​NEONATAL JAUNDICE

Congratulations to all new mums and dads! 
So, your baby was born, looking all fresh, pink and healthy. However, on your arrival at home, having been discharged from the hospital, you found that he is as yellow as saffron. “Oh Dear! What’s wrong with my cutie pie”, you’re worried. Should you be worried? 

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Jaundice is defined as the yellowish discoloration of the skin and sclera (white of the eyes) due to excessive amount of a pigment called BILIRUBIN. 
Bilirubin is produced normally, following the recycling and breakdown of red blood cells. It is excreted in the urine and faeces, to maintain a tight balance and normal concentration in the body. Therefore, anything that increases the rate of breakdown of the red cells, or impedes the excretion of bilirubin, will result in jaundice. 

In fetal life, red cells are much more than in adults. Once the baby is born, he sheds this excess red cells as they are no longer needed. This results in a mild form of jaundice known as PHYSIOLOGICAL JAUNDICE. This form of jaundice is transient and self-limiting. If you worry, it will go. If you don’t worry, it will go! 
There are two things you can do to speed up the clearance of physiological jaundice :

1. Breastfeeding 

2. Exposure to sunlight 

Of the numerous benefits of human breast milk is that it helps to prevent and treat jaundice. There’s a tendency to think that breast milk is the cause of physiological jaundice because it is commoner in breastfed infants. But the truth is, breastfeeding provides a better chance at recovery from jaundice than not breastfeeding. 
Once you have checked with your paediatrician, and they tell you that the jaundice is mild or physiological,   try to expose him to early morning sunlight until the jaundice clears. A plus to this practice is that your baby also gets loads of vitamin D *winks. 

Remember to cover his eyes and genitals before exposure (too much UV rays can damage those organs), and do not expose to midday sunlight (to avoid sunburn)… 

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So, we have talked about physiological jaundice. What about pathological jaundice? Basically, neonatal jaundice is physiological until proven otherwise. Pathological jaundice is just an extension of physiological jaundice, ie. when the latter fails to go away or when there are superimposed factors complicating the former. 

Now, let’s break it down. As mentioned earlier, jaundice can be caused by excessive breakdown of red cells or decreased clearance of bilirubin from the blood due to – 
*Haemolytic anaemias (immune and non immune) 

*Polycythaemia (pathologically high red cell count) 

*Extravasation of blood during delivery (eg. Cephal haematoma) 

*Bruising during delivery 

*Genetic/Familial anomalies in the enzymes required for red haemoglobin and bilirubin metabolisms (eg. G6PD deficiency) 

*Infections (congenital or acquired) eg. Malaria, pneumonia, etc. 

*Some drugs, if taken in late pregnancy or given to the infant (especially sulfur-containing drugs, eg. Fansidar) 

*Congenital malformations of the liver and biliary tract

***In a Nigerian study, 13% of babies with clinical jaundice tested positive for G6PD deficiency. 

 

This list is not exhaustive; it’s just a rough overview. 
Let’s zoom in a little on Haemolytic anaemias. The commonest causes include blood group incompatibility (ABO & RHESUS) and infections (sepsis). Rhesus incompatibility is particularly important. When a baby’s blood group is different from that of the mother (mother Rhesus negative, baby positive), the mother produces some substances called ANTIBODIES. These antibodies may not affect the triggering baby, but subsequent babies are affected. 
These antibodies travel from the mother’s blood, through the placenta and attack the baby’s red blood cells which are seen as “aliens”. The cells break down at a faster rate than the baby’s liver can clear. The resultant hyperbilirubinaemia manifests as jaundice. In severe cases, anaemia or death may occur even before the baby is born (stillbirth) 

There are two components of bilirubin: the conjugated (coupled with a plasma protein) and the unconjugated. When the unconjugated bilirubin exceeds a threshold level, it crosses the blood-brain barrier resulting in a condition called KERNICTERUS. Early signs include muscle weakness, failure to feed and convulsions. This is a neurological disorder that can result in severe intellectual disability or death.

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So that I don’t bore you with too much details, let’s discuss the clinical features and management of neonatal jaundice. 
Of course, jaundice itself is a symptom, but in subtle cases, parents may not be able to detect it easily. It starts with a yellowish tinge in the sclera (white of the eye). You need to be very observant to detect a jaundiced eye because the neonatal eyes consists of more dark than white; plus, they usually sleep for the most part of the day! 

As bilirubin level rises, the skin gradually becomes yellow. In dark-skinned babies, you need to indent the skin gently to see the yellowness. You may also notice changes in the colour of the urine and faeces. 
Other signs and symptoms are related to the underlying cause and resultant effect (complications) of jaundice…

*fever

*irritability (excessive crying) 

*inability to feed

*failure to thrive (loss of weight or failure to gain weight) 

*vomiting 

*muscle weakness

*convulsions

*sudden death

The best way to manage jaundice successfully is to detect it early. As mentioned earlier, unattended jaundice can lead to permanent brain injury and severe handicap or death. Parents should be able to recognise red flags and know when to seek help. Never underrate any sign and never resort to self-medication. 
Treatment modalities include:

1. PHOTOTHERAPY – The baby is placed under a specialised kind of light. This light converts bilirubin into a form that can be easily excreted from the body. The eyes and genitals are protected while extra breastmilk or iv drips are given to replace the fluid loss due to heat. 

2. INTRAVENOUS IMMUNOGLOBULIN – In hemolytic jaundice due to blood group incompatibility, maternal antibodies can be wiped out of the baby’s blood by infusion of IVIG. This therapy is highly effective, faster and more preferable to other invasive treatments. However, IVIG is very expensive and often unavailable in developing countries. 

3. EXCHANGE BLOOD TRANSFUSION – This is a form of blood transfusion that involves gradual withdrawal of the “jaundiced” blood and replacement with normal, compatible, screened blood. The procedure is performed in the special baby care unit and there are potential risks such as infection and transfusion reactions. 

4. ADJUNCT MANAGEMENT – The cause should be determined and treated as appropriate. Breastfeeding should be continued as tolerated. Serial bilirubin levels are checked until normal. Psychosocial support should be offered to parents as they are often in distress due to the prolonged hospital stay. 

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​THE POWER OF SLEEP


Have you ever pondered over the miracles of sleep and wakefulness? Do you know that sleep is so important that an average man spends a third of his lifetime sleeping? Do you give thanks to the One who gives you the ability to sleep and the grace to wake up from your sleep? 

Sound sleep is a mercy from Allaah (Qur’an 79:9). Not everyone gets it. All you do is lie on your bed with the intention of sleeping; the rest of the story is not within your power. If you doubt me, ask anyone who has suffered from insomnia and had to take strong pills in order to sleep. AlhamduliLlaah for the gift of sleep! 

Sleep is the youngest brother of death. Your consciousness, nay, your life is taken away temporarily. However, your heart keeps pumping blood throughout your body. Your lungs keep taking in oxygen and expelling carbon dioxide. Your urethra and anus remain tightened so that you don’t pee or poo on the bed. Your brain is refreshed and rejuvenated. Flashes of information pop up within your brain and you see them as dreams… Have you ever wondered how these processes keep going on while you sleep? SubhaanaLlaah! 

Waking up is the greatest miracle of all. You don’t choose to wake up. Allaah chooses who wakes up and who doesn’t. He created the “circadian rhythm” which triggers you to rise up when your body has rested well enough. And No, it wasn’t just because of the ringing of the alarm clock or crowing of the rooster. 

So tell me, how can a person sleep and wake and not appreciate that it is a privilege to sleep and wake? 

“It is Allah Who takes away the souls at the time of their death, and those that die not during their sleep. He keeps those (souls) for which He has ordained death and sends the rest for a term appointed. Verily, in this are signs for a people who think deeply.” (Qur’an chapter 39 verse 42)

​WHAT ARE YOU DOING WITH YOUR LIFE? 

After my NYSC, I joined the pool of frustrated young Nigerian graduates, actively searching for a job. So one day, I attended a walk-in job interview in Lagos. I had rehearsed the answers to common interview questions and mastered a number of clinical questions that are frequently asked during such interviews. Then, I met a consultant who asked me unusual questions. 
“How old are you?”

Although my date of birth was written clearly on my CV which was right in front of him, I think he just wanted to be sure… 

His next question struck me even harder… 

“So, what do you want to do with your life?”. 
I went silent for about 40 seconds. The question was obviously open-ended and vague, I didn’t know how to start answering. At that moment, I thought about the meaning of life itself. I thought about the purpose of creation. I thought about the things I wanted to do in life and those things I’ll like to be remembered for when I’m gone. I envisioned my life in the next 10 to 20 years. Then, I remembered that I don’t even own my life and, as much as I plan for a great future, nothing is 100% sure; except death.
Within those 40 seconds, a verse of the Qur’an popped into my head:

“And I (Allah) created not the jinns and humans except that they should worship Me” (Qur’an chapter 51 verse 56). 
My dear interviewer, seeing how perplexed I was, went on to explain what he meant… 

“You’re still young and energetic. I doubt if this is the kind of job you should be looking for. It’s OK to gather one or two years of experience and save some money. But you should aim higher. You should take this and that course, undergo this and that training, read this and that book, access this and that resource, write this and that exam…”
I nodded affirmatively but I was still partially lost in thought. He had no idea that I read a different meaning to his question. Each time I remember that interview, that interviewer, and that question, I shake my head and smile. I ask myself: Khadijah, what are you doing with your life? 
“O you who believe! Fear Allah and keep your duty to Him. And let every person look to what he has sent forth for the morrow, and fear Allah. Verily, Allah is All-Aware of what you do.” (Qur’an chapter 59 verse 18) 

MY MIRROR

I love mirrors. I love it when walls are richly adorned by them. There’s this giant mirror in my room. It is almost twice as tall as I am, and about a meter wide. Daily, I stand in front of it and take a long look at myself from head to toe… 

I look into the mirror for a maximum dose of self-love. I call it “self-crush”. I look for the differences between yesterday and today. I see flashes of hope for a better tomorrow, in shaa Allaah. I see the strands of grey hair which herald senescence. I see the freckles and wrinkles which remind me of the ephemerality of my existence… 

I see the mistakes of the past and the opportunities of the future. I see life and death, and the thin line between them. I see my achievements and how awesome I am. Then, I see my weaknesses and how fallible I could be… 

This mirror, besides being an essential piece of furniture, is a great source of reflection and reminder. That, is why I love mirrors. 

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“… Our Lord! Give us in this world that which is good and in the Hereafter that which is good, and save us from the torment of the Fire!” (Qur’an chapter 2 verse 201)

​THE MID-CYCLE CHASE

 

One of the most FAQ’s from young women who are either trying to conceive or trying to delay pregnancy (while avoiding modern contraceptives) is:

“How can I know the ovulation day?”

Knowing the length and dynamics of your cycle will guide you in planning conception and contraception, as well as early detection of abnormalities in your menstrual cycle in general. Ovulation is the process of release of the egg from the ovary and transfer into the fallopian tube where it will be available for fertilization, in the presence of viable sperms. It normally occurs once in a monthly cycle and the egg (in rare cases more than one egg can be released at a time) remains valid for only less than 24 hours. This is why couples are advised to have intercourse at least 3-4days in a week if they want to “catch up” with the ovulation window. 
Here are some tips… 

1. Note the length of your cycle. This is the interval between the FIRST day of one menses and the FIRST day of the next. eg. If you start your menstruation on January 1st  (this is called the last menstrual period –  LMP) and then the next on January 29th, that’s a 28-day cycle. Your ovulation should occur on the 14th of January. This is the average duration but it can be as short as 21 days, and as long as 32 days.

2. It’s quite straightforward for a regular 28-day cycle. But if yours is shorter or longer, just count 14 days backwards from the first day of the next expected menses. These last 14 days after ovulation are always constant. For example, if your cycle is 3o days and your LMP is January 1st, then you’re going to ovulate on the 16th. 

3. Target this day. Add 4 days before and 2 days after. All other factors being normal, ovulation, hence fertilisation should occur somewhere around these days. If you’re avoiding pregnancy, you should avoid sex around these days too (up to a week) or, use a backup contraceptive such as condom. 

4. If the cycle is irregular, this might be difficult to calculate. You may need to see a doctor who may give you some medications to “regulate” your cycle. Ovulation can also be unpredictable at extremes of reproductive age: first 5 years after puberty and before the onset of menopause. 

5. Other options include:

A) Checking the vaginal fluid. It becomes more sticky, stretchy and copious around ovulation period (not accurate) 
B) Checking your body temperature. It rises about 1 degree Celsius around ovulation (not reliable) 
C) Ovulation tracking using ultrasound and blood tests (cumbersome) 
D) Use of ovulation prediction kits, eg. Predicte™ (available in pharmacies)
E) The ovulation pain. Certain inflammatory enzymes mediate the process of ovulation. This subtle inflammation can cause mild lower abdominal pain but, again, you can’t rely on this as many people don’t feel the pain as such.

THANK YOU… 

Dear husband, 
Calm down! This is not a rant. I’m not here to complain about anything. This is a letter of appreciation. I just want to say THANK YOU… 

Thank you for loving me. Thank you for being my Godsent protector and sustainer. Thank you for crowning me as the Queen of your heart. Thank you for trusting me enough to make me the manager of your home. Thank you for believing in my dreams and helping me achieve them. 



Thank you for the basic provisions and the bonuses. Thank you for hustling in the midday sun while I bask in my air-conditioned room. Thank you for going through the bustles of the city to bring me food and clothing. Thank you for risking your life so that I can enjoy mine. 

Thank you for putting up with my mood swings and periodic nagging. Thank you for your understanding during the times I was weak or sick. 
Thank you for the little things you didn’t even remember you did – like fixing the light bulbs and replacing the clock batteries! 

Thank you for the things I didn’t expect you to do but you did anyway. Thank you for the surprise gifts and occasional treats. 
Thank you for your kindness towards my parents and siblings.

Thank you for assisting me to keep my duties towards Allaah. Thank you for waking me up for tahajjud and enjoining me to pray on time. Thank you for reminding me to recite the Qur’an and daily adhkaar.

Thank you for everything I forgot to thank you for. Thank you for the little things I didn’t notice. Thank you in advance for the good things you’re planning to do. Thank you for the things you intend to do but you don’t have the means yet. 

JazaakaLlaah khairan! 

Signed

A grateful wife. 

“70 WAYS TO LOVE YOUR SPOUSE”

The first five years were the bomb.  The intimacy was great. The food was always ready in time. Behaviour was top notch. Looks were flawless. Everything was on point. The best word to describe this phase is: PARADISE. 
By the end of that phase, the theme begins to change. The fertile couple starts experiencing the reality of parenthood while the subfertile ones become extremely tense.  There is a paradigm shift from “my husband/wife” to “my children’s father/mother”. Show of affection becomes a seasonal affair. The bedroom becomes just a place to sleep and snore. Communication is reduced to “please buy diapers on your way home, thanks”…. 
Oops! Sorry, wrong title! I’m not here to give you a list of ways to love your spouse. You will have to find out by yourself. As a general guide, find out what works for you and stick to it. What works for couple A might not work for couple B. What are the things you used to do during the honeymoon that you’re no longer doing? Which of those things can you start doing again? What do you need to do differently now? These are the questions you need to discuss with your spouse over and over, and work out the answers, together. 
No one can teach you how to love your spouse better than your spouse. Ask them what they want and how they want it; however, be realistic and reasonable. Pay attention to the fine details. From time to time, arrange dates and outings; away from the interruptions and tantrums of the kids. 
Monotony kills love in marriage. Up your game! Update your wardrobe according to your means. Upgrade your bedmatic skills. Try out new recipes. Read books to sharpen your mind. Mix with older couples and learn from their success strories (but avoid comparing; each couple is unique). 
Most importantly, search within yourself and strive to bring out a better version of you. You will have to make a lot of sacrifices, but these things pay off eventually. Patience is an essential ingredient; it breeds love, happiness and peace of mind.