INTRODUCTIONNeonatal jaundice is a term for elevated total serum bilirubin in newborns and infants less than one month of age. In otherwords neonatal Jaundice is the yellowish coloration of the skin and the whitepart of the eye (the sclera). 1 Neonatal jaundice occurs in 60 % of term healthy neonates and 80 % of preterm neonates.
2It results from having too much of substance called bilirubin in the blood.Bilirubin is formed when the body breaks down old red blood cells. The liverusually processes and removes the bilirubin from the blood. Neonatal jaundice in babies usually occurs because of a normal increase in the red blood cell break down and the fact that their immature livers are not efficient at removing bilirubin from the bloodstream.There are mainly two types of neonatal jaundice.
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· Physiological jaundice· Pathological jaundice PHYSIOLOGICALJAUNDICE is due to the physiologic immaturity,immaturity in bilirubin metabolism at multiple steps results in the occurrence of neonatal jaundice in the first few days of life .CHARACTERS OF PHYSIOLOGIC JAUNDICE :First appears between 24-72 hoursof age, Maximum intensity seen on 4-5th day in term neonates, Doesnot exceed 15 mg/dl and clinically undetected after 14 days. PATHOLOGICAL JAUNDICE: Bilirubinlevels that deviate from Normal rangeand require intervention i.e.
presence of any of the following signs denotes that jaundice is pathological. Treatment is required in the form ofphototherapy. Clinical jaundice detected before 24 hours ofage, Rise in serum bilirubin by more than 5 mg/ dl/ day, Serum bilirubin more than 15 mg / dl, Jaundice persisting beyond 14 days of life and direct bilirubin >2 mg / dl at anytime. Jaundice comesfrom the French word “jaune”, which means yellow. When it is said that a babyis jaundiced, it simply means that the color of his skin appears yellow.Jaundice in the infant appears first in the face and upper body and progressesdownward toward the toes. Premature infants are more likely to develop jaundicethan full-term babies.
3 In neonates, jaundice tends to developbecause of two factors – the breakdown of fetal hemoglobin as it is replacedwith adult hemoglobin and the relatively immature hepatic metabolic pathwayswhich are unable to conjugate and so excrete bilirubin as quickly as an adult.This causes an accumulation of bilirubin in the blood , leading to the symptomsof jaundice.4 Each year in India over one million newborns die before they completetheir first month of life, accounting for 30% of the world’s neonatal deaths.India’s current neonatal mortality rate of 20 per 1000 live births .Asianmale babies and Native American ones are reported to be most affected byNeonatal Jaundice13.4 millionbabies need treatment for jaundice every year.5Nat Amongst all age group neonates are most susceptibleto mortality and morbidity.
According to UNICEF news letter on April 24, 2008out of every four, a child dies under the age of one in the world, one is anIndian child. The infant mortality rate in the country is 67% per thousand livebirths, in which neonatal mortality contributes 43.4 /1000 against the annualdeath of 9 /1000 (2008). In India neonatal jaundice, contributes 4.55% death inneonatal period. 6 According to the All India institute ofMedical Sciences protocol in neonatology, neonatal jaundice is the commonestmorbidity in neonatal period and 5-10% of all the newborns requireinterventions for pathological jaundice. Neonates on exclusive breastfeedinghave different pattern of physiological jaundice as compared to artificiallyfed babies. Separate guidelines have been provided for the management ofjaundice in sick term babies, preterm and low birth weight babies for jaundicesecondary to haemolysis and for prolonged neonatal jaundice.
7 Delayed initiation of breastfeeding orinsufficient feeding result in poor mobility of the gut, that leads to poor excretion of bilirubin,resulting in accumulation of bilirubin leading to hyperbilirubinemia.Inadequate milk leads to delay the passage of meconium .Passage of baby throughthe vagina during birth helps stimulate milk production in the mother. When thebaby is born by caesarian section the milk secretion is slightly delayed andthe mothers will also be in pain and in sedation, so the feeding is delayed,these babies are at higher risk for this condition. Mothers should be aware ofinitiating breastfeeding as early as possible, either she had caesarian sectionor had a normal delivery. 8 The complication of hyperbilirubinemiais kernicterus. It is due to the severe accumulation of unconjugated bilirubin.
According to a study by Nasrin Khalesi, kernicterus causes 10% of mortality and70% of morbidity among neonates. However, the correct use of phototherapy andtimely blood exchange will control serum bilirubin level which can preventcomplications. 9 Manycases of neonatal jaundice pass unnoticed or are identified late by mothersmaking them present to hospitals late. 10 This can lead to complications such as bilirubinencephalopathy and even death. Interventions to stop progression of neonataljaundice will reduce the morbidity and mortality associated with thiscondition.11 It is thereforeimportant for mothers to recognize neonatal jaundice so as to seek for therapyearly and prevent complications that arise due to neonatal jaundice. 10 Thisstudy is therefore designed to assess the knowledge, attitude and practice ofexpectant mothers on NNJ with respect to their awareness, recognition,knowledge of risk factors/ causes, complications, treatment modalities, andinitial step to take when it is noticed.