🎯 Learning Focus

To understand how premature birth, neonatal infections (sepsis), and birth trauma increase the risk and severity of jaundice in newborns, especially in low-resource African settings.

👶🏽 1. Prematurity and Jaundice

🔍 What is prematurity?

A preterm baby is born before 37 weeks of pregnancy.

🚨 Why are preemies at higher risk for jaundice?

📊 Fact: Nearly 80% of preterm infants develop jaundice, often within the first 24 hours.

🧠 Preemies need closer monitoring, especially if born at home or discharged early from health facilities.

🦠 2. Neonatal Sepsis and Jaundice

🔍 What is neonatal sepsis?

A serious infection in newborns—often from the umbilical cord, poor hygiene, or maternal infection.

⚠️ How it leads to jaundice:

• Sepsis damages liver cells, reducing bilirubin clearance

• Increases red blood cell destruction

• Causes poor feeding, worsening bilirubin buildup

🧪 Signs of sepsis-related jaundice:

• Jaundice within first 24 hours

• Fever or low body temperature

• Refusing to breastfeed, irritability, fast breathing

• Pus or bad smell from the umbilical cord

📖 Reference:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202384/

👨🏿‍⚕️ CHWs and TBAs must refer urgently if jaundice + infection signs are seen together.

🩸 3. Birth Trauma and Jaundice

🔍 What is birth trauma?

Injuries during delivery such as:

• Bruising

• Cephalohematoma (bleeding under the scalp)

• Vacuum/forceps injuries

⚠️ How it causes jaundice:

• Broken blood vessels leak blood into tissues

• Body breaks down this extra blood → produces more bilirubin

• Baby’s immature liver may be overwhelmed

Signs to watch for:

• Swollen or bruised head

• Yellowing that starts very early

• Baby seems unusually sleepy or irritable

📖 Study:
“Birth trauma-induced jaundice in Nigerian neonates”
https://pubmed.ncbi.nlm.nih.gov/31710194/

📊 Summary Table – These High-Risk Causes

📍 Case Example – Uganda

A baby girl born at 35 weeks in rural Mbale district began to turn yellow on Day 1.
Her umbilical cord was tied with a non-sterile string.
She had a low-grade fever and refused to suckle.
The TBA gave her glucose water, thinking it would “give her strength.”
By Day 3, she had seizures from kernicterus.
A referral came too late, and she developed cerebral palsy.

“I wish I had known early signs. I would have taken her to hospital on the first day.” – Her mother

🧭 What to Do as a CHW or Caregiver

✅ Immediate Actions:

• Refer urgently if jaundice starts <24 hours after birth

• Watch for fever, poor feeding, bruises

• Educate families that early yellowing is not normal

🧰 Encourage:

• Skilled birth attendance

• Clean cord care

• Early postnatal visits (within 48 hours)

• Avoid glucose water or herbs—they delay real care

🔗 Useful Resources

1. WHO Guidelines for Managing Sick Newborns
   https://www.who.int/publications/i/item/9789240063027

2. Helping Babies Survive Toolkit – Prematurity & Jaundice
   https://www.helpingbabies.org/

3. Clean Cord Care Training – UNICEF/CHAI Africa
   https://www.healthynewbornnetwork.org/resource/clean-cord-care-toolkit/

🧩 Mini Quiz – Prematurity, Sepsis & Trauma

Q1. Why are premature babies more likely to get jaundice?
A. They drink more milk
B. Their livers are still immature
C. They sleep more
D. They cry too much

✅ Answer: B
Rationale: Preterm babies’ livers are underdeveloped and can’t process bilirubin well.

Q2. What infection-related symptom may occur with sepsis-related jaundice?
A. Swollen feet
B. Umbilical pus or fever
C. Laughing too much
D. Teething early

✅ Answer: B
Rationale: Sepsis often presents with infection signs like fever, umbilical discharge.

Q3. What is a cephalohematoma?
A. A broken bone
B. A scalp swelling from birth injury
C. A sign of healthy birth
D. A new tooth

✅ Answer: B
Rationale: Bleeding under the scalp from delivery trauma that increases bilirubin risk.

🧭 Reflection Prompt:

“Talk with a local TBA or CHW: What do they do when a baby is yellow at birth? Suggest early referral and share warning signs from this lesson.”