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JAUNDIS (KEKUNINGAN PADA BAYI BARU LAHIR) – Bahagian 1

 

 

 

 

 

 

 

 

 

 

 

 

 

KENALI JAUNDIS.

 

Jaundis adalah warna kekungingan pada kulit yang disebabkan oleh kadar bilirubin didalam darah melebihi 80 umol/L.
Jaundis adalah satu fenomena yang biasa berlaku pada bayi. Ia berpunca daripada pencemaran sel darah merah. Untuk lebih memahami proses ini, saya biasanya memberi analogy berikut:

Sel darah merah ibarat kereta yang digunakan untuk mengangkut oksigen. Jika anda hendak meronda di dalam bandar, cukup sekadar menggunakan kereta yang mempunyai kuasa kuda (cc) yang rendah, contohnya kereta Viva. Bagaimanapun, jika hendak berulang alik antara bandar, contohnya dari Kuala Lumpur ke Johor Bharu dua kali sehari, anda memerlukan kereta yang lebih selesa seperti Toyota Vios.
Keaadaan yang sama berlaku kepada sel darah bayi. Semasa didalam kandungan, bayi tidak perlu bernafas untuk mendapatkan oksigen. Oksigen dibekalkan oleh ibu, melalui plasenta (uri). Oleh itu, memadai dengan sel darah merah yang tidak kompleks (Fetal haemoglobin, ‘Viva’). Bagaimanapun, apabila bayi dilahirkan, ia terpaksa bernafas sendiri, dan mendapatkan oksigen melalui udara. Oleh sebab itu, sel darah merah yang lebih kompleks diperlukan (adult haemoglobin . ‘Vios’).

Proses menaiktaraf sel darah merah ini melibatkan pemecahan sel darah fetal, dan dalam masa yang sama, sel darah adult, dibuat di sum-sum tulang. Ada beberapa bahan yang dikitar semula, contohnya zat besi, tetapi sebahagian bahan tidak dapat digunakan, seperti bilirubin, akan dibuang. Bilirubin inilah yang menyumbangkan kepada kekuningan, seperti yang dijelaskan sebelum ini. Bilirubin kemudiannya akan diproses didalam hati, dan dibuang melalui usus. Kehadiran bilirubin didalam najis akan mewarnakan najis menjadi kuning. Atas sebab inilah najis bayi akan bertukar daripada hitam kepada kekuningan selepas 2-3 hari.

Proses pemecahan sel darah ini akan terus berlaku dalam skala yang besar dalam minggu pertama kelahiran, dan kadang-kadang berlanjutan ke minggu kedua. Oleh itu, paras bilirubin akan meningkat setiap hari dalam minggu pertama, biasanya selepas 48 jam.
Keadaan ini dipanggil jaundis fisiologikal, iaitu jaundis yang normal. Kebiasaannya, paras bacaan jaundis ini tidak tinggi (tidak melebihi 250 umol/L).

Bagaimanapun, Jaundis yang tidak normal (patologikal) boleh berlaku dalam keadaan berikut:
1. Ketidakserasian antara darah ibu dan anak. Apabila kumpulan darah ibu O dan anak selainnya sama ada A atau B, dan didalam Rhesus Negative.
2.Kekurangan enzim G6PD pada bayi.
3. Jangkitan kuman pada bayi.
4.Bayi pramatang.
Keadaan diatas boleh menyebabkan pemecahan sel darah merah berlaku lebih banyak, dan menyebabkan paras bacaan bilirubin naik mendadak.

 

Artikel oleh:

Dr Muhammad Salehuddin Sulaiman
M.B.CH.B (Sheffield, UK) M.M (Paeds.)(USM)
Pakar Perubatan Pediatrik
Kuala Terengganu Specialist Hospital

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