'Stop sunning the babies!'

Paediatrician warns against old wives’ remedy for jaundice

BY KIMONE THOMPSON Associate editor features thompsonk@jamaicaobserver.com

Sunday, January 26, 2014

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HEAD of the Special Care Nursery at the University Hospital of the West Indies, Professor Minerva Thame, is urging parents and caregivers in the habit of exposing their babies to direct sunlight as a means of curing jaundice, to stop.

The consultant paediatrician said that not only is direct sunlight ineffective but overexposure to it is potentially harmful to infants.

"This thing about sunning the baby, I am on a campaign to stop it. It is rubbish!" she told the Jamaica Observer.

"If the baby is ill and jaundiced it needs to be treated in hospital, not (by) sunning. Sometimes they come to us and by the time they come to us these levels are extremely high," she said in reference to bilirubin — the brownish yellow substance produced when the liver breaks down old red blood cells, leading to excessive yellowing of the skin and eyes.

In newborns, jaundice is primarily caused by blood incompatibility between the mother and the child. The symptom is yellowing of the eyes and skin.

"Jaundice of the newborn is usually caused when the red cell of the baby and the red cell of the mommy fight each other, breaks up the red cells of the baby, and the liver, which is immature, can't deal with the load so the baby presents with jaundice," Dr Thame explained.

Proper treatment is administered by photo- therapy lamps which project concentrated blue light onto the infant who lies naked with eyes and genitalia are covered. In extreme cases, an exchange transfusion becomes necessary in order to bring the bilirubin level down.

"If we don't get that level down we run the risk of damaging the baby's brain and that's why it's so important to pick it up early and treat it appropriately.

"(With sunning) there is a false sense that you are treating the baby when you are really not because the wavelengths that we use is 460 nanometers, that is blue light. The light from the sun has all the rays in the rainbow spectrum so the very little blue light that is coming through is so small that it won't do what needs to be done," she explained.

Depending on the severity of their illness and their level of prematurity, the babies' average length of admission at the special-care nursery ranges from three days to six or seven weeks.

"Jaundice is extremely common within our population in the nursery," said Thame, explaining that in addition to the blood incompatibility between mothers and their babies, infections and large birth weights particularly in diabetic mothers and the attendant bruising during the birthing process, are also factors which give rise to jaundice.

"Infections, which are very common in the nursery, lead to jaundice. If you have an infection, the infection breaks up the red cells and the same thing happens (with respect to the immature liver being unable to handle the load).

Other cases which the special care nursery sees often are infants of diabetic mothers and prematurity. In reference to the latter, Thame said, "that's the group that we need to target and do much better with".

She was referencing a previous interview with the Observer in which she pointed to a chronic shortage of life-saving equipment particularly for babies born before the full term of between 38 and 40 weeks.

In the article 'Needs are many at UHWI's Special Care Nursery' in last Thursday's Observer, the consultant paediatrician listed eight incubators, six ventilators, six vital sign monitors, eight photo therapy lamps, four radiant warmers and six infusion pumps as immediate needs for the facility. A bilirubinometer to assess infants with jaundice and a sterile area to prepare nutrition for premature babies were longer-term goals, she said.

"I have been in situations where I have had three babies and one ventilator," she said, quickly batting away the tears that had welled up in her eyes. "I'm not God. I don't want to make that decision. That's too hard for me."

Over the last seven years, the neonatal mortality rate at the facility has averaged 21 per 1,000 live births.

The UHWI nursery is one of three organisations that were selected to benefit from the Sigma 5K event set for February 16 this year. The others are the Jamaica Kidney Kids Foundation and the Sickle Cell Unit at UHWI in conjunction with the Sickle Cell Trust in Mandeville. Organisers expect to rake in $17 million from the event.

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