Ayurveda, new-born jaundice and sunshine: How a simple ancient midwifery practice saved hundreds of 1000s of babies worldwide.

Stay with me, its a long post, but it’s a joyride.

It is a common advice most of us, as new parents would have received.
‘You baby has high jaundice and needs light therapy to get the bilirubin levels down for her/his safety.’

Newborn jaundice, also known as physiological jaundice develops in approximately 60% of term and 85% preterm babies.

It classically becomes visible on day 3, peaks on days 5-7 and resolves by day 14 in term and 21 days in preterm babies.

Bilirubin, the compound that we test for in the liver test panel to diagnose jaundice has two parts (direct or conjugated and indirect or unconjugated).

Clinically, jaundice is diagnosed when total bilirubin is more than 3mg/dL.

If a newborn develops jaundice within 24 hours of birth – it is always a bad sign and there has to be a dreaded disease that we need to diagnose. But if the newborn develops jaundice beyond 24 hours, it could be physiological jaundice.

When indirect bilirubin goes above 25 mg/dL, the excess bilirubin crosses the blood-brain barrier and starts damaging brain cells in the basal ganglia region and newborns develop seizures, limpness, reduced feeding and can die from it – this condition is called KERNICTERUS.

But a simple action can drastically reduce bilirubin levels and prevent brain damage from high jaundice in newborns…and it includes sunshine.

Dr. Richard Cremer, a consultant pediatrician in Essex, UK found that Sister Jean Ward, a British nurse in charge of the premature-neonates nursery at Rochford General Hospital did something lovely for the babies. She would wheel out the more delicate newborns out into the courtyard, sincerely convinced that the combination and fresh air and warm sunshine did far better than the studdy overheated incubator in the ICU.

In 1956, during a ward round, the pediatricians saw a preterm infant who looked ‘…pale yellow except for a strongly demarcated triangle of skin very much yellower than the rest of the body.’

When asked about this, nurse Jean explained that this was a jaundiced baby who had been exposed to sunlight. A corner of the sheet had covered an area of the baby’s skin and it was, as the Sister noted, ‘… the rest of the body that seems to have faded.’

Accidentally, one day, a tube that contained the blood sample of a jaundiced baby was misplaced on the window sill, and the serum was ‘…green instead of yellow and the bilirubin content was far below what was expected. The doctors figured out that while exposed to sunlight there had been a reduction in the bilirubin content of the sample!

Dr Cremer and Perryman, a biochemist, went on to demonstrate that, when exposed to daylight, sunlight and artificial light, bilirubin levels in jaundiced blood decreased rapidly and, in 1958, they published their observations demonstrating that both sunlight and blue light (delivered by their home-made phototherapy unit consisting of eight 40-W ‘light blue’ fluorescent tubes) would decrease bilirubin levels in jaundiced newborns.

And thus, “phototherapy for treatment of neonatal jaundice” became the standard of care, helping newborn reduce jaundice rapidly, so that their little brain do not get damaged with high levels of bilirubin.

A commonly used rule of thumb in the baby-ICU is to start phototherapy when the total serum bilirubin level is greater than 5 times the birth weight. Thus, in a 1-kg infant, phototherapy is started at a bilirubin level of 5 mg/dL; in a 2-kg infant, phototherapy is started at a bilirubin level of 10mg/dL and so on.

But this was not performed as a standard in many parts of the world because clinicians found that this was not “scientific enough” and they contined using the more invasive and aggressive “plasma exchange” therapy, a type of blood dialysis in all little ones.

So a group of scientists did what needs to be done and figured out the science behind it. In a series of biochemical experiments, they showed that when bilirubin absorbed light, it became “excited” and interacted with oxygen and in the process, generated multiple intermediate forms of bilirubin (called photoisomers) with low molecular weight which were easily excreted in the urine, unlike the heavy weight original bilirubin that stayed in the body to cross the brain and damage brain-cells.

Currently, phototherapy has become the first line of management of physiological jaundice because of which the more aggressive and terrifying plasma exchange therapy is barely performed.

But it was not Sister Jean or Dr. Richard Cremer who identifed the value of light therapy to save little babies.

In the ancient scripture Atharvaveda from which Ayurveda originated, the Sage, Acharya Caraka observed and wrote about babies afflicted with kamala vyadhi or jaundice and the treatment for the same was Surya Kirana Snana (exposure to sunlight) which they found reduced yellowishness of the skin when done over multiple days – similar to what doctors identified more than 2000 years later!

So the life saving art of phototherapy and sunshine treatment of neonatal jaundice was already described in Ayurvedic practice, performed by ancient midwives, more than 2000 years ago – we, through the scientific method just figured out how it helped.