Mrs Piara Begum (not a real name) paid a visit to me in our out patient department in the morning with a 3 days old boy in her lap. The boy was deeply jaundiced and unable to suck. This was her fourth pregnancy. All previous children died of jaundice during neonatal period and every time she paid visit to kabiraj for treatment. This unfortunate uneducated lady is the wife of a day labourer, who is also not literate. She did not pay any visit to any health facilities during any pregnancy.
Anyway, I admitted the baby. After admission we did the blood grouping of mother and baby along with some other investigations. The mother was found of B negative blood group and the baby was A positive. So the jaundice of the baby was due to Rh incompatibility. We started phototherapy immediately and started preparation for exchange transfusion. In Rh incompatibility, the first pregnancy usually does not affect much but on query we found she had an abortion earlier to her first pregnancy.
Around 75% of the newborn develop some jaundice on day two or three and mostly the cause is physiological, so we designate it as physiological jaundice. This condition subsides within next 10-12 days without any intervention other than sunbathing and frequent breastfeeding.
But jaundice on the very first day of life is pathological and we become concerned about it. This pathological jaundice is mostly due Rh incompatibility, ABO incompatibility, sepsis, congenital sphero-cytosis, TORCH infection and for other reasons. Early intervention is required in these conditions to save the baby. Alarming condition does occur in Rh incompatibility.
If mother is Rh negative and the baby is Rh positive, Rh antibodies develop in mother's blood in response to baby's Rh antigen. These antibodies can cross the placenta. These antibodies come to the baby's circulation and get attached to the baby's RBC. Finally they are being destroyed and ultimately jaundice and anaemia develop.
First pregnancy is usually spared as sufficient IgG antibodies are not produced, but in subsequent pregnancies the amount of antibodies increase and cross placenta and produce severe newborn jaundice.
This is a preventable condition but unfortunately because of ignorance, patients like Piara Begum suffer. If she would have been given injection anti D immunoglobulin soon after her first abortion, her second pregnancy would be safe.
If early prompt proper management is not being done the baby may die of bilirubin encephalopathy, and many more complications may also occur. Regular visit to health facilities during pregnancy is very important for mother's as well as the baby's health. At least 4 antenatal check ups are mandatory. Please make aware your friends, relatives and neighbours about newborn jaundice.
The author is a Professor of Paediatrics at Community Based Medical College, Mymensingh.