.

It took another 2 hours to organise blood and the exchange blood transfusion was done. For the first week of admission, we all doubted Kofi would make it. His heart kept stopping and he would stop breathing. The doctors on the ward had to assist him to breathe many times a day. Eventually, after several days of antibiotics, drips, and treatment under a special blue light, Kofi pulled through and was discharged home. He was still not able to breastfeed but his mother learnt how to squeeze the breast milk into a little cup and feed it to him.

Kofi will never be a normal child. His brain was severely damaged by the jaundice. He may not have normal intelligence and will develop very slowly. If he does walk at all, it will probably not be until he is about 3 or 4 years old. Even then it will be with difficulty. He will probably be deaf and may have fits for the rest of his life. He may never be able to go to a normal school and his mother will have to take care of him for the rest of his life. He might never be fully independent.

Jaundice in Newborns comes about because the blood of the newborn baby which is perfect for the baby in the mother’s womb is not suitable after the baby is born. It therefore tends to break down very quickly in order to make way for “adult” blood. As it breaks down, it produces a yellow pigment called Bilirubin and this is released into the baby’s blood. In some babies, because of infection or some other cause, this breakdown happens even more quickly than normal and a large amount of the yellow pigment is released into the blood. This can enter the baby’s brain. When this happens the baby needs to be treated quickly to prevent his brain from becoming damaged. The treatment may involve the use of special blue lights which help get rid of the yellow pigment, or in severe cases, like Kofi’s, the use of donated blood to wash the yellow substance out of the baby’s body.

New born jaundice is one of the tragedies of newborn care in Ghana. Even though more than half of newborn babies will have a little harmless jaundice, a few babies will go onto develop a more serious form. Since it is not always easy to distinguish between the harmless type of jaundice and the dangerous kind, mothers should bring babies to hospital to be assessed. All health workers who treat new born babies should make sure they know the difference between the two types of newborn jaundice so that they can give appropriate advice. We sometimes admit babies whose mothers actually reported to a health centre but were told by an ill informed health worker that there was nothing wrong with the baby. If a health worker is in doubt, they should refer the baby. It is obviously better to refer a baby with the “safe” type of jaundice than to send a baby with the dangerous type back home.

Most importantly, mothers, grandmothers and other family members should make sure that they take the newborn baby out of the dark room and into the sunlight at least once every day so they can get a good look at the baby. It is not only yellow eyes or skin that can be picked up. Many things can go wrong in the first week of life – skin infections, cord bleeding, anaemia and many others things may be missed if the baby is kept indoors all the time. Sickness often progresses very rapidly in these our tiny little patients and a slight delay may result in the loss of a precious life.

I can’t find who said this so forgive me for not acknowledging the source of the statement. While we strive as a nation to achieve the Millennium Development goals, let us remember that:

“Every child is a thread in the fabric of our national future – social progress unravels with every child afflicted by disease and death”

By Dr Gyikua Plange-Rhule, Komfo Anokye Teaching Hospital