File photo : A baby

I
stood at the triage area of the Mother Baby Unit (MBU) ready and alert
for the day. I checked the clock on the wall and it was 7 past 9am.
Sounds of crying babies filled the air – as they engaged in a fierce
competition to see who can cry loudest. The babies at the triage seemed
to be winning though, with the volume and pitch of their cries reaching a
crescendo whenever the needle of the cannula pierced their delicate
skins, as the doctors tried frantically to locate a vein and set a line.

I
took a glance at the Stable unit and noticed that the doctors had
already started ward rounds. I hurriedly joined them – to enrich my
practical experience as a medical student and as a bonus, get my logbook
signed. The sleep-deprived House Officers presented the various cases
to the supervising Specialist and management plans were made.

Anxious
mothers looked up to us (the team) for good news, like – ‘your baby is
better today’, ‘everything is okay now’ and ‘you’ve been discharged’. I
could bear with them as the painful experience of childbirth deserved
some chill time at home with family and friends. But unfortunately, not
all newborns are stable enough to be discharged on the day of birth.
Some would have to admitted, monitored and treated till they are well
enough to go home.

As
we moved to the next cot, the supervising doctor exclaimed excitedly;
“King Yellow!” The entire team burst into laughter. I peered into the
cot and saw a lovely little baby whose arms and legs kept punching and
kicking in the air. He was under a blue light with a cot sheet spread
over to keep the light in. That was phototherapy – treatment given to
babies with mild jaundice.

He
grimaced slightly as the doctor reached out to touch him. The blue
light was turned off momentarily and I saw the yellow tinge in his skin
clearly. The doctor rubbed his gum and feet and commented that the
jaundice was a lot better compared to some days before.

Everyone
was happy because he was responding to therapy and there was very
little to no fear of him developing a permanent neurological problem.
Apparently, he was named ‘King Yellow’ because his jaundice was so
severe- he was yellow from head to toe before admission. But with timely
intervention and treatment, he was almost back to normal.

The
day went slowly and at 5pm we finished our last tutorial for the day. I
headed back to the hostel with some classmates. Three of us decided to
return to MBU for night duty at 7pm (we were required to do two night
shifts for each rotation). I made my way back to the MBU with a full
belly and my head spinning with a tinge of headache in the background. I
guess that was my body telling me I needed some sleep. The waiting area
of the MBU was quiet with just two people there.

They
were seated calmly and engaging in some sort of casual conversation. As
I washed my hands at the entrance to the triage and main wards,
something felt off about the general atmosphere. I made my way towards
the triage.

There,
I found a young woman in a straight dress with an African cloth
strapped just above her bosom. Her hair was partially covered with a
scarf, with loose strands sticking out from the sides. She was in
slippers, with her feet covered in dust. She had folded her left arm and
her right palm on was her lips. She sobbed profusely and I could see
her eyes – fiery red. I was informed that they just arrived as a
referral from a hospital they reported to few hours before. Her
appearance was suggestive of a desperate woman and it didn’t take long
for me to notice why.

At the triage, I saw her baby lying down, being attended to by two
doctors. Both were trying to locate a vein for intravenous access. The
baby was completely yellow and its movement was so lax and
uncoordinated. There were occasional jerks of the legs, followed by
variable periods of inactivity. I drew closer and saw his eyes – they
were outright yellow! His eyelids fluttered for a moment and then stayed
put, with the eyes dazed.  I asked the doctors if they needed my help
and yes they did.

They
asked me to hold a light source for them to have a better view.
Concurrently I heard one specialist shout to another staff to get the
equipment for exchange transfusion ready. Though many attempts were
being made to save the poor baby, we knew deep down that the situation
didn’t look good. 

Behind us, I heard the father of the baby lament helplessly that they
had already lost a child to neonatal jaundice and it seemed like he was
reliving the experience all over again. I was stabbed at heart and tried
to hold back the tears which welled up in my eyes. In the meantime, the
doctor found a vein and started taking blood samples for laboratory
investigations. The expression on his face looked neither good nor
comforting as he conceded; “Charley, the child is in BIND oo”.

Neonates
are babies from day 0 to day 28 of life. When  their eyes or skin turn
yellow, it is known as Neonatal Jaundice. It is caused by excess
bilirubin in the blood (bilirubin is a yellow pigment produced when red
blood cells break down). It is quite common in newborns and usually
harmless; but can lead to serious consequences  like BIND (Bilirubin
Induced Neurological Deficit).

BIND
is the most feared complication of Neonatal Jaundice. Unfortunately,
BIND is permanent and irreversible. It puts newborns at risk of
developing complications which they would have to live with for the rest
of their lives.  The child might never gain neck control, crawl, walk,
talk, or suffer a severe intellectual disability.

There is good news though! BIND can be avoided by early identification and treatment of Neonatal Jaundice. So dear parents and caregivers, when your newborn’s eyes or skin begin turning yellow (especially in the first seven days of life), seek medical attention immediately.

Remember that when the yellow (Neonatal Jaundice) is cleared, BIND would be bound, and a baby will be saved.

The authors are KNUST medical students. This article was written to create awareness on Neonatal Jaundice, as part of the Christian Medical fellowship – KATH’s Neonatal Jaundice Project.

Source: De-Graft Kwaku Ofosu Boateng| Daniel Danso Aboagye| KNUST medical school|judahpraise18@gmail.com