What do expectant mothers know about neonatal jaundice

These mismatches can lead to a faster breakdown of red blood cells. Internal bleeding. This is bleeding inside the body. Some babies have too many red blood cells. This is more common in some twins and babies who are small for gestational age. A genetic condition, like G6PD deficiency. An infection, like sepsis. Bruising at birth. A bruise happens when blood leaks out of a blood vessel. Sometimes babies get bruises during labor and birth. When large bruises heal, bilirubin levels may rise. Some babies are more likely than others to have jaundice.

These include: Premature babies. A premature baby is one who is born too early, before 37 weeks of pregnancy. A premature baby is more likely than others to have jaundice because his liver may not be fully developed. For most newborns, this is once every 2 to 3 hours about eight to 12 times each day. A lactation consultant is a person with special training in helping women breastfeed.

Babies with East Asian or Mediterranean ethnic backgrounds. Ethnic background means the part of the world or the ethnic group your ancestors come from. An ethnic group is a group of people, often from the same country, who share language or culture. Ancestors are family members who lived long ago, even before your grandparents. How do you know if your baby has jaundice?

If untreated, kernicterus can cause: Athetoid cerebral palsy. The findings by Kemper et al 8 , 9 are consistent with previously published literature demonstrating that stresses created by medical issues early in childhood create parental anxieties and insecurities about infant health that can have lasting effects on the mother-child relationship.

To develop a substantive understanding about the current maternal experience with neonatal jaundice, we designed a qualitative study guided by grounded theory methods. The following 2 sites were chosen to increase the heterogeneity of mothers' experiences: a community hospital serving an economically and ethnically diverse population, and an urban teaching hospital serving primarily low-income African American and Hispanic patients. Local prevailing physician adherence to the American Academy of Pediatrics hyperbilirubinemia practice parameter was not available.

Qualitative studies seek to describe the range of experiences in the population and capture variability of responses. We used purposeful sampling by means of criterion and maximum variation strategies 20 , 21 to identify Spanish- or English-speaking mothers of term infants who exclusively or partially breastfed their infants at postpartum discharge and who represented a range in age, parity, ethnicity, language, and treatment. Medical record abstraction for all jaundiced infants at study sites determined eligibility.

Eligible mothers were recruited using a script describing the study. If mothers agreed to participate, an interview was scheduled for approximately 4 weeks after recognition of jaundice. Sampling continued until theoretical saturation, when no new relevant data were emerging. The ethnographic interview guideline 22 was developed using literature on neonatal jaundice and breastfeeding 1 - 9 , 23 - 26 and included experience with jaundice recognition and treatment; mothers' understanding of and emotional response to jaundice; perceptions of jaundice seriousness and its current effects on their infants; infant feeding decisions; interactions with and information received from medical staff, family, and friends; recommendations to improve future jaundice experience; and demographic information.

Three trained female ethnographers including P. Mothers were encouraged to lead the conversation, with the ethnographer using prompts to guide the discussion toward any issues on the interview guideline not brought up by the mothers. This method standardized the information collected without limiting the information given by the mothers.

Intracoder and intercoder agreement were determined by means of regular team meetings to ensure internal consistency of data analysis and consistency of code definition. Once coded, text was retrieved using the qualitative data analysis software.

Themes were analyzed in relation to key variables by all investigators. The women's experiences with neonatal jaundice were compared and contrasted to gain insights into the range of maternal concerns and factors influencing their perceptions about jaundice and their infants. Representative quotations for each theme were selected. In a previous portion of this study, we identified important factors that have an impact on the breastfeeding relationship, so those results are not included herein P.

Sixty-nine women were eligible for the interviews. Eleven mothers declined participation, citing time constraints, and 13 could not be contacted or failed to attend the interview.

Of the 24 mothers who did not participate, 14 were Latina and 12 of their infants had received phototherapy.

Forty-five mothers were interviewed from October 1, , through April 30, To validate interview findings, investigators attempted to convene 2 focus groups, with unsuccessful attendance rates. One mother attended each session. Both women, who had never been interviewed, were interviewed individually, and the results were included in the analysis of the other interviews. Interviews were conducted 2. Table 1 highlights participant characteristics. Half of them were born outside the United States and had lived in the United States from 1 to 25 years mean, 7 years.

Mean age was 27 years, range, years. Among multiparous women, 19 had previous breastfeeding experience, and 14 had experienced jaundice with a previous neonate. Thirty-nine study infants experienced jaundice within the first 6 days of life, with most having nonhemolytic jaundice. Eight infants had breast milk jaundice, with elevated bilirubin levels occurring after 1 week of age. Peak bilirubin levels for all infants ranged from Mothers repeatedly expressed concerns regarding their experience with neonatal jaundice.

These concerns grouped into themes that included their perceptions of causes of jaundice, their reactions to jaundice management, and their responses to the yellow skin. These are discussed below, along with the interplay of these themes and the mothers' guilt, distress, and worries regarding the effects of jaundice management.

Quotations to illustrate maternal concerns are presented in Table 2. Each woman discussed up to 10 different causes of neonatal jaundice. The most common responses agreed with biomedical explanations, ie, bilirubin levels were too high or "not clearing out of the system"; blood cells were "not functioning" or were "reacting to mothers' cells"; and a liver issue involved its "prematurity" or a "development problem.

Twenty-six mothers believed that breastfeeding led to jaundice. Nine of them had had a previous infant with jaundice. Their understandings of how breastfeeding caused jaundice related to the quantity or quality of their breast milk P. S, unpublished data, August The next most common category of responses was uncertainty about the cause of jaundice, with most stating that they had not been given an explanation. These mothers were exclusively Spanish-speaking, young, non—high school graduates whose infants had undergone blood testing only.

Many of these mothers specifically asked interviewers for more information about the cause of jaundice. A theme of maternal guilt arose in 18 interviews, regardless of intervention type or language spoken. These mothers believed that they had caused the jaundice, using phrases like "got it from me," "did something wrong," "not being a good mother," or "doing my baby harm.

Mothers who described their neonates as being "born with it" described what they did or did not do during pregnancy. Mothers who believed they had caused the jaundice after delivery discussed their diabetes, current illnesses and medications, or, most commonly, breastfeeding.

Several Latina mothers shared their belief that maternal emotions transmitted to the infant during pregnancy or through breastfeeding can cause jaundice. The term bilis means anger in Spanish. This meaning and a lack of understanding about causes of jaundice accentuated their perceptions, as seen in the following example:.

Bilirubin, they are like bilis when one gets mad. I felt that when I was pregnant and had so much stress, that's what caused it. Also, I was scared in the hospital. I thought that was affecting my milk and making him worse. When asked if she still felt that way, she responded: "Yes, because they haven't told me very well what happened. Fewer mothers explained that jaundice was normal or part of giving birth, attributing it to labor, bruising during delivery, or an adjustment to the new environment.

A few commented simply that "babies are born with jaundice. Mothers expressed strong emotional reactions toward jaundice treatment protocols and the resulting mother-infant separation. Most mothers indicated that the blood testing process was difficult to watch and painful for mother and child. This historical remedy may also contribute to delay in care in case of severe jaundice. Another interesting finding was the fact that, the sense of urgency in seeking medical care was lower in mothers with higher parity, even though awareness on NNJ increased significantly with increasing parity.

This, however, was not statistically significant. Mothers who used to have normal babies, may not be worried much about NNJ. For most new born, NNJ is of little consequence, but the potential remains for acute bilirubin encephalopathy and kernicterus from high-unconjugated bilirubin concentrations in term babies, or even lower levels in preterm babies.

NICE guidelines 24 Conjugated hyperbilirubinemia is always abnormal, and its cause must be investigated and managed promptly. Therefore, our findings may not be generalizable to the whole country. Majority of expectant mothers attending antenatal clinics at Korle Bu Teaching Hospital and Mamprobi Polyclinic are aware of NNJ but have poor knowledge of the causes, danger signs and treatment of NNJ, irrespective of their level of education, their parity, and their sources of information.

Their attitude in seeking medical care in case of NNJ was however good. More education on NNJ should be given to expectant mothers during antenatal visits. Our special gratitude to the management of the Department of Gynaecology and Obstetrics of the Korle Bu Teaching Hospital and the Mamprobi Polyclinic where this study took place.

Frederick Djan and Mr. Clement Narh contributed to the data analysis. Cecilia Asabre, Dr. Bright Danyoh and Mrs. Jemima Amanor assisted in the data collection. Eunice Brown contributed to the initial brainstorming on this topic.

National Center for Biotechnology Information , U. Journal List Ghana Med J v. Ghana Med J. Author information Copyright and License information Disclaimer. Corresponding author: Taiba J Afaa moc. This article has been cited by other articles in PMC. Methods This was a cross-sectional study involving expectant mothers. Results Out of the respondents, Conclusion Majority of expectant mothers attending antenatal clinics at a Teaching Hospital and a Polyclinic in Accra, Ghana are aware of NNJ but have poor knowledge about the causes, danger signs and treatment of NNJ, irrespective of their level of education or their parity.

Funding None declared. Keywords: Jaundice, new born, mothers, knowledge, Accra. Introduction Jaundice, which is yellowish discolouration of the sclera and the skin, is common in term and preterm neonates. Results Out of a total of expectant mothers who participated in the study, 73 Table 1 Maternal characteristics. Open in a separate window. Table 2 Awareness of NNJ in relation to selected maternal characteristics.

Table 3 Knowledge about neonatal jaundice. Discussion The level of awareness to NNJ in our study Conclusion Majority of expectant mothers attending antenatal clinics at Korle Bu Teaching Hospital and Mamprobi Polyclinic are aware of NNJ but have poor knowledge of the causes, danger signs and treatment of NNJ, irrespective of their level of education, their parity, and their sources of information. Acknowledgements Our special gratitude to the management of the Department of Gynaecology and Obstetrics of the Korle Bu Teaching Hospital and the Mamprobi Polyclinic where this study took place.

References 1. Sege R. Management of neonatal hyperbilirubinemia. Evid Rep Technol Assess Summ ; 65 :1—5. A structured, Pre-tested, researcher administered questionnaire was used to interview the respondents. Data was analysed using SPSS version Results: The mean age of the expectant mothers was Fifty-five