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Hospitals alerted about brain damage linked to untreated jaundice

By Lindsey Tanner, Associated Press, 5/2/2001 16:42

CHICAGO (AP) Short hospital stays after birth sometimes called ''drive-through deliveries'' may be contributing to infant brain damage caused by untreated severe jaundice, health officials warned Wednesday.

In an alert issued to the nearly 5,000 hospitals it evaluates, the Joint Commission on Accreditation of Healthcare Organizations said doctors are seeing a re-emergence of a rare condition called kernicterus in newborns.

Kernicterus can develop if jaundice becomes severe, and usually causes a form of cerebral palsy with poor muscle control. Hearing loss, teeth malformations and other handicaps also may occur.

''These cases are true tragedies, not only for the children, but also for the families,'' said Dr. Paul M. Schyve, the commission's senior vice president.

Jaundice affects more than half of all U.S. newborns. It may go away by itself or with treatment that usually involves placing the infant under special fluorescent lights. Blood transfusions are done in severe cases.

Kernicterus is not monitored by the Centers for Disease Control and Prevention, but an informal physicians' registry suggests that about 90 cases and three deaths have occurred since 1984, said Dr. Jeffrey Maisels. Maisels heads an American Academy of Pediatrics subcommittee that is revising 1994 guidelines for treating jaundice.

While those 90 cases are a tiny portion of the estimated 4 million annual births nationwide, doctors suspect the numbers are higher.

Sending babies home a day or two after birth what critics call ''drive-through'' deliveries has contributed to the problem, according to the academy and the commission. Jaundice may not become obvious until several days after a newborn has gone home.

The rise in kernicterus is especially troubling because the condition is preventable if jaundice is treated early, said Maisels, chairman of pediatrics at William Beaumont Hospital in Royal Oak, Mich.

The commission's recommendations include evaluations for all newborns with jaundice, medical follow-ups for newborns within two days after they are sent home, and education of parents about jaundice and its risks.

Jaundice can cause a yellowing of the skin and involves an elevated level of bilirubin, which is a naturally occurring byproduct of decomposing red blood cells.

The liver filters bilirubin from the blood, but newborns' livers typically do not start functioning fully until a few days after birth, making them prone to jaundice.

Maisels said doctors are not certain how bilirubin damages the brain, but autopsies of infants with kernicterus have found yellow staining in a region of the brain that controls movement.

Simple blood tests can detect elevated bilirubin levels and are recommended by the academy for all newborns who appear jaundiced.

Babies at increased risk for jaundice include those born a few weeks prematurely, those who may be improperly nourished because of inefficient breast-feeding, and those who have siblings who have had jaundice.

Kernicterus is believed to have been somewhat common in the 1940s and '50s, before the development of a jaundice treatment called exchange transfusion, which replaces a newborn's blood with adult blood.

The condition had become rare by the 1970s, when newborns routinely remained in the hospital for several days after birth, Maisels said.

Some have blamed shorter stays on managed care, but an industry trade group notes that since 1998, federal law has required plans to cover hospital stays of at least 48 hours at the mother or doctor's request.

Susan Pisano, spokeswoman for the American Association of Health Plans, said virtually all member groups will pay for bilirubin tests after newborns have been sent home. The group represents more than 1,000 health maintenance organizations and other managed-care plans nationwide.

-- Anonymous, May 03, 2001

Answers

This article bugs me. Women that choose to have babies at home are usually well-versed in what to look for the first few days and are willing to take on the added responsibility. Women that choose to have babies in the hospital do so for a number of reasons, but tend to rely on their health providers to detect those early problems. I had wondered with "drive through" deliveries how long it would be before we would start seeing problems.

My middle daughter developed jaundice late in her second day and was treated and I continued treatment at home when we left on the 4th day. This never would have been caught before she went home if we had been sent home at 48 hrs. I knew a little about jaundice, but I wonder now if I would have caught it myself in time.

Funny, when I had my first child, average hospital stay was 5 days for normal delivery and 7 days for c-section, by the time I had my youngest, it was 3 days for any delivery.

-- Anonymous, May 03, 2001

My first, Elphine, was a hospital birth, and she developed jaundice, ending up staying there for 5 days while I was discharged after 3. I was utterly wiped after 40 hours of labor (with a midwife, no pain meds), and was not at that point able to be very assertive about dealing with it. I did finally try some Pitocin, which has been associated with jaundice, I believe.

Second baby, no jaundice, but a sort of drive-by delivery of my choice at the freestanding birthing center run by my midwives. Had Thumper, left for home 4 hours later, no problems, other than having to break it to Elphine (then 3) when we did the follow-up visit to the midwife that she was not going to put Thumper back inside me, as Elphine had suggested.

-- Anonymous, May 03, 2001

For weeks, a 6-year old lad kept telling his first-grade teacher about the baby brother or sister that was expected at his house.

One day the mother allowed the boy to feel the movements of the unborn child. The 6-year old was obviously impressed, but he made no comment. Furthermore, he stopped telling his teacher about the impending event.

The teacher finally sat the boy on her lap and said, "Tommy, whatever became of that baby brother or sister you were expecting at home?"

Tommy burst into tears and confessed, "I think Mommy ate it!"

-- Anonymous, May 03, 2001