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Last Updated: Friday, 21 July 2006, 16:02 GMT 17:02 UK
Call for new baby jaundice checks
Image of light therapy being given to a jaundiced baby
Neonatal jaundice can be treated using light therapy
All newborn babies should be checked for jaundice to prevent unnecessary deaths from a related brain disease, says England's Chief Medical Officer.

In his annual report, Sir Liam Donaldson called for more advice for parents about the warning signs of kernicterus.

He also asked the government to consider offering a screening blood test to all new babies.

Kernicterus can be avoided completely if newborn jaundice is spotted early.

Severe jaundice

It is damage to the brain caused by the abnormal build up of one of the body's waste products, bilirubin.

Bilirubin is produced by the breakdown of red blood cells, which occurs more rapidly in newborn babies.

If more bilirubin is produced than the liver can break down and remove from the body then it can deposit in various places, including the brain, where it can cause cerebral palsy, and the skin and eyes, which it turns a yellow colour.

Warning symptoms and signs
Severe jaundice - particularly in the first 24 hours of life
Impaired consciousness
Abnormal muscle tone
Spasms in the head, neck and spine
Seizures

It is normal for newborn babies to have slightly raised bilirubin levels, which causes varying degrees of jaundice, because their livers are immature. Indeed, jaundice is common in breastfed babies.

About 80% of premature babies and 50% of full-term babies develops jaundice in their first few days of life. In most cases the jaundice will disappear after a couple of weeks and no specific action is needed.

However, jaundice can be more serious and bilirubin can reach toxic levels, leading to kernicterus, which can cause long-term brain damage and even death.

Warning signs

Although kernicterus is fairly rare - it currently affects about one in every 100,000 newborn babies in the UK - its incidence appears to be increasing.

Also, it can have a devastating impact on the child and family concerned.

In the last two years, 14 cases of kernicterus were reported in the UK. Four of these babies died and six have long-term neurological and developmental problems.

From studying these cases and others, experts say that kernicterus rarely occurs 'out of the blue' and that there are warning signs.

We need to raise awareness among health professionals and parents to help tackle this preventable disease
Sir Liam Donaldson

The baby may become sleepier and more difficult to rouse, they may have abnormal muscle tone and develop head, neck and spine spasms and may experience seizures.

The jaundice that can lead to kernicterus often develops in the first 24 hours of life.

Dehydration and inadequate breastfeeding are often linked and there may be other medical problems associated, such as infection, prematurity, severe bruising related to delivery and diseases that cause an abnormal turnover of red blood cells.

Experts believe part of the reason why kernicterus cases are increasing and being missed is that women and their newborn babies are increasingly being discharged from hospital very soon after delivery, sometimes hours later. This can be before jaundice has peaked and breastfeeding might not be properly established, leaving some babies at risk of kernicterus.

Guidance

Also, there is no standardised protocol or guidelines for medical staff to follow to prevent kernicterus.

Although jaundice can be picked up by examining the baby, this is not reliable and it can be masked in darker-skinned babies. Testing blood bilirubin levels can detect which babies need treatment.

Sir Liam said: "We need to raise awareness among health professionals and parents to help tackle this preventable disease.

"I would like to see a national register of kernicterus, education and training programmes for health professionals, explicit advice for parents on what to look out for when they leave hospital and finally I would ask the National Screening Committee to consider the cost effectiveness of a bilirubin blood test to help identify the risk of kernicterus."

The National Institute for Health and Clinical Excellence is due to publish guidance on postnatal care which will include a section on jaundice recommending surveillance and investigation of any severe cases.




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