Lecture Note: “Neonatal Jaundice and Ayurvedic Management”

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  Neonatal Jaundice and Ayurvedic Management  

  Dr. Rashi Sharma  
Associate Professor, Dept of Kriya Sharir
Faculty of Ayurveda, IMS, BHU

  based on the lecture available at  
Neonatal Jaundice and Ayurvedic Management 

Neonatal jaundice is a condition that occurs when a baby has a high level of bilirubin in the blood. Bilirubin is a yellow substance produced in the body during the destruction of senile red blood cells. When the lifespan of RBCs approaches 120 days, they undergo destruction, producing bilirubin in the blood. The liver helps in the breakdown of bilirubin; thereafter, it is removed from the body via stools. A high level of bilirubin makes a baby’s skin and white sclera, that is the white portion of the eye, look yellow. So, whenever the blood has a higher level of bilirubin, it makes our skin and sclera of eyes look yellowish in colour. This condition is known as neonatal jaundice.

Jaundice is a common condition in newborn babies because babies have a higher number of red blood cells in their blood. These red blood cells are broken down and replaced frequently. When the baby is growing in the mother’s womb, the placenta removes bilirubin from the baby’s body. The placenta is the organ that grows during pregnancy to feed the baby.

What happens after birth? After birth, the baby’s liver starts doing this function. It may take some time for the baby’s liver to get matured and to do this function efficiently. After a newborn baby’s liver is not fully developed, so it is less effective in processing the bilirubin, and its removal from the blood is somehow incomplete. It means that the level of bilirubin in babies can be about twice as high as in adults. So as the age advances, the baby grows to nearly 2 weeks old, they are producing lesser bilirubin compared to the previous age, and their liver becomes more mature. Hence it becomes more effective in the elimination of bilirubin from the body. Hence jaundice often corrects by itself without causing any harm.

  Symptoms of newborn jaundice:  

It is estimated that 6 out of every 10 babies develop jaundice, including 8 out of 10 babies who are born before 37 weeks of pregnancy. It means all those 8 out of 10 babies taking birth in premature conditions are more prone to develop jaundice. Hence premature babies are more prone to jaundice. It can take 5 to 7 days to appear, and usually, jaundice lasts for about 3 weeks. If the baby has jaundice, their skin colour will look slightly yellow.

The yellowing of the skin starts usually on the head and face before it spreads towards the lower extremities, the chest, and the stomach area. Gently pressing the fingers on the tip of the baby’s nose or their forehead can make it easier to find out yellowish discoloration. This is practically possible; we can ourselves identify whether the skin is discoloured yellowish or not. We can easily gently press on a spot on the nose, and if the colour changes to whitish or yellowish, we can identify whether the child is undergoing jaundice or not. Changes in skin colour may be more difficult to identify if the baby has a darker skin tone. In these cases, yellowish discoloration can be identified in other areas.

For example, we can look at their sclera of their eyes. Sclera is the whiter portion of the eye. We can see inside their mouth; the granule beneath the tongue can be more easily suggestive of jaundice. We can also find out yellowish discoloration on the sole of feet, we can find out on the palm of hands. A newborn baby with neonatal jaundice may present these symptoms as well. The child can be sleepier; the child may not want to feed or not feed as well as it was doing previously. The child passes dark yellowish-coloured urine and also passes pale-coloured stool.

There are some etiological factors of neonatal jaundice. Sometimes jaundice may be caused by another health issue that is known as pathological jaundice. Few causes of pathological jaundice can be considered as a hypothyroidism condition. It can be due to ABO incompatibility or Rh incompatibility.

Sometimes urinary tract infection also induces jaundice. If there is any blockage or problem in the passage of bile ducts or gallbladder and in cases of G6PD deficiency, glucose 6 phosphate deficiency, and more or less Crigler-Najjar syndrome. What is this syndrome? It is an inherited condition that affects the enzyme responsible for processing bilirubin.

So, in these cases, there could be a possible reason behind developing neonatal jaundice in a newborn. Let’s have a look at the clinical examination of neonatal jaundice. The paediatrician should check for skin pallor by digital pressure, and the underlying colour of the skin or subcutaneous tissue should be noted.So yellowish discoloration of the skin in newborn progresses in cephalocaudal direction. The newborn should be examined in white light. Newborns who are detected with yellow skin beyond the thighs should undergo an urgent laboratory investigation for bilirubin levels.

This is an alarming sign for the physician to undergo urgent lab investigations when the newborn is presenting with discoloration of skin, yellowish discoloration of the skin, which is presenting beyond the thighs. In these cases, the condition usually gets better within 10 to 14 days and won’t cause any harm to the baby. Somehow, if treatment is not required, continue to breastfeed or bottle feeding regularly should be done.

Newborn jaundice can last more than 2 weeks if the baby was born premature. However, it usually improves without treatment. If the baby’s condition gets worse or the discoloration doesn’t disappear beyond 2 weeks, it requires paediatrician consultation.

If the baby’s jaundice does not improve over time or tests show higher levels of bilirubin in their blood, they may be admitted to the hospital, and treatment with phototherapy or exchange transfusion can be started.

  Phototherapy:  

During this procedure, the child has to be laid under the white lights of a phototherapy stand, and the genital portions and the eyes have to be covered with a cloth. In this manner, the child can be prevented from some damage due to white lights from the phototherapy stand. So neonatal jaundice can be treated easily without or with minimal adverse effects with phototherapy. The efficacy of phototherapy depends on the surface area exposed to phototherapy.

Sometimes double surface phototherapy is also advised for more severe cases of hyperbilirubinemia. In those cases where bilirubin rises excessively and doesn’t come down easily, we advise double surface phototherapy for the child. Continuous phototherapy is somehow better than intermittent phototherapy so that the condition of hyperbilirubinemia comes out easily.

Phototherapy should not be interrupted except during breastfeeding or a nappy change. These are some details for phototherapy; it is a treatment with a special type of light. It is of two types: conventional phototherapy and Fiber-optic phototherapy. During phototherapy, the baby’s temperature is monitored. IV fluids may be required if the baby is becoming dehydrated. So, we should check for dehydration conditions as well.

Bilirubin levels tests are repeatedly done every 4 to 6 hours after phototherapy has been started. Once the baby’s bilirubin levels have stabilized, they will be investigated 6 to 12 hourly. Phototherapy is generally a very effective therapy for newborn jaundice. So, these are some factors we should consider while undergoing phototherapy for a newborn jaundice case. Sometimes when phototherapy is not quite effective in cases, then exchange transfusion is advised. If your baby has a very high level of bilirubin in their blood or phototherapy has not been proven effective, they may need a complete blood transfusion.

During an exchange transfusion, the baby’s blood will be removed through a plastic tube placed in blood vessels in their umbilical cord, arms, or legs. Blood is replaced with blood from a suitable matching donor. In this way, exchange transfusion is carried out with hyperbilirubinemia cases where phototherapy is not successful.

If the jaundice is caused by Rh incompatibility or Rh mismatch, then intravenous immunoglobulin may be used. IV immunoglobulin is usually only used if phototherapy alone has not been so much effective, and the level of bilirubin in the blood is continuing to rise; then we advise immunoglobulin usage.

  Kernicterus:  

In newborn babies with very high levels of bilirubin in the blood, this wedge is actually otherwise known as hyperbilirubinemia. The bilirubin can cross the thin layer of tissue that separates the brain and blood, which is actually known as the blood-brain barrier. The bilirubin can damage the brain and spinal cord, which can be life-threatening. Brain damage caused by high levels of bilirubin is also called bilirubin encephalopathy. These are some adverse effects of hyperbilirubinemia. If the condition doesn’t get stabilized or proper time-effective therapy is not given to the child, then kernicterus may develop in some cases. The baby may be at the risk of developing kernicterus only if there are some conditions that are not followed well. So, what are those conditions in which the baby can be at a risk of developing kernicterus? So first is, they have a very high level of bilirubin in their blood, and second, the level of bilirubin in their blood is rising rapidly. They don’t receive any treatment in early conditions. So, these things are keeping in mind, and things to be noted here as if the baby is not receiving any treatment at early conditions, the baby may be at a risk of developing kernicterus. So, while giving attention to the delivered cases to the patient which is discharging after delivery, we need to advise once the patient finds any kind of yellowish discoloration; they quickly consult a physician; they quickly get their child examined for underlying jaundice.

  Ayurvedic management of neonatal jaundice:  

In Kashyap Samhita, there is an indication of Surya Darshan that is exposure to the baby in the sunlight and Chandra Darshan, which is exposing the baby to moonlight. So, these two things are advised in our ancient Ayurvedic text in Kashyap Samhita. Surya Darshan is suggestive of taking the child out and giving exposure to the sun, and Chandra Darshan stands for exposing the baby to moonlight. It can be correlated as a type of phototherapy for the prevention of neonatal jaundice. One more thing is advised in ancient Ayurvedic text that is the Jatakarma Sanskar of the newborn. Jatakarma Sanskar: Jatakarma Sanskar involves early feeding with Madhu and Ghrita. Madhu is honey, Ghrita is ghee. It may help in disturbed enterohepatic circulation of bilirubin. Madhu and Ghrita actually provide nutrients and energy to the newborn, which provide essential glucose as well as immunity to the newborn. So, in this manner, Jatakam Sanskar of the newborn can be helpful in preventing neonatal jaundice. Ayurvedic management: Ayurvedic approach for neonatal jaundice. Once we are supposed to diagnose properly what are the reasons, what are the etiological factors for jaundice that are quite essential. So, the diagnosis of the probable physiology and pathology of jaundice is required. Use of proper care to the mother is done. Avoidance of Pitta vitiating Ahar Vihar during pregnancy and after delivery is done. Since jaundice in Ayurveda is considered to be happening due to vitiating or aggravating factors of Pitta dosha, and we are supposed to pacify advanced or increased Pitta dosha in the Garbhini or the pregnant lady. So, we are supposed to pacify Pitta dosha or all those reasons, all those Ahar Vihar, all those etiological factors which may increase Pitta dosha in the pregnant lady. So, before delivery and after delivery, the pregnant lady or the mother is advised to have to avoid Pitta pacifying factors. Further, avoidance of Dhoom Paan which is a form of smoking and Svedan. Svedan is heating up the body in the form of external or internal. These things are further somehow increase or pacify Pitta dosha in the body. So further the mother is also supposed to avoid such factors. Ajeerna is a form of indigestion should be avoided during lactation. Stanyashodhak chikitsa to the lactating mother, Paittik Stanyadushti is considered as one of the most important causes of neonatal jaundice. So, since all neonatal jaundice is supposed to be considered under this category of Pitta dosha, so Pitta Shamak Ahar Vihar is therefore advised to the mother. However, Ayurvedic literature indicating etiopathogenesis, prevention, principles management, and medications of jaundice, these measures can be applied in case of newborn very cautiously. Some medications which may prove beneficial in case of newborn jaundice are given here. So, usage of the following medications is no doubt advised in Ayurveda, but they are to be used only under consultation with a well-qualified Ayurvedic physician or Ayurvedic paediatrician. Ayurvedic Paediatrician may advise having Kumar Kalyan Ras, Gurduchi or Nimbapatra Swaras with honey or Madhu, Haridradi Ghrita can be used, Mandoor Bhasma can also be advised in the case of newborn jaundice. Further, Punarnava Mandoor can also be equally effective in case of newborn jaundice. At last, more commonly if I say, what I have seen in my clinical practice, usage of coconut oil is also very effective in case of neonatal jaundice, Coconut oil provides conservative management in the case of hepatitis or obstructive jaundice as it contains medium-chain triglycerides, and there is no need for bile for its absorption. This is the most important thing to consider since all fatty substances, cholesterols or lipids, they all require bile for their absorption. This coconut oil does not require or there is no need for bile for its absorption, giving energy or other fat-soluble nutrients that are provided by coconut oil itself. In this manner, we can go for the Ayurvedic approach for the management of neonatal jaundice quite effectively, but do remember, first we need to identify the discoloration of the skin by gently pressing the nose or the skin of the forehead to judge, to identify, to diagnose the yellowish discoloration, which can be suggestive of underlying jaundice in a newborn. Once the discoloration is confirmed, then we are supposed to immediately consult a physician or some paediatrician. So, the Paediatrician will advise after giving clinical examination of the newborn; they will advise either phototherapy or exchange transfusion in case of higher levels of bilirubin in blood.  It is to be noted that things which are mentioned in the context of Ayurvedic management are to be performed only under a good physician, Ayurvedic physician or Ayurvedic paediatrician consultation.

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