Health
Screen newborns for jaundice before discharge, paediatricians tell mothers
Child health experts have stressed the need for all newborns to be screened for jaundice before they are discharged from hospitals, stating that early detection can prevent babies from permanent neurological disabilities such as brain damage, cerebral palsy, and in some instances, death.
The seasoned paediatricians noted that while neonatal jaundice, which is characterised by yellowing of the eyes and skin, is preventable and treatable, many newborns in the country are still affected and die from the condition due to missed symptoms, lack of testing, exposure to triggers, delays in accessing care and mismanagement with home remedies.
In interviews with PUNCH Healthwise, the experts identified four primary causes of neonatal jaundice in Nigeria as ABO blood group incompatibility between mother and baby, Rhesus factor incompatibility, glucose-6-phosphate dehydrogenase (G6PD) deficiency, prematurity, and infection.
They strongly stated that babies born with these risk factors must have their bilirubin levels checked and monitored daily before discharge, stressing that any neonate with suspected jaundice must be immediately placed on treatment.
The paediatricians further urged parents to closely observe their babies after returning home and seek immediate medical attention if they notice yellowing of the eyes or skin, poor feeding, unusual crying or convulsions.
Practices such as exposure to sunlight, giving newborns glucose water, antibiotics or herbal mixtures, the experts asserted, were not effective in the management of jaundice and could cause further harm to the babies.
The child health experts called on hospitals to make jaundice screening, especially the bilirubin test, a non-negotiable part of newborn care before discharge.
A study published in 2024 in BJOG: An International Journal of Obstetrics and Gynaecology found that neonatal jaundice remains a major cause of newborn admissions in Nigeria.
The study, which analysed more than 77,000 babies born in or admitted to 54 referral hospitals across the country’s six geopolitical zones, recorded 3,228 cases of neonatal jaundice, equivalent to 41.9 cases per 1,000 newborn admissions. Among babies delivered in the participating hospitals, the incidence was 12.5 per 1,000 live births.
It also revealed that globally, an estimated 1.1 million newborns develop severe neonatal jaundice each year, with Africa accounting for one of the highest burdens.
Jaundice, if left untreated, can lead to severe jaundice, which can lead to kernicterus, a preventable form of brain injury that may cause cerebral palsy, hearing loss, learning disabilities and death.
Providing expert insight on the matter, a Professor of Paediatrics at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nma Jiya, described neonatal jaundice as the yellowing of the eyes and skin in babies aged zero to 28 days.
Continuing, he asserted, “Neonatal jaundice is preventable, and it’s treatable. But delays in recognition cause brain damage or death in thousands of Nigerian babies yearly.”
The consultant paediatrician and Director, Institute of Child Health at UDUTH, added that untreated jaundice is one of the causes of cerebral palsy, a condition he defined as a problem with movement and posture, accompanied by intellectual impairment.
He explained that there were two types of jaundice, physiological and pathological jaundice, describing physiological jaundice as one that appears after the third day of life, peaks around the fifth or sixth day and resolves on its own by the seventh to tenth day in full-term babies.
“The jaundice that appears within 24 to 48 hours of birth, the yellowness of eyes or skin observed within the first day or second day, is likely to be pathological jaundice. And if by day 5 or 7 it does not resolve, even irrespective of the day, once it reaches 20 mg per deciliter in measurement, irrespective of the day, that is what we call pathological jaundice,” the don explained.
Jiya urged parents to physically examine their newborns in the first two to three days, stating, “They should look at the eyes and see whether the eyes are yellow. And they should pinch the skin of the child and look at it and see whether there is yellowness. It usually starts from the face and spreads down to the chest, abdomen, and legs.”
Beyond skin colour, he listed danger signs that required immediate hospital attendance: “You should also watch out for the baby who has poor feeding. If the baby suddenly becomes weak, tired or lazy to breastfeed properly. Or the baby is having high pitch crying, which means a sharp, unusual cry that sounds different from a normal hunger or discomfort cry. Or they should look at the neck, if the baby is arching their back or neck. This means the jaundice is already affecting the baby. That is even a late danger sign. And some may even come with convulsions.”
The professor of paediatrics identified the four major causes of neonatal jaundice in Nigeria as blood group incompatibility between mother and baby, G6PD deficiency, prematurity and neonatal infections.
He stressed that newborns who have a father with blood group A or B or AB and a blood group O mother would have jaundice, stating that such babies should begin treatment immediately after birth without waiting for visible signs of jaundice to develop.
Jiya urged parents to desist from using camphor or naphthalene balls and medicated balms on newborns, noting that they can “trigger massive breakdown of red blood cells in babies and then jaundice.”
He further said that exposing babies to early morning sunlight does not effectively treat jaundice.
The don said, “The myth is that they put the baby in the early morning sun. But the medical fact is that sunlight is insufficient. Direct sunlight also causes sunburn, dehydration, or hypothermia. It will raise the temperature, which is also not good for the baby. Another myth is to give glucose water to flush it out. But the real medical fact is that glucose water cannot work. Jaundice cannot be eliminated that way. It requires phototherapy to break them down, or exchange blood transfusions if it is very severe.”
Jiya assured parents that phototherapy is safe and lifesaving, stating that while some babies may develop minor skin rashes or loose stools during treatment, these side effects easily resolve within days.
Also, a professor of Paediatrics and Consultant Paediatrician with special interest in perinatal medicine and infectious diseases at the Usmanu Danfodiyo University, Sokoto, Ben Onankpa, warned that jaundice can permanently damage a baby’s brain if not detected early.
He said, “Jaundice, ordinarily, is dangerous to the brain, and more dangerous in newborns. Because some jaundice can be physiological, others can be pathological. That means disease-causing and non-disease-causing.
“What causes the jaundice is a product called bilirubin. Bilirubin is a product of broken-down red blood cells. When it is not cleared from the body, it can go to the brain and prevent the brain from doing normal functions, especially for babies.”
Onankpa stated that all newborns must be examined, first through physical examination, and once yellowness in the face or eyes is detected, blood tests must be done to determine the bilirubin levels.
He added that babies found to have high bilirubin levels should not be discharged until they receive appropriate treatment.
The don asserted that “All babies, especially in areas where jaundice is predominant, must be screened for jaundice before going home.”
The consultant paediatrician warned hospitals against rushing to discharge newborns without proper examination for jaundice.
He said, “Before jaundice becomes visible in newborn babies, the level has to reach about 5–7 mg per deciliter. If you are finding between 3–4 mg per deciliter, you will not see it visibly on the baby. If you see the value between 3–4 mg per deciliter, then keep the baby and continue to evaluate because the value might go up.”
The child health expert further confirmed that jaundice could develop even before birth in severe cases, saying, “Jaundice can occur in utero when the baby is inside. When the antibodies cross the placenta and go and immobilise the red blood cells, the baby becomes jaundiced. When the molecule becomes overwhelming, the baby can become jaundiced in utero. Some even die in utero because of the jaundice.”
The researcher on anti-microbial stewardship said that antenatal care was the foundation of prevention, stating, “Prevention starts from antenatal care. The mother should be screened for some diseases, such as G6PD deficiency, infections in the mother during pregnancy, and malaria present during pregnancy. Antenatal care is very key.”
Onankpa reiterated that parents should not attempt to manage jaundice at home using sunlight or glucose water.
He added that treatment depends on the severity of the condition, with babies receiving phototherapy or exchange blood transfusion where necessary.
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