For Mrs Adeola Fasola, her daughter’s birthday brought to her mind the need for early interventions when a newborn has jaundice.
“Twenty years ago, I gave birth to a beautiful baby girl. It was a smooth vaginal delivery, and both of us were discharged shortly after. While waiting for my husband to pick us up, a man who happened to be a laboratory technician walked into the ward,” recounted Mrs Fasola.
That casual question and offer to run the test for a small fee turned out to be a life-changing act. To my shock, within moments of the test, three doctors rushed into the ward with urgent news saying the baby’s bilirubin levels were dangerously high.
Mrs Fasola added, “We couldn’t go home. Instead, my newborn daughter had to undergo three exchange blood transfusions to bring her levels back to normal. Without this intervention, she would have suffered severe brain damage, leading to cerebral palsy or other long-term disabilities.”
Today, Mrs Fasola’s 20-year-old daughter is a vibrant law student, her brain intact and thriving, thanks to that early diagnosis and intervention.
Researchers in a review published in BJOG: An International Journal of Obstetrics and Gynaecology put the incidence of neonatal jaundice at 12.48 per 1000 live births among babies born in the 54 referral-level hospitals across the six geopolitical zones of Nigeria. The incidence rose to 41.92 per 1000 live births when all newborn admissions were included (inborn and outborn). There were also substantial regional and centre variations.
Although these studies provide important information on the prevalence of jaundice among the special care baby unit admissions, these estimates do not capture newborns with jaundice who are not admitted to a special care baby unit.
Dr Joy Alejo, a paediatric neurologist at the University College Hospital (UCH), Ibadan, declared that when a child has jaundice as a newborn, what is medically termed neonatal jaundice, the bilirubin level of the blood becomes elevated.
“Normally, elevated blood bilirubin is not something that damages the brain. However, the blood-brain barrier that protects the brain from this toxin in newborns is not fully developed. So, if a newborn has jaundice in the first month of life, bilirubin can easily cross into the brain and damage particular areas of the brain.
“The jaundice may appear trivial, but a few years down the line the child begins to manifest with epilepsy and other brain problems.”
Dr Babatunde Ogunbosi, also a paediatric infectious diseases specialist at UCH, Ibadan, declared that tests for jaundice in newborn babies are usually done when there is a suspicion of jaundice.
According to him, “So if a child doesn’t have jaundice, then you don’t test. That’s why it’s good that in the first 72 hours of life, a newborn baby is seen by a healthcare professional who is conversant and familiar with newborns, whether it’s a midwife or a doctor.
“It takes experience, and then it has to be done in bright light. So if the person that is managing doesn’t have experience or the lighting is poor, then they might not pick it.
“Some babies are particularly at risk of jaundice, and so they will probably have heightened observation over them. For example, preterm babies, babies that have had a history of jaundice, or if there’s a mismatch between the blood group of the mother and the baby. So for those, you’re more vigilant.”
When jaundice is visible, it is often noticeable first on the face, then on the chest, stomach, and groin areas, then farther along the arms, legs, wrists, and ankles, and then finally on the palms, soles of the feet, and nailbeds. However, in some babies, this head-to-toe progression of jaundice may not be seen, and the jaundice may appear over the entire body like a tan.
Also, it can be checked by gently pressing the finger on the baby’s forehead or nose. If the skin is jaundiced, it will appear yellow when the finger is removed (just before blood returns to the area).
Dr Ogunbosi declared that detecting and treating high levels of bilirubin in a new baby early is important to protect the baby’s brain and spinal cord from any form of damage.
In addition, Dr Tope Farombi, a neurologist at the Chief Tony Anenih Geriatric Centre at UCH, Ibadan, emphasised the importance of protecting brain health throughout life.
“From the very beginning of life, brain health is shaped by timely care, preventive measures, and proactive interventions. This moment fuels my work as a neurologist and advocate for brain health equity. It reminds me that preserving brain health isn’t just about managing diseases later in life. It’s about taking action at every stage, from infancy to old age, to safeguard and optimise the potential of the human brain,” she declared.
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