Interventions for Neonatal Jaundice

in Developing Countries
A literature Review
Florence Nyahobia Attuah

Bachelor’s thesis
November 2021
School of Health and Welfare
Bachelor´s Degree Programme in Nursing
Attuah, Florence

Interventions for Neonatal Jaundice in Developing Countries

Jyväskylä: JAMK University of Applied Sciences, November 2021, 31 Pages

Degree Programme in Nursing and Bachelor´s Thesis

Permission for web publication: Yes

Language of publication: English

Abstract

Neonatal jaundice occurs to 60% of term babies and 80% of preterm babies of 140 million yearly,
newborns worldwide experience jaundice in their first early stage of life, the rate of new born
mortality raises due to negligence.
The aim of this study is to use different available research on Interventions for neonatal jaundice.
The purpose of the study is to provide information that can be use by health professional to control
and care for neonate with Jaundice.
The study was conducted as a literature review and data was collected using four databases:
Cinahl Plus full- text, PubMed advance full-text, Medline full-text and ProQuest full text. Seven
articles were chosen, and results were analysed by inductive analysis. Three main categories were
generated: Role of a nurse, maternal challenges and Treatment to intervene in the care for neonatal
jaundice. The result indicated the need for effective education, communication, maternal
awareness, treatment to reduce neonatal jaundice

Keywords/tags (subjects)

Neonatal, jaundice, intervention, developing countries

Miscellaneous (Confidential information)

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Contents

1 Introduction .......................................................................................................................... 5
2 Neonatal Jaundice ................................................................................................................ 6
2.1 Epidemiology ..................................................................................................................... 6
2.2 Causes of physiological jaundice ....................................................................................... 7
2.3 Causes of pathological jaundice ........................................................................................ 9
2.4 Assessment and Treatment............................................................................................. 10
3 Aim, Purpose and Research Question ............................................................................... 12
4 Methodology ...................................................................................................................... 12
4.1 Literature Review ............................................................................................................ 12
4.2 Literature search ............................................................................................................. 13
4.3 Studies reviewed ............................................................................................................. 15
4.4 Data Analysis ................................................................................................................... 15
5 Results ................................................................................................................................. 16
5.1 Role of a nurse................................................................................................................. 17
5.2 Maternal challenges ........................................................................................................ 18
5.3 Treatment........................................................................................................................ 19
6 Discussion ........................................................................................................................... 20
6.1 Discussion of the result ................................................................................................... 20
6.2 Strength and Limitations ................................................................................................. 21
6.3 Ethical considerations, validity and reliability................................................................. 22
6.4 Conclusion and recommendations ................................................................................. 23
References .................................................................................................................................. 24
Appendices ................................................................................................................................. 28
Appendix 1. Critical Appraisal of the articles (Hawker et al.2002) ............................... 28
Appendix 2. Summary of reviewed articles ...................................................................... 29
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Figures

Figure 1. Data analysis process.......................................................... 16

Tables

Table 1. Inclusion Criteria...................................................................... 13

Table 2. Selection process………………………………………………................... 14

Table 3. Main themes and sub-themes .............................................. 16

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1 Introduction

Neonate or a new born is the first four (4) weeks of extra uterine life of a child. It is also

considered as the 0 to 28 days life of a child. At the age, many critical events of life happen

in the child’s life, which includes establishment of feeding pattern, bonds parents, high risk

of infection, neonatal jaundice and most cases of birth defects are identified during this

period. (WHO, 2021)

Jaundice is one of the most common conditions that affect over half of new-born babies in

the first week of life which requires medical attention to prevent future complications in the

neonate or even death. Jaundice is either Physiological or Pathological. (Fernandes, J. I. d.

S., Reis, A. T., Silva, C. V. d., & Silva, A. P. d.,2016)

Neonatal Physiological jaundice occurs to 60% of term babies and 80% of preterm babies of

140 million yearly newborns worldwide experience jaundice in their first early stage of life

approximately, it generally appears after 24hours of birth and disappears usually at 7 days

if age, which is typically harmless. Whereas Pathological jaundice occurs within 24 hours of

birth and last for more than 7 to 10 days of age. (Olusanya, Kaplan and Hansen, 2018).

Jaundice occurs due to excessive break down of the red blood cells in the neonate because

of low life span of erythrocyte, inability of the enzyme glucurony transferase to bind with

bilirubin to glucuronic acid to make it water soluble, so that it can be excreted into the liver

then into the colon. Hence a buildup in the serum causing hyperbilirubinemia. (Maisels,

2006).

Neonatal Jaundice can also occur as a result of low or inadequate breastfeeding, causing a

lack of fluids, and nutrients which aid in intestinal movement to actually prevent

reabsorption of unconjugated bilirubin from being absorbed in the intestines back into

circulation, this is common in mothers who were not able to establish breastfeeding as early

as possible. (Maisels, 2006).

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It can also occur as a result of blood group incompatibility thus RhD, and ABO.

Although Rh isoimmunization is not really common in Europe due to Rh prophylaxis in the

treatment of Rh-negative mothers, it’s common in the underdeveloped countries or low-

income countries. (Huang,Kua,Teng,TangWeng&Huang, 2004)

Neonatal Jaundice is a condition that needs adequate care and attention most especially

because it’s actually difficult to distinguish a healthy baby who does not need active

treatment and unhealthy baby who require serum bilirubin testing. Complications of

Jaundice should be prevented as much as possible.

Some complications of jaundice are Acute Bilirubin Encephalopathy and kernicterus. (Urs,

Shivashankar, & Simon,2010).

2 Neonatal Jaundice

2.1 Epidemiology

Neonatal Jaundice is defined as the yellow discoloration of the skin, sclera and mucosa of

the new born as a result of accumulation of excess unconjugated bilirubin in the blood.

Neonatal jaundice affects newborns without a serious threat in the health of the neonate in

the first week of life (physiological jaundice), it usually resolves by itself within 3-to-5-day

(Olusanya et al 2018).

High bilirubin causes neurological impairment such as impaired cognitive development,

disorder in language processing and including cerebral palsy. Hyperbilirubineamia

presenting as jaundice is the said to be leading cause of hospitalization in first week of life,

for a neonate to be said to be experiencing jaundice, the child should have total serum
 7

bilirubin higher than 5-6mg/dL and serum bilirubin≥ 12mg/dl require phototherapy

treatment. (Olusanya et al,2018)

Hyperbilirubineamia is a global burden as survivors experience disability-adjusted life –

years which accounted 113401 in 2016. It is also high cause of neonatal mortality and

morbidity, in 2010 24 million of 134 million of live births and 481000 late –preterm

developed jaundice with a death toll of about 114000 and 63000 survived with a long term

neurological defects. Jaundice is said to be the 13th primary cause of death in America and

ninth Europe. It is the 12th in Sub-Saharan Africa. Few studies have been documented on the

effects of neonatal jaundice and its prevalence in Africa, (olusanya et al,2018)

(Magai,Mwaniki,Abubakar,Mohammed,Gordon,Kalu,Mwangi,Koot&Newton,2020)

discovered that, 9% of infants who received phototherapy and 17% of infants who received

exchange blood transfusion in a population of 5262 developed sensorineural hearing

impairment in a community study in Nigeria. Also a study in Kenya of 169 participants,

revealed that none of the infants developed a seizure disorder, one was diagnosed of

moderate palsy and 4 infants developed nystagmus.

2.2 Causes of physiological jaundice

Neonatal jaundice is either physiological or pathological. Physiological jaundice is a normal

transitional stage which affect majority of term newborns who have a constant increase of

unconjugated bilirubin levels and jaundice on the third day.(Cohen, 2006)

Increased erythrocyte breakdown

Newborns have a higher bilirubin production than adult. The fetus depends on

haemoglobin F which has unlimited oxygen saturation in hypoxic environment than

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hemoglobin A. At birth when pulmonary system begins to function, the large red cells are

destroyed and causes an overload in the system. (Fraser & Cooper, 2014).

Enzyme deficiency

During the first 24hours after birth, there is a decline in bilirubin conjugation as a result of

reduced level in the enzyme uridine diphosphoglucuronosyl transferase (UDP-GT). This

enzyme is responsible to conjugate unconjugated bilirubin to a conjugated bilirubin. The

deficiency of these enzyme contribute to neonatal jaundice (Frank, 2021).

Increase enterohepatic reabsorption

In the newborn both mono and diglucuronides are excreted into the bile and gut, the

conjugated bilirubin in the intestine are hydrolyzed into unconjugated bilirubin by beta

glucuronide in the intestine due to lack of bacteria in the colon, then the unconjugated

bilirubin is then again reabsorbed into the enterohepatic circulation contributing to

jaundice. (Maisels, 2006).

Brestfeeding and jaundice

This is jaundice as a result of breastfeeding which happens 2-4days postnatal or appears 4-

7 postnatal, this conflicting jaundice has been called human milk jaundice, as it’s revealed

that few fluid and colostrum causes’ slow intestinal movement causes exposure to beta

glucuronides which converts conjugated bilirubin to unconjugated. (Cohen, 2006)

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2.3 Causes of pathological jaundice

Pathological jaundice on the other hand is as a result of a disease or an underlining

condition. In pathological hyperbilirubineamia, there is a rise in bilirubin level of

˃12.9mg/dl and binds on albumin and it being lipid soluble is able to cross the blood brain

barrier and accumulated in the brain causing neurotoxicity. The etiology is as a result of

transport, production, conjugation and excretion of bilirubin .This further causes cell

damage and apoptosis leading to neurological disorders (Moncrieff, 2018). Factors that

cause haemoglobin destruction also increase bilirubin production.

ABO incompatibility

This often occurs when the mother is blood group O and the fetus is blood group A or B.

blood group A and B do not have antigen, whereas group O develop antibodies that crosses

the placenta and attach to fetal red blood cells and destroys them, thereby causes

hyperbilirubineamia

Sepsis or infections. (Maisels, 2006).

Neonates can develop infections from the birth canal or vagina, the placenta,or even from

the care givers hands. Infections such as cord sepsis, malaria may lead to the rapid

destruction of the red blood cells

G6PD Deficiency and UGT1A1 (UDP-glucuronosyltransferase 1A1)

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Neonate with this enzyme deficiency has an increased risk of hemolysis, as this enzyme

protects the integrity of the erythrocytes from destruction, hence due to its deficiency the

erythrocytes are rapidly destroyed. (Fraser et al, 2014). According to (Huang et al,2014) a

study in Taiwan revealed that neonates who carry 211 variant of UGT1A1 have a higher risk

of hyperbilirubinaemia and neonate with G6PD deficient developed mild

hyperbilirubineamia.

Prematurity

Neonates born of less than 38 weeks of gestation, have low birth weight a risk factor of

hyperbilirubin and also immature liver to function fully and excrete bilirubin from the blood

this brings about a build up of bilirubin in the blood causing jaundice.

Cephalohematoma

Neonates too large for gestational age that are born per vagina turn to develop birth injury

due to difficulty in delivery. The injury may cause bruising and breaking of red blood cells

(Kwame tender)

2.4 Assessment and Treatment

Neonatal jaundice is diagnosed by physically assessing the neonate for presence of

yellowish discoloration of the conjunctiva, the sclera and skin. Although assessment with

the eye is old fashion and not effective in dark pigment neonate and bilirubin level of

8mg/L may not be seen with the eye. (Muchowski,2014). Also babies who are born with

low birth weight, preterm babies, neonate of a diabetic mother, babies with delayed cord

clamping etc are at a risk of developing jaundice. Nurses should take a blood sample for

laboratory investigation prior to discharge to check total serum bilirubin level from the

neonate. (Turnbul, & Petfy,2012).

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Early intervention in the care of neonatal jaundice helps to prevent any future

complication such as brain damage and infant mortality as a result of high bilirubin.

Hyperbilirubineamia is detected by checking the total serum bilirubin level or total

cutaneous bilirubin level of the newborn, it is important that all the bilirubin level of the

infant is interpreted in terms of the infants age in hours and not in days to know the

actual concentration. Jaundice is treated through exchange blood transfusion,

phototherapy, intravenous immunoglobulin etc.( Woodgate, & Jardine,2015).

Phototherapy: this therapy works by using light to infuse energy similar to drugs/

medications. This allows the bilirubin to be absorbed by the skin and subcutaneous tissue.

The photo therapy helps to excrete bilirubin without the conjugation system by the liver

and some are excreted in the urine. With this procedure, the neonate body is expose to

light continuously or intermittently and the eyes are protected with the mask and genitals

covered as well in a cot and not in an incubator, Phototherapy is usually the first light of

treatment for jaundice. (Muchowski,2014).

There are two (2) types of phototherapy - these include, conventional phototherapy and

fibreoptic light system. Conventional phototherapy use high intensity white light or blue

florescent light, or LED, the infant is placed forty- sixty centimeters (40- 60cm) beneath the

light and the entire skin or a larger portion of the body is exposed. The latter, which is the

fibreoptic light system gives high density light without ultraviolet or infrared irradiation.

A quartz halogen bulb is passed through a filter, then fibreoptic bundle into a woven optic

fiber channeled down.( Kato, Iwata,Yamada ,Kakita,Yamada, Nakashima, Sugiura,

Suzuki,Togari,2020)

Exchange transfusion: this is an intravenous/ invasive procedure where excess bilirubin is

removed from the body. And also when the infant is exhibiting signs of acute bilirubin

encephalopathy Sensitized red blood cells are replaced with blood compatible with both

mother and child’s serum. This is usually done for infants with rhesus or ABO
 12

incompatibility and G6PD defects. This is considered in severe situations and when

phototherapy fails. (Muchowski,2014).

3 Aim, Purpose and Research Question

The aim of this study is to use different available research on Interventions for neonatal

jaundice in developing countries. The purpose of the study is to provide information that

can be use by health professional to control and care for neonate with Jaundice. The re-

search question is: What are the interventions for neonatal jaundice in developing coun-

tries.

4 Methodology

4.1 Literature Review

Literature review is an indispensable tool in helping the researcher to answer the research

question thus, helping her to achieve the objectives and goals of the research. It involves

critically analysing the previous studies and research in relation to the subject area and the

particular topic so as to get a broad understanding and knowledge on results, discussions

and conclusions reached. It is the basis on this that the researcher in this research will

answer the research question. In Academic nursing, literature review has become very

important because day in and day out, there are many new developments and as such the

need to update the knowledge and information for effective nursing.

In conducting literature review, one needs to compare and contrast the literatures selected

relevant to the topic, critically evaluate them, identify the contribution each literature makes
 13

to the topic and integrate your discussion of the literature into your argument on the topic.

(Rowley & Slack, 2004)

4.2 Literature search

Literature for this review was collected from four databases, Cinahl Plus full- text, PubMed

advance full-text, Medline full-text and ProQuest full text. The articles used were published

between the years of 2010-2021 and was written in English.The search key words that was

used in the research CINAHL Plus were “neonatal jaundice” which resulted to 100 articles.

In PubMed the key word used for the search were “intervention” AND “jaundice” AND

“new born OR infant OR neonatal” which resulted to 500. In both Medline and ProQuest

search key word “neonatal jaundice” which yield 50 articles in Medline and 29 in ProQuest.

After the research the total number attained was 840 articles in all four data-based searches.

After narrowing the research 357 articles were chose base inclusion criteria. To refine the

articles and find quality articles related to the research topic, 135 articles were selected base

on relevant studies, after close examining 28 articles where conducted based on developing

countries. Finally, a total number of 7 articles were chose, those best answers the question

of this study. The tables below show the process and selections of articles.

Table 1. Inclusion criteria

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Table 2. Selection process.

Data base Scope of Based on inclu- Relevant Developing Answer

search sion criteria studies countries search

questions

Cinahl Plus 100 18 15 10 2

full- text

Medline 29 9 5 3 1

ProQuest 50 30 15 5 1

PubMed 500 300 100 10 3

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4.3 Studies reviewed

The summary of the studies reviewed is accessible in Appendix 2. Five of the seven

studies were conducted in developing countries such as Africa and Ashia (Dinesh Dharel

et al 2017, Margaret Brethauer et al (2010), Loc T Le et al (2014), H. Goli1, et al (2020) & C.

N. Onyearugha et al (2016), one study was conducted in Portugal (Rafaela Seixas Ivo et al

2017) and last study was conducted in Rio de Janeiro (Juliana Iasmin de Souza Fernandes

et al 2016). The studies were conducted by descriptive study using the quantitative ap-

proach.

Two studies were conducted to explore maternal perceptions about the management of

neonatal jaundice. (Dinesh Dharel et al 2017& Rafaela Seixas Ivo et al 2017). Challenges

and experience mothers face during treatment, (Juliana Iasmin de Souza Fernandes et al

2016 & Margaret Brethauer et al 2010). (Loc T Le et al 2014 & H. Goli1, et al 2020) two

studies describe how families lack knowledge by use traditional method of healing and

delays care treatment.

4.4 Data Analysis

In analysing the data, the inductive content analysis method was used to analyse the

literatures selected for this thesis. This is a qualitative method whereby the author generates

theories and themes by studying documents, articles, recordings etc, critically examining

and comparing the articles. (Daymon and Halloway,2011)

In doing so, the author began by reading through each selected article several times and

organized the raw data through open coding- making notes and headings and she read

through the articles. Then transported the notes and headings to a new sheet called the

coding sheet after which themes were built by grouping headings under a broader category

which are called the themes. The themes therefore become the new knowledge generated

from the articles selected for the purpose of this thesis. This analysis is adopted from (Day-

mon and Halloway,2011) on how to do inductive content analysis which involves

organizing the data, coding and categorizing, interpreting the data and evaluating the

interpretation.
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The articles selected were organized by assigning numbers to them thus 1, 2, 3…… and

whiles reading, main and interesting ideas that came out of each article were jotted down

and some were highlighted. Words like care, education, management etc came up as the

codes and they were properly grouped into themes. Figure 1 shows an example of data

analysis process used by the author.

Figure 1. Data analysis process.

5 Results

The identified factors that promote effective management in caring for jaundice in ne-

onate were described in three analytical themes namely role of a nurse, treatment and

maternal challenges. In all, three main themes were developed and the table illustrates

the intervention for neonatal jaundice.

Table 3. Main themes and sub-themes of intervention for neonatal jaundice.

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Role of a Nurse Effective education

Effective Communication
Follow up

Maternal challenges Lack of knowledge

Emotional and physical difficulty
Unclear information
Treatment
Phototherapy treatment

5.1 Role of a nurse

Effective education: Were a significant intervention to help reduce infant death cause by

jaundice. Government with the help of healthcare professionals to promote awareness

through compaign, in the form of educative advert on electronic media and where large

population mostly gathered such as place of worship, schools, market places, communal

and social meetings. (Onyearugha, Chapp-Jumbo& George,2016). Furthermore, (Dharel &

Bhattarai ,2016) stated that nurses education should not be limited, but also educate the

whole family including mother in-laws who have strong influence on mothers with

neonatal jaundice, to avoid traditional method of treating jaundice by giving their infant

sun bath which may cause shivery, eye problem and skin exposure.

Effective Communication: Communication improved the interactions between health care

professionals and family members, with neonatal jaundice to reduced feelings such as in-

security, guilt and fear towards the treatment. Nurses through effective commuination

built a good supporting network for mothers facing new reality. (Fermandes, Reis, da

Silva & Peixoto da Silva, 2016)

Follow up: According to the findings of Goli, Ansari, Yaghoubinia (2020), mothers with

their neonate who are discharged early without any follow up to recognised neonatal

jaundice keep increasing, neonatal jaundice mostly appear in three to five days after birth.

Mothers are mostly discharged 48 hours after vaginal birth and 96 hours after caesarean
 18

birth. It found that most family members lack knowledge about the illness which led

many in using the traditional way to treat their infant. This caused delay in mothers seek-

ing right treatment at the hospitals. Also, (Le, Partridge, Tran, Le, Duong, Nguyen &

Newman ,2014) affirmed that short hospital stays after delivery and no follow up may de-

lay treatment.

5.2 Maternal challenges

Lack of knowledge: Findings from Onyearugha1, et al (2016) indicated that there was lack

of public education and awareness concerning neonatal jaundice which has a lot of

consequences in the community, as it does not educate the families on what to expect and

how they play a role in the child’s healing process. Maternal knowledge to notice various

factors and conditions related to jaundice is very low. Also, (Dharel & Bhattarai ,2016)

study also revealed that, some mothers and families had misconceptions about neonate’s

jaundice. They believed that the illness in babies were caused by mothers’ inability to

maintain good hygiene, poor nutrition during pregnancy, and believe that evil spirit was

behind the cause of jaundice. Based on these misconceptions it also affected the way

mother and family members related to the new born. Although some were aware of

identifying yellow skin as a cause for concern, they detected it after being cautioned by

healthcare professionals. Most mothers turn to seek guidance from heath workers when

the condition was severe, depending on their income and support from families. Others

were conscious of it only after the incident. The result of the qualitative study shows that

maternal knowledge of neonatal jaundice in Nepal was very low. (Dinesh Dharel et al,

2016)

Emotional and physical difficulty: According to (Brethauer & Carey,2010) Mothers and

Family members felt worried and frustrated in the first few weeks of the life of their in-
 19

fants, when their new-borns were re-admitted back to the health care centre due to jaun-

dice illness after being discharged. They felt robbed of the time to bond and care for they

neonate. Mothers described their fears watching their babies’ eyes covered like they were

blind whiles receiving treatment under the phototherapy light and also feared for a lot for

having to prepare and transport the baby for daily blood test. ( Ivo, Ribeiro, Ponce de

Leon, Schardosim, Guarda & de Oliveira Beleza 2017)

Unclear information: findings from (Ivo, et al,2017) showed that there was conflict of

information on the part of health care professional on the treatmet of jaundice thus some

nurse will infrom the mothers to wake the infant and feed, whiles others tell the mothers

to allow the infant to sleep for long and feed anytime the baby is awake. The Family

complained of the nurses not giving them enough information about the treatment and

care procedure.(Fermandes, Reis, da Silva & Peixoto da Silva, 2016) further added that

mothers complained of inadequate time and work overload on the part of nurses, this

caused insecurity on the part of mothers coping with complication the treatment can

bring.

5.3 Treatment

Findings from ( Ivo et al, 2017; ) indicate that phototherapy is the best way to treat neonate

with jaundice. Nurses should be vigilante on the management of phototherapy such as

covering the eyes of the infant whiles under the light to prevent eye damage in the future,

checked the weight of the baby to ensure if they gain or lose weight, constant monitoring

of vitals signs, fluid balance and avoid burns by not using any cream or oil on the baby`s

body and regulate the machine from overheating.

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6 Discussion

6.1 Discussion of the result

Health workers plays an important role in preventing and improving health conditions of

the population. For a successful recognition, development and implementation of

healthcare management programs regarding care plan for neonatal jaundice, it is effective

that we consider the experience of nurses in this field. They are responsible for identifying,

diagnosing, treating and follow-up. The objective of the study is to make use of available

literature reviews to provide information that can be useful for healthcare professionals in

assessing and caring for neonates with jaundice.

Comparing, contrasting and carefully evaluating literatures helps identify literatures that

contributes to the topic or best answers to the question of the studies. (Rowley & Slack, 2004)

The 7 articles selected for this study was based on the inductive content analysis method as

this qualitative method enables the researcher to generate theories and themes by

examining and comparing them.

According to UNICEF, there is a high probability of neonatal mortality in the very first

month of their life. Although the rate has decreased, 2.4 million died globally (UNICEF Sept,

2020). The selected literatures reviews that inadequate knowledge for nurses, lack of

communication and follow-up were among the challenges healthcare providers face in

terms of dealing with families. Nurses education should not be limited. They should have

up-to-date information regarding the sector they are in and acquire working skill of

communicating. Government must provide the necessary equipment for dealing with

patients as soon as possible. Obtaining blood samples for laboratory investigation and

continuous 48 hrs monitoring for possible signs of jaundice prior to discharge helps in early

detection and reduction of newborns death. Healthcare practitioner should be able to assess,

diagnose and suggest which treatment (pharmacological, intravenous immunoglobulin,

 21

exchange transfusion phototherapy) best suit the patient. Mothers need to feel secured with

the treatment ongoing. Nurses should be certain bilirubin is below 14mg/dl before

discontinuing treatment.

As supported by the result of this study, although nurses are primarily responsible for

intervening in caring for neonates with jaundice, families of the patient and the government

play a role in the care plan. As noted in the findings, lack of martenal awareness of jaundice

and its signs and symptoms has contributed to late treatment and follow-up. Having no

knowledge of the condition of neonates may affect a mothers behaviour in identifying the

illness, causing a set backs in seeking medical treatment according to a study in China

(Zhang, Hu,Wang, Zhang, Zhang, & Hu, 2015).

The discovery of such behaviour can influence the development in healthcare professionals

in controlling and managing the care plan of newborns with jaundice as this study aimed to

achieve. Education and counselling is significant at this point to help parents get adequate

knowledge on the type of jaundice and the implications of late treatment. Discussion of

measures including how parent can assess the newborn, home care plans, adequate feeding,

explanation of different approaches available in treating the newborn may relieve parent

from fear and misconception.

6.2 Strength and Limitations

The literatures chosen for this study focused mainly on the subject in different countries

setting. The retrieval of up-to-date data information based on the quantitative approach

study helps identify how critical the condition is and emphasizes on the importance of

ensuring effective pediadric healthcare management in all professional sectors as the

findings elaborate. Maternal perception plays a vital role as to how much information

nurses need to provide. The obtained articles concerning parental behaviour and perception
 22

were limited. As a result of this, with a qualitative approach, researchers could dig in more

information as hypothesis cannot be based on a small group of people.

6.3 Ethical considerations, validity and reliability

Ethics in research are applicable criteria used in perfoming research (Clark,2021). It serves

as principles and guidelines for researchers to explore on reviewing, evaluating and

reporting findings without tampering on author’s and participant’s perception and image.

Example of such misconduct includes plagiarism and data falsification. The Enago

Academy views plagiarism as using other's material in any form without fully

acknowledging the rightful author. Even though one might not intend to go against this

principle, it's still disciplinary offense. Avoiding such academic misconduct includes no

copy and pasting directly from the source, correct referencing, use of quotation marks etc

(Enago Academy, 2021).Not complying with these regulations could result badly. Not

only will the publication be pulled down, one could be imprisoned by regulators or

withdraw oneself from the institution,(Margaret, 2018). According to the authors of the

selected literature, permission for collecting and reporting information were granted . To

respect this ethical consideration, all secondary data were cited and listed among the

references.

Validity of a research measures the accuracy of a study results regarding to it's method.

This could be done by comparing it to other research with the same idea. (Middleton,

2021). Measures were taken during the selection of articles by analysing and evaluating

them carefully within a certain criteria. Author mentioned of participating in the research

fully. Following the school ethical requirements and a way of avoiding research

misconduct such as plagiarism, all retrieved data were cited and included in the reference

list.

Reliability in a study is very important as it evaluates how consistent a research method or

techniques is used in order to obtain result. (Middleton, 2021). It clarifies the process and if

even different people used it, it could give similar results.

 23

The selected literatures detailed a step by step measures taken in terms of conducting the

study. The author of this study, followed the instructions documented in Jamk database

regarding analysing findings and methodology, ensuring that readers will easily follow

up.

6.4 Conclusion and recommendations

Neonatal jaundice is a condition that require adequate concentration especially in

developing countries in Africa. In my analysis , neonatal jaundice is very important to be

included in WHO problem of concern. Nursing mothers should be given adequate

information and education about the condition. Nurses or midwife should ensure follow

up care for neonate as high risk, since the stay in hospital after vaginal delivery is very

short. During Antenatal visit, mothers should be informed and sensitized about the

condition and it’s management to allay anxiety and thereby the need for early medication

interventions. Especially with phototherapy and the possible complications if mothers

overlook or disregard the condition. Further research is required especially in Africa in to

identify early signs and symptoms, management, and prevention of complications. Also I

recommend that, basic machines needed in the care should be available in possibly every

hospital or clinic that has a gynecological and maternity unit .

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References

Brethauer, M., & Carey, L. (2010). Maternal Experience with Neonatal Jaundice. MCN: The

American Journal of Maternal/Child Nursing, 35(1), 8-14.

Clark, K. (2021). Ethics in research. MD Anderson Cancer Center. Retrieved 21 November

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 28

Appendices

Appendix 1. Critical Appraisal of the articles (Hawker et al.2002)

Author 1 2 3 4 5 Data 6 Ethics 7 8 9 Total Comments

Abstract/ Introduction Methods Sampling analysis and Results Transferability Implications
title and aims and data bias or and
generalizability usefulness
Juliana 4 4 4 4 4 4 4 4 4 36
Iasmin de
Souza
Fernandes et
al (2016), Rio
de janeiro
Rafaela 4 4 4 3 4 4 4 4 3 34
Seixas Ivo et
al (2017),
potugal
Dinesh 4 4 4 3 4 4 4 4 4 35
Dharel et al
(2017), Ne-
pal
Margaret 4 4 4 3 4 4 4 3 3 33
Brethauer
et al
(2010),
Loc T Le et 4 4 4 3 4 4 4 3 3 33
al (2014),
vietnam
H. Goli1, et 4 4 4 3 4 4 4 3 3 33
al (2020),
Iran

4 4 4 3 4 4 4 4 3 33
C. N.
Onyearugha
et al (2016),
Nigeria
 29

Appendix 2. Summary of reviewed articles

Author and Purpose of the Participants and meth- Key findings Critical Ap-

country of study ods praisal

study

Juliana Iasmin To expose the A descriptive study, using Mothers’ feelings and 36
challenges faced a qualitative approach, reactions towards
de Souza by mothers of conducted phototherapy
Fernandes et al newborn babies by interviewing 10 treatment; The lack of
who are submitted mothers whose babies
knowledge when facing
(2016), Rio de to phototherapy experienced neonatal
treatment in a phototherapy while a new reality and The
janeiro rooming-in between healthcare
rooming-in setting team as a support
the months of June and
October of 2014 in a network for the
public health institution in mothers.
the city of Rio de Janeiro

Rafaela Seixas To analyse the descriptive study with a limited knowledge 34

Ivo et al (2017), maternal qualitative approach. 30 regarding
perception about mothers treatment was
potugal
phototherapy participated, after perceived. Regarding
and to describe the educational
signing the Term of Free
the mothers' material, there was
evaluation and Informed Consent satisfaction and its
of an educational recommendation
by 100% of the
tool in the same
mothers.
theme

Dinesh Dharel et This study was In-depth interviews They usually resorted 35
conducted to were conducted with 32 to traditional
al (2017), Nepal
explore mother’s mothers of infants measures of
perception about avoiding certain foods
under six months of age
the causes, and reported that
recognition, with health workers did
management and a history of jaundice in not offer specific
the neonatal period remedies and that
outcome of
attending the outpatient some health
neonatal jaundice department of Ilam workers even
District Hospital. approved such
Audio-taped data were practices.
transcribed and

analyzed thematically
 30

Margaret To describe A descriptive Three major themes 33

emerged
Brethauer et the lived phenomenological relating to the
experience of design with 6 mother’s educational
al (2010), experience: (1)
mothers mothers everyone has a
having an who had infants different opinion,
and therefore no one
infant with really knows for sure;
with neonatal (2) feeling defensive
neonatal
and at fault; and (3)
jaundice. jaundice knowing now what I
would do differently if I
had another baby.

Loc T Le et al Factors delaying Trained research Early discharge 33

(2014), care-seeking are assistants administered without follow-up,
not known, a 78-item questionnaire low maternal
vietnam
we sought to to mothers during home knowledge, cultural
visits 14–28 days after practices, and use of
study care
birth traditional
practices and except those we could treatments may limit

traditional beliefs not contact or whose or delay detection or

relating to babies remained care-seeking for

neonatal jaundice hospitalized at 28 days. jaundice

in northern

Vietnam

H. Goli1, et al This study qualitative study, Maternal 33

(2020), Iran showed that conventional awareness,
mothers need to a necessity in the
content
improve their treatment process”
information on analysis approach
“The traditional
jaundice and was used to explain
medicine, a
change their 8 mothers’
attitude towards paradox in
experiences healthcare and
it and its and perception of “The challenges
treatment care provision for of treatment
outcome in the
jaundiced infants main ones’, and the
sub-themes
“Recovery in the
light of correct
diagnosis”
“Care sensitivity”
“Understanding
the disease” and
 31

“Family distress

and concern”.

C. N. 33
Onyearugha et al To evaluate the This was a Health care
(2016), Nigeria knowledge and questionnaire-based providers should
practice of study involving 300 be encouraged to
expectant expectant mothers
disseminate
mothers during antenatal visit.
information on
towards
NNJ to the
neonatal
general
jaundice.
population in

places of

worship,

communal and

social gatherings.