Health
Why babies of parents with incompatible blood groups risk jaundice — Paediatricians
Janet Ogundepo
Babies born to a mother with blood group O and a father with blood group A, B or AB have a 90 per cent chance of having jaundice at birth, child health experts have warned, stating that many parents are unaware of this biological certainty and continue to lose children to preventable brain damage and death because the condition is neither recognised nor treated in time.
The paediatricians stated that ABO blood group incompatibility was one of the four main causes of neonatal jaundice in Nigeria, and that couples with this combination should ensure every one of their newborns undergoes phototherapy, without waiting to observe signs of yellowing.
They noted that said neonatal jaundice, which is characterised by the yellowing of the eyes and skin in babies aged zero to 28 days, was both preventable and treatable, but that delays in recognising it were causing brain damage and death in thousands of Nigerian babies every year.
Severe jaundice, the child health experts told PUNCH Healthwise, is one of the causes of cerebral palsy, a condition that affects a child’s movement and posture following injury to the brain.
They urged intending couples to, in addition to knowing their genotype, know their blood groups.
The paediatricians also advised parents and health workers to examine newborns for yellowing of the eyes and skin before discharge from hospital and during the first few days after birth.
Findings from studies conducted in Nigeria, India and South Africa revealed that ABO compatibility was responsible for most cases of neonatal jaundice.
One of the studies by AS Patel et al, titled “Association of ABO and Rh incompatibility with neonatal hyperbilirubinaemia,” found that most cases of clinical jaundice occurred in babies with blood group A or B and born to mothers with blood group O, adding that nine in 10 newborns with ABO incompatibility developed jaundice.
PUNCH Healthwise earlier reported that all newborns need to be screened for jaundice before discharge from the hospital.
The screening would help to ensure early detection of the condition and prevent babies from permanent neurological disabilities such as brain damage, cerebral palsy, and in some instances, death.
PUNCH Healthwise also reported that cerebral palsy occurs in about five children per 1,000 in Nigeria, with many parents seeking traditional medicine or concoctions to cure the condition.
A professor of Paediatrics at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nma Jiya, explained that when a mother was blood group O and the father was blood group A, B or AB, the baby would inherit the father’s blood group, triggering the mother’s immune system to attack the baby’s red blood cells, causing them to break down and produce excess bilirubin, the yellow pigment responsible for jaundice.
“If a mother is blood group O, either positive or negative, and marries a husband whose blood group is A or B or AB, all their children will have jaundice. If a mother is blood group O and the baby is blood group A or B, all the children of that woman will become jaundiced from day one,” he said.
The don stressed that this was not a one-off occurrence but a pattern that repeated itself across every pregnancy in the same family.
“From day one, from the first born, they will have jaundice. Second born, the same thing. Third born, the same thing. Fifth born, the same thing. They will have jaundice. And severity is more when the baby is A, and the mother is O,” he said.
Jiya said the solution for families in this situation was not to wait and watch but to act immediately at birth.
“Once they are delivered, they must be sent to neonatal units to commence them on treatment, phototherapy, put them on that blue light. So people should know this one,” he said.
The paediatrician called on couples to screen their blood groups before marriage just as they screened for genotype.
“So it is also better people should do their blood group. So it is not always good for, say, a man that is blood group A or B or AB to marry a woman that is blood group O. But a man that is blood group O can marry anybody, any woman, whether blood group O or B or so on. It does not happen,” he said.
Beyond ABO incompatibility, Jiya stated that Rhesus incompatibility, which occurred when a mother had a negative blood type and the baby inherited a positive blood type from the father, could cause jaundice.
The professor of paediatrics explained that in such cases, the first baby was usually unaffected but subsequent pregnancies became progressively more dangerous unless the mother received an injection called Rhogam to prevent her immune system from attacking future babies.
Jiya said parents must examine their newborns daily for the telltale signs of jaundice, beginning with the face and tracking the yellowing as it spread downward to the chest, abdomen and legs.
The doctor further noted that phototherapy, treatment with blue light, was the correct medical response to neonatal jaundice and was very safe, dismissing fears that the light caused radiation or harmful side effects.
Adding to the call for early detection, a professor of Paediatrics at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Ben Onankpa, said every newborn, especially those born to mothers with a previous history of delivering jaundiced infants or those with ABO incompatibility, must be screened and treated for jaundice.
Onankpa explained that the major causes of severe neonatal jaundice in Nigeria include ABO and Rh blood group incompatibility, prematurity, glucose-6-phosphate dehydrogenase deficiency and infections, including malaria during pregnancy, which can increase the breakdown of red blood cells.
The paediatrician also urged parents to reject home remedies such as exposing babies to sunlight or giving them glucose water, describing both practices as ineffective.
Instead, he advised mothers to watch closely for yellowing of the eyes and skin while bathing their babies and seek immediate medical attention if the signs appear.
Onankpa maintained that prompt hospital treatment with phototherapy or exchange blood transfusion, depending on the bilirubin level, remains the safest way to prevent permanent brain injury or death from severe neonatal jaundice.
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