Traditional jaundice management frequently interferes with
the Convention on the Rights of the Child
What is jaundice?
60 percent of newborn develop jaundice. Preterm babies are affected up to 80 percent. This is a normal adaptation of the human body after birth. However, 10 percent of all newborn have an elevated bilirubin level, which can cause non-reversible neurological damage, if not treated. This results in 14 million babies requiring treatment every year. An effective method is blue light phototherapy, which breaks down the bilirubin. But common practice often requires hospitalization, leading to delayed discharge or a readmission, mainly in the first week of life. During the treatment with blue light the baby is naked and blinded in a cot. Hypothermia in relation with phototherapy has be reported and the newborn has to be kept warm, artificially. Dressing and undressing the baby between the feeding sessions contributes to additional thermal stress. Simply holding the baby is a challenge. Natural newborn care is impossible and mother and child separation is still common. A study conducted on "Maternal Experience with Neonatal Jaundice" described the experiences:
physical and emotional exhaustion
distressed by infant's physical appearance
loss of control
negative family impact
Brethauer M, Carey L. Maternal experience with neonatal jaundice. MCN Am J Matern Child Nurs. 2010 Jan-Feb;35(1):8-14; quiz 15-6. doi: 10.1097/01.NMC.0000366803.88540.1d. PMID: 20032753. Kumar P, Murki S, Malik GK, Chawla D, Deorari AK, Karthi N, et al. Light emitting diodes versus compact fluorescent tubes lor phototherapy in neonatal jaundice: a multi center randomized controlled trial. Indian Pediatrics 2010;47(2):131-7.
Interference of natural newborn care
The first days of life are filled with getting to know the new baby and to establish routines for the entire family. A significant part of natural care is carrying the uneasy or crying baby around. Especially dads show patience, walking with the newborn, to put her or him asleep or helping to release burbs, while giving the mum a break. When feeding is effective, diaper change starts to become an important routine, too. All this is delayed and interrupted, when the baby and a parent have to stay longer in the hospital or need to be readmitted due to the medically prescribed phototherapy. That is, when parents feel the loss of control and become insecure of their capabilities. Because parents feel uncomfortable in the clinical environment, nurses take over a majority of the baby care. Advance of fiber-optics blankets for phototherapy still do not deliver the full flexibility of care while deliver the treatment.
Infant Calming Responses during Maternal Carrying in Humans and Mice: Gianluca Esposito , SachineYoshida, RyukoOhnishi; Current Biology, Volume 23, Issue 9, 6 May 2013, Pages R341-R343; DOI: 10.1016/j.cub.2013.03.041
Breastfeeding concerns at day 3 after birth
Breastmilk is evidently the best nutrition for the baby. On top of the nutritional value, breastmilk also has immunological properties and is helping to prevent the build-up of bilirubin, the cause for newborn jaundice. The World Health Organization recommends exclusive breastfeeding for the first six months of life. Breastmilk also offers health benefits for the mother e.g. to return the uterus size of pre-pregnancy, to reduce postpartum bleeding and on longer term, to reduce the probability of breast cancer. Although, breastfeeding contributes to a very intimate bond between mother and the newborn, it comes with many concerns. 95 percent of all women do have concerns of continuing exclusive breastfeeding due to pain and latching issues. Underfeeding caused by insufficient latching can also lead to so called breastfeeding jaundice. A study revealed, that day three after birth is critical for quitting the attempt to breastfeed. This is the same day, when the jaundice therapy usually starts. The practice of mother and child separation during traditional blue light phototherapy is an additional risk to establishing sufficient feeding cues and therefore the chance to establishing exclusive breastfeeding.
E. Wagner: Breastfeeding Concerns at 3 and 7 days Postpartum and Feeding Status at 2 Months, Pediatrics, 2013 OCT; 132(4): e865-e875
Interruption of therapeutic kangaroo care (KMC)
Kangaroo care (KMC) is a practice, where the parent and the newborn child are in direct skin-to-skin contact as long as the baby wants. It helps foremost preterm babies to regulate the body temperature and stabilize heart and respiration rate as well reduces apnea episodes. In hospital initiated KMC with stable babies < 2000g was associated with a reduction in mortality, nosocomial infection and sepsis as well as hypothermia. Another outcome was a reduced average length of stay by 2,2 days. Preterm babies have a high occurrence of jaundice and often need to start phototherapy in the first 48 to 74 hours. The practice of kangaroo care is abruptly interrupted. It is a trade-off between life-supporting KMC an the avoidance of possible neurological damage.
Conde-Agudelo A, Díaz-Rossello JL. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD002771. KMC initiated in hospitals in stable <2000g babies, improves survival by 40% (8 studies), reduces nosocomial infection by 55% (3 studies)
Sarmila Mazumder, www.thelancet.com Published online October 4, 2019 https://doi.org/10.1016/S0140-6736(19)32223-8 (© 2019. World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved)
Potential negative impact
No natural care
Unnecessary hospital days 1,688,000
No exclusive breastfeading
Overuse of baby formula €3.7bn
Thousands of preterm fatalities