+++ HEALTH

Friday, February 15, 2002
Jaundice Related Disability Could Be Making a Comeback

Weblinks:
Just the Facts on Jaundic
http://www.aap.org/mrt/factskj.htm

Jaundice in Full-Term Infants
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5023a4.htm

More from Bilirubin.net
http://www.bilirubin.net/pick.html

Micki Flowers

KIRO 7 EYEWITNESS NEWS HEALTH

REPORTERhttp://www.bilirubin.net/pick.html Nearly half of all babies develop jaundice after they're born. A rare few are left with lifelong disabilities. Effective therapies had nearly eradicated the problem since the 50's. But a gap in medical care could be bringing it back.

Thirteen year old Cameron Chapman hopes to play on a soccer team soon. But he'll need to overcome great obstacles.

Severe jaundice when he was just five days old left him with cerebral palsy and hearing loss. Doctors treated him but it was too late.

Cindee Chapman, Cameron's mother, said "I'm shocked that there's more and more cases of children being diagnosed with the type of Cerebral Palsy and hearing loss that Cameron has."

Dr. Craig Jackson, Medical Director of the Infant Intensive Care Unit at Children's hospital, says photo therapy with these blue lights effectively reverses jaundice in most infants. And a simple heel prick test can detect which babies should be treated. But in the last decade, shorter hospital stays for newborns mean trouble can develop after a baby is sent home.

Any baby who's discharged from the hospital in less than 48 hours after birth should be seen within 2 or 3 days. Parents are not trained to recognize Jaundice in their babies.

Even follow up visits might be the whole answer. Meet Conor Morse. He was yellow when his mother brought him to a Pediatrician two days after discharge from the hospital. Janet Morse says her son was given a test to detect severe jaundice only because she insisted. By then it was an emergency.

"He had problems breathing. In the ER, before he went to I-C-U they resituated him twice."

After aggressive intervention, Connor is normal today. But it haunts his mother. "I really think that the doctors should be more insistent."

Doctors say parents need to watch for more than just a yellowish color to a baby's skin and eyes. They also need to pay attention to if a baby is lethargic, and not feeding well or urinating often enough. If you're concerned, see a doctor immediately. or we can reverse the "rules"that HMO's came up with for sending babies home in less than 24 hours If a babe is born at ten minutes to midnight it is cnsidered the past day and they shove them out thr door at noon. There are valid reasons for babis to be watched for at leat 4 days before they go home. Thanks to the HOM's priority to build the highest return for their investors, hundreds, thousands of people have suffered harm and/or died. After all, ther main goal is to their investors profits.

-- Cherri (jessam5@home.com), February 15, 2002

Answers

Been there, done that. One HMO made us wait a week for the baby to be seen for the first time outside of the hospital. Very dark jaundice by then. They told us to lay the naked baby in sunlight. It was winter. They refused to allow "bili" lights, even though they are always available in a regular OB ward. I put the naked baby on my chest to provide warmth from below while we ran the heater as high as it would go. We lay near a window. It was slow going away. We just did it for every kid that came after. We didn't know what could happen if a baby got jaundice.

-- helen (hmo@stands.for.home.made.options), February 15, 2002.

And if there are no investors there are no HMOs. Don't know if you own a single share of stock by 401k proxy or otherwise Cherri but if you do would bet you didn't buy it because you 'liked' the company.

The industry is doomed. The managers have dumped tens of thousands of employees while trying to perserve a business model that provides a product for less than what people are willing to pay. Good healthcare was never cheap.

The problem is threefold. You have a growing senior group plus a fast growing group of kids with inutero related drug problems. Lastly, you've got damned near the entire country thinking that we health professionals don't need to be paid unless, of course, it's by somebody else not accepting that that means by someone else. It's your health and I wouldn't dare suggest what it's worth to you.

-- Carlos (riffraff@cybertime.net), February 16, 2002.

Carlos,

I've never thought the problem lay with the care providers, but rather with the insurance companies, HMOs and the hospital administrators ... and yes, with people who think that medical care should be free.

I profess complete helplessness here; I'm not sure what the answer is. In countries with socialized medicine, the quality suffers and people end up waiting in line to see a doctor, anyway. We seem to be heading the same way without even the "benefits" (tongue in cheek) of socialization!

It's not one single problem, it's a host of little problems that work together to form a nightmare. I had a friend years ago who worked for one of the big medical equipment vendors (GE? can't remember) and he bragged on how much they charged just to replace a fuse or a spring clip. He showed me a bracket that I could have built in my shop for $10 (and if mass-produced, it would have been about 50 cents). They sold it to hospitals for $175 -- NOT including labor.

Everyone knows about the $400 hammers for the military, but very few people know about the $4000 table lights sold to medical clinics.

These things have to be paid for somehow. Unfortunately, in the past, many hospitals did so by overbilling insurance. That's ALSO a fact. They did it to try to make up the cost of caring for people who couldn't pay, so I can understand it, but it DID happen.

HMOs were created to put an end to this. They have ended up, as Cherri says, just being intriguing investments for some people.

And the folks who do the grunt work -- like my doctor, you, and my sister (an RN), get blamed for it.

It's not really the doctor's fault. Most of the ones I've met would love to do a few extra tests to make sure that the pain in your chest isn't a mild heart attack, but the HMOs won't approve the tests. Without approval, the hospital administration will not let the tests be done.

Again: I don't know what the answer is. Like you said, quality medical care costs money. SOMEONE has to pay it.

-- Stephen M. Poole (smpoole7@bellsouth.net), February 16, 2002.

A pedantic correction: my sister IN LAW is the RN in Winston-Salem, NC; my sister is a respiratory therapist in Columbia, SC (though she's taken a break for a few years to help raise their new kid).

-- Stephen M. Poole (smpoole7@bellsouth.net), February 16, 2002.

Stephen: About the scandal of the hammers that the military supposedly paid $400 for, my understanding is that this figure is just a figment of crappy accounting, which the military should never have let contractors get away with. Supposedly in such cases, overhead is evenly divided among items both large and small, inflating greatly the "cost" of small items while reducing the figure for items requiring a lot of processing.

-- Peter Errington (petere7@starpower.net), February 16, 2002.

Valentine's night I had dinner with a woman friend. As we left the restaurant, she had an unexplained choking attack. I thought it would go away if she remained calm but it got worse. I called 911 on the cell phone from the parking lot. They arrived within minutes. By this time she was feeling better. They offerred to take her to the ER but she declined. She had to sign a waiver acknowledging that she had refused hospital care. There was no charge for the Emergency response. I doubt if there would have been a charge had she gone to ER. Who pays for this service? What happens if it is exploited (ie, what if I called 911 once/week for semi-false alarms)?

-- (lars@indy.net), February 16, 2002.

Did you tell your wife?

-- Carlos (riffraff@cybertime.net), February 17, 2002.

Helen, nice to know that you 'discovered' the trick. When I taught classes I explained this very common ailment for newborns and what to do about it. It was common knowledge for me. Too bad more people just aren't aware.

Cherri, I couldn't be more thrilled about being 'shoved out the door'. I hated having to stay in the hospital one minute longer than I needed. Having babies (as I discussed with Tar one time) is a very natural event and shouldn't be done in a hospital unless warranted by high risk pregnancy.

-- Maria (anon@ymous.com), February 19, 2002.

Maria, why isn't it part of the standard instructions when you take a baby home? It's such a simple thing to do.

While I don't mind going home right away, I still want to be in a hospital when I give birth. If anything goes wrong, we're already where we need to be. One of ours would have died in a home birth, and no warning ahead of time.

-- helen (babies@are.fun.teenagers.are.not), February 19, 2002.