How to determine and what should be the norm of bilirubin in newborns. Limit values ​​of bilirubin in infants and the normal level The level of bilirubin in the blood is normal in newborns

In the course of growing up, a person goes through five periods of development, according to experts. The first and second are newborn children and the period of breastfeeding, the third is the stage of teething, the fourth is junior school age and the fifth is senior school age. Let's talk about the very first period of development - newborn children.

Newborn children undergo significant adaptation and restructuring of the body within 28 days (this is how long this period lasts). All organs begin to function, although many of them began to function in utero. A newborn switches from an endogenous method of nutrition to an autonomous endogenous one. At the same time, some natural processes in the body require careful monitoring by the child’s mother and medical staff.

Diseases of the newborn period also have fundamental features. Let's talk today about physiological jaundice or, in other words, high bilirubin in a newborn. Physiological jaundice occurs in 60-70% of newborns. Appears after birth on the third day and begins to fade away on days 8-10. In some cases, icteric discoloration is observed for 2 or even more weeks. The relative immaturity of the liver and the rapid breakdown of red blood cells determine the production of bilirubin.

What is bilirubin in newborns

Bilirubin is one of the elements of hemoglobin decomposition (fetal hemoglobin is dominant in the newborn’s body, at the time of birth 80-85%). The vector of the process is as follows: during the period of decay, red blood cells contribute to the release of hemoglobin, which, as a result of this decay, takes the form of toxicity. The body begins to prevent toxins and, under the action of enzymes, removes bilirubin.

Norm of bilirubin in newborns

The bilirubin coefficient in newborns changes from the moment of the first birthday; its norm and limit shows what level of icteric pigment is present in the blood. The value of bilirubin in newborns determines whether drug treatment should be used.

The first thing the attending physician should do is take blood for bilirubin in newborns. If the indicators significantly differ from the norm, then this fact indicates the presence of pathological types jaundice.
The composition of bilirubin in the blood is always present, but if it increases, measures should be taken into account that can help reduce it. So, let's look at bilirubin in newborns in the table of its norms.

During the period of prematurity, the child is characterized by special conditions and bilirubin levels will differ from the specified norm above in the table. This whole process requires hygienic conditions and careful care of the newborn, as well as proper organization of breast or artificial feeding.

Usually general state premature babies with elevated bilirubin levels are more difficult than those of a full-term baby. This is because bilirubin is more toxic for a premature baby, this is due to the underdeveloped nervous system. The upper level limit for them is 171 µmol/l.

Bilirubin norm values ​​by day and month. Table

The level of bilirubin in a newborn may vary depending on the days and months lived. Bilirubin is divided into two types: direct (soluble) and indirect (insoluble). Insoluble bilirubin is not excreted in the urine. Combining with protein, albumin enters the bloodstream into the liver, where it is completely absorbed and, as a result, direct bilirubin is formed, which is already excreted in the urine.

Most children experience relatively physiological jaundice in the first days of life. If the indicators are too high, this indicates that physiological jaundice is not a diagnosis here. Treatment should involve a more thorough examination of the newborn.

Methods for determining bilirubin

When determining bilirubin, parameters are examined according to three criteria: general, direct, indirect. Marked when in good condition no more than 25% of the direct bilirubin parameter.

Bilirubin levels are determined in three ways:

1. The most accurate level of bilirubin in newborns is determined by a blood test taken from a vein on the baby’s head. The longer the period of jaundice, the more likely it is that such an analysis needs to be done;
2. Determination of bilirubin using bilitest (a device that determines the level of bile pigment);
3. Cramer's rule. It is based on the spread of yellow color: first on the face, then throughout the body.

Bilirubin in physiological and pathological jaundice

Let's consider preventive treatment for two types of jaundice: physiological and pathological.

Physiological jaundice

For mild, transient jaundice, no treatment is undertaken. In the case of physiological, bilirubin in the blood serum is observed at an acceptable level. It poses a threatening danger to the health of the newborn. But there is a possibility that if the baby is not properly provided with care and proper nutrition, it may develop into a pathological condition.

In addition to putting the baby to the breast, it is necessary, whenever possible, to connect a special ultraviolet lamp over the child. This phototherapy will quickly get rid of the yellow pigment and, therefore, reduce the level of bilirubin. Under its action, bilirubin breaks down into non-toxic components, which are then easily excreted by the body.

Pathological jaundice

In some cases, pathological jaundice, which requires urgent hospitalization, occurs in:

• Incompatibility of blood between mother and fetus;
• For various complications during pregnancy;
• Conflict between the Rh factor of the child and mother;
• In premature babies.

With a very high bilirubin ratio in the blood, bilirubin encephalopathy can develop. It develops due to a high toxic effect on the nerve tissue of the brain.
Bilirubin encephalopathy can develop with a highly pronounced concentration of bilirubin in the blood serum. In the first days of the appearance of icteric coloring, it is necessary to put the newborn to the breast.

The colostrum produced by the mother is capable of actively leading to the process of emptying without delays in the urinary and intestinal tract. Consequently, bilirubin will not be able to stay in the body for a long time.

The barrier between the circulatory and nervous systems provides protection from toxic effects. When bilirubin is higher than normal, this barrier becomes permeable, resulting in brain tissue becoming susceptible to toxins.
To avoid such a diagnosis, it is recommended to monitor the level of bilirubin in the blood every day.

Basic actions for increased bilirubin

From all of the above, several conclusions should be drawn:

• Do not self-medicate under any circumstances;
• If the bilirubin level is 290 or higher, the child needs urgent medical attention;
• If you observe a yellow skin color for 3 weeks, with colorless stool and dark urine, this is a sign congenital disease urinary tract.
• Up to seven days, jaundice in most cases goes away on its own and does not require special treatment, the main thing is to consult the pediatrician.

Prevention of increased bilirubin in newborns

A mother must take care of her baby even when he is in the womb. She should know what causes jaundice in newborns. Therefore, she should not mindlessly consume foods that are harmful to the liver, so as not to harm the child. It is advisable to comply balanced diet high in iron and other nutrients to promote normal operation liver and intestines. And of course, during pregnancy it is better to forget about bad habits.

It is imperative to see a doctor during pregnancy so that he can monitor the level of antibodies in the mother’s blood, identify infectious diseases and treat them in a timely manner.

Natural childbirth without any painkillers often helps prevent jaundice in the baby.

It is important to breastfeed your baby immediately after he is born. The more often a mother feeds her baby her milk, the less likely she is to suffer from jaundice.

Sunlight is an excellent preventive measure against jaundice in an infant, since exposure to light removes bilirubin from the body more quickly. Sunbathing is beneficial for babies.
Under no circumstances should a newborn be constipated, as toxins will be absorbed into the intestines and poison it.

If you have been told by health care workers that your baby has an increased level of bilirubin in the blood, do not despair and do not refuse medical treatment. Still, trusting a doctor is better than resorting to self-medication, since it is unknown what the consequences may be. It would be especially unnecessary to adhere to the opinions of other mothers, since each child is individual and requires special attention and certain treatment.

Bilirubin in the blood of newborns is assessed as an indicator of the correct functioning of the baby’s internal organs. If the concentration of this pigment is exceeded, immediate treatment is required. High rates are primarily indicated by a yellow tint to the skin.

Every parent should know what this means, how dangerous an increased value can be and how to fix this problem.

What is bilirubin

This substance is a pigment that is formed in the human body as a result of the breakdown of hemoglobin. When its amount is within normal limits, bilirubin is excreted from the body along with feces and urine. Its presence is observed constantly, but in small quantities.

You should always monitor the indicators, since exceeding optimal values may cause general intoxication. In addition, if this substance penetrates the structures of the brain, kernicterus may begin to form.

Classification

A blood test evaluates three types of enzyme:

• indirect bilirubin;
• straight;
• general.

The first two types are present in the human body. The third, as is clear, is their sum.

It is non-toxic and is removed naturally. Features of indirect are its combination with fats, toxicity and ability to accumulate in tissues. This type of bilirubin is excreted only after it is converted by a gastric enzyme into a direct enzyme.

Norms of values

Normal bilirubin levels in infants may fluctuate. At birth, the limit is from 51 to 60 µmol/l, but hemoglobin continues to break down. As a result, tests may show inflated values ​​already on the 3rd day of a baby’s life. Further indicators decrease.

Below is a table by day reflecting the rate of bilirubin.

After a week of life, the high concentration of the enzyme decreases. The level of the substance stabilizes by 21 days. A baby's pigment levels should be constant at one month. The monthly table shows only the threshold values. When an increase in bilirubin is observed at 2-3 months of life, immediate therapeutic intervention is required.

Premature babies are diagnosed with jaundice in almost 80 percent of cases. Their enzyme concentration, unlike that of healthy children, will be lower. In addition, bilirubin in this case is most often indirect.

Reasons for the increased rate

If elevated bilirubin is diagnosed in newborns, this is the first sign that jaundice has begun to develop. It has two forms:

• physiological jaundice, which in most cases does not pose a danger and goes away on its own by the 4th week of the baby’s life, but constant monitoring of the baby’s condition is required, since the disease can become complicated;
• pathological, which requires immediate treatment; in its absence, the risk of adverse consequences increases.

Causes high values enzyme are as follows:

• difficult pregnancy;
• complications during labor;
• prematurity;
• diabetes;
• asphyxia in the fetus during pregnancy or childbirth, for example, when the child is wrapped in the umbilical cord.

The values ​​of indicators in the pathological form of jaundice can go off scale. In this case, the provoking factors are those listed above. In addition, excessively high bilirubin may indicate problems such as:

• violations hormonal levels;
• Rhesus conflict;
• liver pathology in an infant;
• obstruction of the intestines or biliary tract;
• diseases at the genetic level, against the background of which the erythrocyte membranes are destroyed.

Pathological jaundice can also be provoked by certain medications that a woman took during pregnancy.

If jaundice has been diagnosed, therapeutic measures are aimed not only at its treatment, but also at eliminating the main provoking cause.

How to reduce a high rate

When found high level enzyme in the baby's blood fluid requires immediate consultation with a specialist. He will determine the cause of the increase in pigment concentration and prescribe the necessary treatment.

To achieve this, the following therapeutic measures are carried out:

1. Infusion therapy. The main task of this method is to replenish the lost fluid that the body lost during phototherapy. For these purposes, the child is administered soda, glucose solution, membrane stabilizers and substances that help improve microcirculation.
2. Phototherapy. To carry out the procedure, the newborn is placed in a crib over which an ultraviolet device is installed. When exposed to radiation, excess amounts of the enzyme begin to be rapidly eliminated from the body. Before starting ultraviolet treatment, the baby's eyes are covered with a special bandage. The duration of exposure to the lamp can be several hours a day. The child is taken out of the crib only for the duration of the task hygiene procedures. The duration of the course is several days.
3. Purpose of enterosorbents (Smecta and Enterosgel). The main purpose of taking medications is to prevent the reabsorption of bilirubin into the blood fluid. To normalize the level of electrolytes, the baby is given IV drips. To restore liver function and eliminate it from the body toxic substances hepatoprotectors are prescribed (Essentiale or Silibor).

If the baby is breastfed, then the mother is advised to follow some simple recommendations:

• exclude too sweet, spicy and fried foods from the diet;
• drink up to two liters clean water;
• do not go on diets or overeat;
• eat more fresh vegetables and fruits that do not cause an allergic reaction in the baby;
• Steam dishes or bake them in the oven.

Following these tips will reduce the load on your child’s liver.

When diagnosing pathological jaundice The following medications are prescribed:

1. Hepel. Helps accelerate the outflow of bile, eliminate the symptoms of loose stools, and maintain normal activity of the gallbladder and liver.
2. Ursofalk. It is recommended to use it in the form of a suspension. The medication is prescribed if gallbladder weakness is detected.
3. Elkar, under the influence of which the excess enzyme is destroyed and the liver is cleansed of the accumulation of toxic substances.

When diagnosing a complicated form of jaundice, a blood transfusion is given.

Reasons for low level

Low bilirubin is diagnosed in extremely rare cases. Among the main causes of this pathology are:

• iron deficiency;
• chronic malnutrition;
• low level of fetal hemoglobin.

Often a low value of the indicator is observed when the rules for performing the bilirubin test are violated. Certain medications, including ascorbic acid and antibiotics, can distort the results of the study.

Sometimes a decrease in pigment indicates various pathological processes, such as:

• chronic form of hepatic and renal failure;
• leukemia at the acute stage;
• tuberculosis.

Also, a low enzyme may indicate various infectious diseases.

How to improve a low score

To normalize the level of bilirubin in the blood of a baby, it is necessary Special attention pay attention to the child’s nutrition, thanks to which the indicators will quickly return to normal.

If any pathologies are detected therapeutic actions are aimed at eliminating the underlying disease, which could provoke a critical decrease in the enzyme.

It is important to remember that traditional medicine can only be used as a auxiliary treatment simultaneously with taking medication and only with the permission of the attending physician.

What consequences can a deviation from the norm lead to?

High levels of bilirubin in the blood lead to negative consequences for the central nervous system and brain of the baby. In addition, excessive values ​​can provoke the development of bilirubin encephalopathy, which is manifested by symptoms such as:

• enlarged spleen or liver;
• convulsions;
• decreased blood pressure;
• prolonged sleep or, conversely, insomnia;
• lack of appetite.

If the disease is not treated promptly, the risk of developing certain complications increases. These include:

• hearing impairment;
• oligophrenia;
• paralysis;
• dementia.

A reduced amount of enzyme in the absence of therapeutic measures can lead to rickets, which is determined by the baby’s lack of weight gain over several months.

How to take blood for bilirubin

In the first days of life after birth, the baby undergoes blood donation for multiple tests. Among the latter is the determination of the concentration of bilirubin in the body. In this regard, most mothers are concerned about where the baby’s blood is taken from.

Special laboratories are equipped with professional equipment, with which you can establish the enzyme level with an accuracy of tenths of a micromole.

Thanks to this device, it becomes possible to determine the most accurate value of bilirubin in the blood fluid of an infant and provide timely treatment even before the first symptoms of jaundice begin to appear.

The analysis proceeds according to the following scheme:

• for the first time, blood is taken from the umbilical cord immediately after the baby is born;
• every other day the sampling is carried out from the heel;
• subsequent analyzes are carried out daily.

For babies who are at risk, that is, those born during a complicated pregnancy, blood fluid is taken from a vein in the head. For this, a special thin needle is used.

This method should not be abandoned, since with a small needle size the child practically does not feel pain.

There is another way that allows you to control bilirubin levels - bilitest. It is used only as a preventative measure or when jaundice is not suspected.

This test is carried out using a special device that examines color skin at the place of its application. The tester allows you to measure the level of yellowness of the epidermis of a newborn, as well as determine the pigment concentration.

Bilirubin level is the most significant indicator, which allows you to generally assess the health of the newly born child.

Experts do not recommend ignoring the analysis, since thanks to it it is possible to identify the development of jaundice and other pathological abnormalities and begin timely treatment. The main thing is to remember that the lack of therapy can lead to not the most favorable consequences.

The problem of high levels of bilirubin in the bloodstream of an infant is currently relevant. Imperfections in the process of cleansing the body of pigment cause damage to the child’s nervous system and can cause severe consequences. Physiological jaundice of newborns most often occurs on the 2nd – 3rd day and disappears by the 7th day of life. Its early appearance (on the first day) or slow disappearance indicates pathology.

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Main causes of jaundice

An increase in the level of bilirubin in the blood gives the baby's skin a yellowish color. It appears when blood cells - red blood cells - finish life cycle. Red blood cells die, and the hemoglobin they contain disintegrates. The breakdown product is bilirubin. Indirect free pigment is highly soluble in fats, but poorly soluble in water. In order to get rid of bilirubin, the baby’s body needs it to become water soluble. Processes fat-soluble pigment into water-soluble pigment in the baby's liver. Once it becomes water soluble, bilirubin leaves the liver and enters the intestines. The main part of it leaves the body along with feces, and part of it returns to the blood again and again becomes fat-soluble.

Bilirubin that dissolves in water is called direct bilirubin. And the fat-soluble pigment is called indirect, or unconjugated.

High amount of bilirubin



Yellowness of the baby's skin high level bilirubin

Most often, a baby in the first days of life contains a larger number of red blood cells in the blood than an adult. In addition, the life cycle of red blood cells in newborns is short. This explains physiological (normal) jaundice.

In a pathological (abnormal) situation, when more red blood cells die, more bilirubin is produced. The reason for this may be incompatibility with the mother due to the Rh factor. During pregnancy, a woman with Rh negative blood may form antibodies to fetal cells (red blood cells) if they are Rh positive. Through the placenta, the baby's red blood cells enter the mother's bloodstream. The pregnant woman’s immune system recognizes them as an antigen (a protein molecule that causes the synthesis of antibodies), that is, as a foreign structure, and begins to produce antibodies against them. These substances return back into the baby's blood through the placental system and begin to destroy his red blood cells. In the most difficult cases The baby is born with yellow skin color. Such children may develop deafness, delay mental development and even death. Therefore, neonatologists and pediatricians take neonatal jaundice seriously.

In civilized countries, a pregnant woman whose Rh negative blood, receives an injection with antibodies at 28 weeks. These substances prevent the mother from producing antibodies.

There is another reason for the disintegration of a large number of red blood cells. Other fetal red blood cell antigens encourage immune system pregnant woman produce antibodies against the baby's blood cells. Blood groups have other types of antigens called 0, A, B or AB. Just as in the case of the Rh factor, if a woman has 0 and the child has any other blood type, then the formation of antibodies against the fetal blood can occur. This condition is called ABO or blood group incompatibility.

The destruction of more red blood cells occurs as a result of bruise, extensive trauma due to difficult childbirth. These lesions are not always visible to the eye, such as a kidney bruise. Blood cells break down when injured, forming bilirubin.



The liver does not process pigment

At birth, the child has a rather immature liver, and it is not able to process all the bilirubin that arrives in the first days. This is another cause of normal newborn jaundice.



Bilirubin circulation

As soon as the liver matures and grows, it will become better at processing bilirubin into a water-soluble state, and physiological jaundice will go away. Most often this happens on the third or fourth day after birth. The exception is the liver of premature babies, which is even more immature. This is the reason why premature babies have more pigment in their blood than those born at full term.



Intestinal obstruction

The pigment enters the intestines, a small part of it penetrates through the walls into the newborn’s body. Insufficiency of the child's stool increases the level of newly absorbed bilirubin in the blood.

The most common cause of non-hepatic circulation of pigment is the baby's reduced intake of mother's milk. This happens most often due to a lack of breast milk. The results are frequent constipation in a child or fecal retention.

Breastfeeding and jaundice

With the type of jaundice, which usually appears in the first days after birth, the newborn should not be weaned from the mother's breast. If the baby is feeding well on breast milk, the jaundice will most likely go away on its own. In a situation where a newborn does not suck mother's milk well, it is necessary to normalize breastfeeding.

In the first few days after birth, a woman produces colostrum, which has a laxative effect, which is very important for jaundiced children. An increase in fecal mass leads to the elimination of more bilirubin. The volume of newly leaked pigment into the body decreases.

Standard indicators of soluble and insoluble bilirubin

If the child develops normally, then the pigment finishes decomposing and is eliminated from the body by the end of the first month. A baby in the first months of life and a newborn have the same indicators as those characteristic of an adult body, since everyone has this substance in a small volume.

The first month is quite unpredictable. At this time, complete normalization of pigment in the blood occurs, but there may be an unstable situation. Great importance has the ratio of direct to indirect bilirubin and the total amount of these values ​​( total bilirubin).

The pigment level is determined as a result of a blood test of the newborn, but it is possible to conduct a bilitest independently. It is necessary to unfold the diapers and carefully examine the baby in good lighting:

1. 1. Jaundiced neck and head of the child - pigment level is about 170 µmol/l.
2. 2. Amazed top part body - bilirubin 256 µmol/l.
3. 3. The stomach became jaundiced - 340 µmol/l.
4. 4. Arms and legs became yellow - reached 430 µmol/l.
5. 5. A critical condition is damage to the feet and hands. It is necessary to seek qualified help.
6. 6. When the level of pigment in the blood is more than 520 µmol/l, pediatricians make a diagnosis of bilirubin encephalopathy (kernicterus). In this case, the child’s nervous system suffers from toxicity, which leads to serious problems.

You should not limit yourself to conducting an independent bilitest; you need to take a blood test of the child. It is important for the doctor to know not only the level of pigment in the blood, but also the ratio of direct and indirect bilirubin. Insoluble in newborns is normally 25% of the total amount, this will be 5.1 µmol/l. Indirect makes up the main part - 75%, its limit is 15.4 µmol/l.

Norm of total bilirubin in children

Each laboratory has its own units of measurement for total bilirubin. The most common unit of measurement is micromoles per liter (µmol/L). In the first days of life, bilirubin levels in newborns are overestimated:

• in full-term infants - up to 256 µmol/l;
• in premature infants - up to 170 µmol/l;
• at one month old baby The bilirubin rate varies from 8.5 to 20.5 µmol/l, as in an adult.

Pigment level table by day:

Excessive bilirubin levels are the result of severe jaundice, which eventually stains the feet and palms. A newborn with high pigment levels requires hospital treatment.

Necessary tests



Determination of bilirubin level using bilitest

After the baby is born, neonatologists determine the amount of bilirubin in blood taken from the umbilical cord. After two days, the analysis is repeated. For premature babies, bilirubin levels are determined one day after birth and then monitored every 24 hours. In newborns with increased risk development of jaundice (complicated childbirth, pronounced yellowness of the skin and visible mucous membranes), blood is taken for analysis from a vein in the head.

If there are no signs of jaundice, the child can undergo a bloodless bilitest. For analysis, a device is used, which is a photocell that records the color of the skin on the baby’s forehead. The result of the amount of pigment is visible immediately. The disadvantage of this test is the inability to determine direct and indirect bilirubin.

Treatment options

In severe cases, blood transfusions are performed. Exchange blood transfusion causes the removal of unconjugated bilirubin and antibodies from the child’s body, and also replenishes the lack of red blood cells. More often, blood that is negative for the Rh factor is used, of the same group as that of the newborn. Whole blood is not transfused; Rh-negative red blood cells are used together with fresh frozen plasma.

If hemolytic disease newborns is caused by group incompatibility, red blood cell mass of group 0 (I) is used, and plasma is either AB (IV) group or one-group.

Indications for blood transfusion in the first day of life in full-term newborns:

• The amount of indirect bilirubin in cord blood more than 60 µmol/l.
• The content of indirect pigment in peripheral blood is more than 340 µmol/l.
• Hourly increase in the amount of free bilirubin > 6–10 µmol/l.
• Severe anemia (hemoglobin level less than 100 g/l).

Phototherapy process in an infant with jaundice

Phototherapy is an effective treatment method. The need for exchange transfusions decreased by 40% after the introduction of phototherapy. Instead of using special lamps, a system is used consisting of a light source in the form of a halogen tungsten lamp with a built-in photo-optical cable, through which the light passes to the fiber-optic pad from the lamp. The pillow is a special mattress with woven fiber optics. It has a protective coating that is in contact with the baby’s skin. It reduces the risk of spreading infections. Under the influence of phototherapy, pigment in the skin is destroyed and excreted in urine and feces.

To reduce the reabsorption of bilirubin in the intestines, cleansing enemas and Enterosgel are used in the first hours of the baby’s life. If jaundice occurs as a result of gallbladder insufficiency, then Ursofalk and Drotaverine are prescribed. These drugs have a choleretic effect.

Pediatricians also prescribe Elkar for jaundice, low metabolism, and lack of appetite. It speeds up the liver detoxification process and pigment breakdown. It is used in children from the moment of birth.

Bilirubin is a pigment that is formed when red blood cells break down. It is present in small quantities in the body of a healthy person.

An increase in bilirubin levels indicates the development of some pathological process. However, it must be remembered that this condition is typical for newborn children. In all infants, this indicator is slightly increased, which is due to a physiological feature.

Norm of bilirubin in infants

After the baby is born, or rather, after the umbilical cord is cut, the first blood test is taken. It allows you to determine the baby’s blood type, hemoglobin levels, red blood cells, white blood cells, bilirubin, ESR (erythrocyte sedimentation rate) and other indicators. This is necessary to assess the condition of the newborn baby and identify possible pathologies. What should be the level of bilirubin in a newborn baby and in the first year of life, what is the norm and what are the limits?

Several types of bilirubin are determined in the blood:

• Total bilirubin. It shows the level of all pigment found in the body of a newborn baby;
• Indirect bilirubin. Its amount must exceed 75% of the total volume of pigment; it is not excreted from the body until it turns into a straight pigment;
• Direct bilirubin. Its concentration should be less than 25% of the total bilirubin volume.

It should be noted that total bilirubin levels in full-term and premature infants are slightly different.

Table of norms for total bilirubin in newborns by day:

Such changes in indicators are associated with the normal physiological process taking place in the baby’s body. During this period, intensive breakdown of red blood cells occurs. They participated in gas exchange (respiration) of the fetus. And after his birth, the extra red blood cells disintegrate as unnecessary. If the indicators are exceeded, this indicates the development of jaundice in the newborn. Let's take a closer look at the types of jaundice.

Normal indicator in the 1st month

Bilirubin levels depend on the age of the baby. If the level of this substance is increased in newborns, then the norm of bilirubin in one month old baby reaches correct readings.

The rate of bilirubin in newborns at 1 month should be the same as in adults - from 3.5 to 20.5 µmol/l. This is due to normalization metabolic processes and improving the functioning of the digestive and excretory systems.

A newborn who has reached the age of 1 month begins to produce enzymes that help transform indirect bilirubin into direct bilirubin and remove it from the body with urine and feces. The secretion of bile by the gallbladder is also improved.

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Since bilirubin increases due to massive destruction of red blood cells, the levels increase in newborns. But over time, the number of red blood cells normalizes, and the bilirubin level stops increasing. Excess of this substance is eliminated from the body thanks to all of the above. physiological processes, and the pigment level is normalized.

Physiological jaundice in infants

More than 50% of newborns begin to turn yellow within 48 to 72 hours after birth. This condition is not dangerous and is not a manifestation of any pathology. This condition lasts no more than 2–3 weeks.

Reasons for the development of physiological jaundice in newborns:

• Availability diabetes mellitus the baby's mother;
• Baby born ahead of schedule;
• Asphyxia of a child;
• The woman suffered from various diseases during pregnancy;
• Fetal hypoxia (the baby experienced a lack of oxygen while in the womb).

In some cases, late physiological jaundice is noted. This condition occurs when a newborn is breastfed and gains weight at a rapid rate. The age of the baby in this case is 7 days.

The cause of yellowness is the hormone estrogen, which is found in excess in breast milk. Under its influence, bilirubin cannot be excreted from the body, and its accumulation leads to the coloring of the skin and mucous membranes in a yellow tint.

As a rule, this condition goes away on its own. In some cases, doctors give the mother recommendations that will help speed up the process of removing this substance from the baby’s body.

Pathological jaundice

In case if external signs jaundice and blood counts do not normalize after 20 days, then they speak of a pathological form this state. This is very dangerous, since bilirubin, when in excess, begins to be deposited in the brain. This can lead to serious disorders in the nervous system, which will manifest itself convulsive syndrome, increased arousal, sleep disturbance and decreased or complete absence appetite.

Reasons for the development of pathological jaundice:

• Rhesus conflict pregnancy;
• Premature birth;
• Blood type conflict between mother and baby;
• Pathological condition of the liver and biliary tract;
• Genetic predisposition to increased destruction of red blood cells;
• Hormonal disorders in the baby;
• Intestinal obstruction due to various reasons;
• The use of drugs during childbirth that stimulate labor.

The condition of pathological jaundice requires strict monitoring and treatment in a hospital setting. Treatment is accompanied by regular monitoring of laboratory parameters.

Consequences of deviations in bilirubin levels from normal levels

Elevated bilirubin levels in a newborn's blood test are an alarming signal. This can lead to the development of bilirubin encephalopathy (that is, damage to the brain and major nerves). A large number of This substance cannot be blocked by blood proteins, and therefore it penetrates into the structures of the nervous system.

Signs of bilirubin encephalopathy:

• An enlarged spleen and liver can be felt;
• The sucking reflex is impaired;
• Hypotension (low blood pressure);

• The newborn constantly sleeps, he is lethargic, apathetic;
• Convulsions are noted;
• Apathy may be replaced by motor agitation.

Bilirubin encephalopathy can appear in the first few hours of a newborn's life. That is why all children, without exception, undergo a laboratory test to determine the level of bilirubin in the blood.

If bilirubin encephalopathy is not treated in time, then a baby at the age of 6 months may develop severe complications: hearing impairment, decreased or complete loss of vision, paresis and paralysis, both partial and general.

If the baby’s jaundice does not go away for a long time or any of the above symptoms appear, then it is necessary to consult a doctor as soon as possible to decide on treatment.

Causes of abnormalities in infants older than 1 month

In children older than a month, normally the levels of this pigment should decrease and approach the values ​​of an adult. However, in some cases persistent elevated values ​​are observed. In this case, the newborn must undergo thorough diagnostic test in order to identify the cause of this condition.

Reasons for increased bilirubin in children older than one month:

• Liver pathologies: cirrhosis, hepatitis, malignant neoplasms, abscesses in the liver, fatty degeneration;
• Jaundice of mechanical nature (blockage of the bile duct with a stone or tumor);
• Vitamin B12 deficiency;
• Food poisoning;

• Treatment with antibacterial drugs (Tetracycline, Erythromycin);
• Increased pathological formation of red blood cells;
• Leptospirosis;
• Inflammation of the pancreas with a chronic course.

Ways to reduce bilirubin in newborns

An increase in bilirubin levels certainly needs to be monitored. Since the baby’s body is not always able to cope with big amount of this substance, then it needs help.

With the development of physiological jaundice, a wait-and-see approach is followed with monitoring of laboratory bilirubin values.

The baby should be given water to drink. In this case, the baby will urinate more often, and the color pigment will leave the body in the urine.

In the maternity ward, babies with jaundice are treated with phototherapy. The baby is undressed and placed under special lamps. Eyes must be protected from light; children wear masks that do not allow the light of the lamp to pass through.

Methods for treating pathological jaundice:

• Phototherapy;
• Intravenous drip administration of drugs;
• For long-lasting icteric skin tint, the use of activated carbon and choleretic drugs;
• In severe cases, blood transfusion is indicated;
• If jaundice does not go away after 4–5 days, then the baby is not discharged from the maternity ward home, but is transferred to a hospital to continue treatment.

About 3 days after birth, a blood test is taken from the baby for bilirubin, the norm for newborns is 60-250 µmol/l. Much attention is paid to the compliance of its indicators with the established norm. Bilirubin is formed during the breakdown of red blood cells. This substance is present in every body - both children and adults. There are direct and indirect forms of total bilirubin in newborns. The direct form is formed during the processing of decay products by the liver, has the ability to dissolve, due to which it is easily excreted from the body with feces and urine.

In newborns, the second form of bilirubin predominates due to insufficient processing of decaying red blood cells by the liver. This substance is toxic and has an adverse effect on the nervous system. Without dissolving into liquid media and without leaving the baby’s body through intestinal tract or the urinary system, indirect bilirubin causes a phenomenon such as jaundice in newborns.

Features of newborn jaundice

Jaundice is manifested by yellowing of the skin, mucous membranes, and sclera of the eyes. It is dangerous only when elevated level bilirubin. Its increase is observed in cases where the liver does not have time to transform the combination of indirect bilirubin with albumin entering the blood into the direct form of this substance and subsequent removal from the body.

With jaundice, the content of yellow pigment in the blood increases not only due to insufficient functioning of the liver, but also due to protein deficiency and significant changes in living conditions. The baby experiences stress during childbirth and immediately after birth, its way of receiving nutrition changes, and breathing appears , starts working digestive system. After adapting to its environment, the baby's body normal development by the end of the first week of life it is able to cope well with all its functions.

When bilirubin levels exceed the norm, the yellowness of the skin and mucous membranes becomes more pronounced. It should be borne in mind that the intensity of its manifestation is influenced not only by the pigment content, but also individual characteristics the child’s skin - color, thickness, condition of the capillaries running in it. The development of jaundice occurs when the concentration of bilirubin in the blood of a full-term infant reaches 35 µmol/l, and in a premature infant - 85 µmol/l.

Normal and critical indicators of bile pigment

The level of bilirubin in newborns is determined laboratory method. While in the maternity hospital, he is checked 2-3 times. The first time a test for bilirubin in newborns is done 3-4 days after birth, comparing the results obtained with the normal concentration in the blood. The table below contains data for normal, non- dangerous for the health of the baby and pathological values ​​of bile pigment requiring treatment.

So, the norm of bilirubin in the blood of newborns is:

• immediately after birth - 60 µmol/l;
• from 3 to 7 days - 250 µmol/l;
• from 14 to 21 - 20 µmol/l.

The permissible limit for blood concentration is 324 µmol/L for a full-term baby and 175 µmol/L for a premature baby. The difference in indicators is explained by an increase in the permeability of the vascular walls in babies born prematurely and the penetration of substances from the blood plasma into the brain tissue. The adverse effect is aggravated by the higher sensitivity of these cells due to their immaturity. As a result, kernicterus (also called bilirubin encephalopathy) can occur due to toxic damage to the brain nuclei. Therefore, doctors must monitor blood test data taking into account the daily bilirubin norm in newborns.

Physiological (transient) jaundice - borderline state, characteristic of the majority (60-70%) of children. It requires continuous monitoring of the child’s condition and monitoring the concentration of bilirubin in his blood to prevent the development of undesirable consequences for the baby's body. During the first month of life, indicators can significantly increase and decrease, sometimes quite large fluctuations are observed over a short period of time. The normal level of bilirubin in a one-month-old baby is from 8.5 to 20.5 µmol/l. This value practically coincides with the indicators of an adult.

Causes of physiological jaundice

Yellowing of the skin and mucous membranes with physiological jaundice occurs as a result of changes in the composition of hemoglobin in the blood. In the fetus, type F quantitatively predominates, while in an adult, type A predominates. The first type of hemoglobin ensures better binding and supply of oxygen to cells during intrauterine development. After the baby is born, the first type of protein is intensively destroyed, and the body begins to produce the second.

These processes contribute to a significant increase in the concentration of indirect bilirubin.

Symptoms of kernicterus and its consequences

If bilirubin levels exceed the permissible limit, including for a short period of time, this negatively affects the development of the baby. Toxins accumulate in brain tissue, which can lead to bilirubin encephalopathy, the consequences of which are deterioration or loss of vision and hearing, liver failure. Also, children who have had this disease may lag behind their peers in development. Serious intoxication of the body can result in death.

Symptoms of kernicterus:

• increasing lethargy, the appearance of drowsiness;
• increased pigmentation, its distribution not only in the upper, but also in the lower half of the body;
• loss of appetite, decreased sucking reflex;
• the baby can throw back his head, there is stiffness of the neck muscles;
• the appearance of convulsions, sometimes even to the point of paralysis.

Therapeutic measures

Previously, to normalize bilirubin levels they used intravenous administration 5% glucose solution, phenobarbital, vitamin C, which enhance the effect of liver enzymes. To improve the excretion of pigment with bile, they used choleretic drugs, for binding in the intestines and preventing reabsorption into the blood - adsorbents. The child's body must receive sufficient amounts of protein and vitamins.

Currently, phototherapy is usually used for treatment. This method is different high efficiency and is more physiological. It is based on irradiating the baby's skin with special lamps. The radiation has a certain wavelength that promotes the transition of bilirubin into lumirubin, a photoisomer of this substance that does not have a harmful effect on nerve tissue, easily soluble and excreted from the body without the need for processing by the liver.

To prescribe treatment, it is necessary that the pigment concentration exceeds the limit permissible value, amounting to 250 µmol/l for children born full-term, and 85-200 µmol/l for premature births, taking into account the child’s weight. Subsequently, regular monitoring of indicators is carried out until the norm of bilirubin in newborns is achieved. Therapeutic procedures are carried out in a hospital under the supervision of medical personnel.

Causes of other types of newborn jaundice

Mother's diseases, in particular diabetes, infectious diseases, and hormonal imbalances, can also contribute to an increase in bilirubin levels in a newborn. Jaundice is often observed when the blood groups of the child and mother are incompatible. Breastfeeding sometimes leads to the development of lactic jaundice, which is a reaction of the baby's body to the composition of mother's milk - the hormones and fatty acids it contains.

To test the assumption about the effect of milk on the development of jaundice, the baby stops breastfeeding. To reduce the activity of components that suppress liver function, expressed milk is processed by heating to a temperature of 55-60 °C and then cooled to 37 °C. Milk that has undergone similar treatment is given to the child. If the assumption about the “milk” origin of jaundice is correct, the bilirubin level decreases within 2-3 days.

Timely treatment can normalize bilirubin levels. To determine the cause of jaundice, a thorough medical examination of the child is necessary. To prevent the development of jaundice in a newborn with high bilirubin levels, a pregnant woman should adhere to healthy image life, eat right, avoid drinking alcohol and smoking, avoid infection infectious diseases and use of medications.

yamladenec.ru

Why is the accumulation of bilirubin in the baby’s body dangerous?

Bilirubin is formed from breakdown products of red blood cells. This is a yellow pigment. The human body strives to push out new substance. The child's liver cannot yet cope with such a large load, so a certain amount of bilirubin continues to remain inside the body.

Doctors divide this substance into two types: direct and indirect. Direct bilirubin is less dangerous; it leaves easily human body and is most often excreted in the urine. But the increased level of indirect bilirubin may harm brain tissue, if its quantity exceeds the norm. Due to this, the child may have a delay mental development, he may lag behind his peers mentally, hearing and vision impairments occur.

Indirect bilirubin is an insoluble pigment, so its removal from human body seems impossible. In order for it to leave the body, it must be transformed into direct bilirubin.

Increased levels of pigment in the body has a negative effect on the nervous system newborn Signs that require you to quickly begin removing bilirubin from the body:

• The child sleeps more often than normal and is lethargic.
• Poor breastfeeding or no sucking reflex at all.
• The newborn's arms and legs twitch restlessly.
• Cramps.
• Palpation reveals an enlarged liver and spleen.
• Blood pressure is high.

The norm of bilirubin in the body of a newborn

The table shows the limit values ​​of bilirubin norms in a newborn in its first days of life.

After the birth of his child take blood from the umbilical cord for analysis in order to determine bilirubin levels. Usually by the end of the first month it is possible to get rid of this problem. During this period, the amount of pigment substance in the body should not exceed 20.5 µmol/l.

There are 2 types of jaundice in newborns.

1. Physiological - manifests itself in the first days after the baby is born and goes away after a couple of weeks. She doesn't pose much of a threat.

Causes:

• Premature birth.
• Hypoxia.
• Asphyxia of the newborn.
• Various diseases of the mother during pregnancy, including diabetes.
• A large amount of estrogens in breast milk.

2. Pathological. Poses a great danger to the child's health.

Causes of manifestation:

• Different blood groups in the child and his mother and Rh conflict.
• Penetration of infection into the child’s liver.
• Genetic diseases that lead to the destruction of red blood cells.
• Prematurity.
• Minor hemorrhages in a child.
• Intestinal obstruction.
• Medicines taken by the mother during the last month of pregnancy and used by doctors during childbirth.
• Hormonal disorders.

How is the treatment carried out?

In order to get rid of jaundice, it is necessary to lower the level of bilirubin in the body.

Previously, glucose and drugs were used to remove yellow pigment choleretic action, ascorbic acid, enzymes. All these medications help break down bilirubin as quickly as possible and facilitate its release.

Currently in hospitals It is recommended to perform treatment using a special lamp, under which the baby is placed. This method is called herbal medicine. During irradiation, bilirubin is transformed into lumirubin. This new substance is absolutely harmless to the body of a newborn. Lumirubin is excreted in feces or urine. During this treatment, the baby may suffer from drowsiness, have loose stools, and peeling skin. At the end of the procedures (approximately 96 hours), all these troubles disappear without a trace. Within a day, lumirubin is completely eliminated from the body.

If the level of bilirubin is very high and if the above treatment method is ineffective, a blood transfusion is performed. But this happens in rare cases.

After treatment and removal of the harmful pigment, the baby is considered healthy. But anyway It is recommended to be observed by a neurologist for some time, since jaundice could have a negative effect on the nervous system and mental abilities.

Treatment is mainly carried out for pathological jaundice. If the disease is physiological, then it only requires the supervision of a pediatrician.

With physiological jaundice The best way removal of bilirubin from the child’s body - natural feeding. Breast milk, digested in the stomach, has a laxative effect and the unnecessary pigment comes out along with liquid feces.

A young mother should not panic if she discovers a problem such as jaundice in her baby. Currently, doctors can easily cope with this problem. Moreover, its manifestation is detected in the maternity hospital and the newborn is immediately given the necessary treatment.

pechen.guru

Norm of bilirubin in the blood of newborns

For every family, the birth of a child is a joyful event and a real miracle. Naturally, a mother worries about the health of her baby. In the maternity hospital, in the first hours of life, children are checked for bilirubin levels. What is this and is this indicator important for the baby’s life?

What is bilirubin

Bilirubin is a substance that is present in everyone's blood and is formed during the breakdown of red blood cells. It can be direct or indirect. The direct form of bilirubin is not harmful to life: it is a product processed by the liver. It is a soluble substance and is easily excreted from the body with the rest of the fluid (urine and bile). Indirect bilirubin is completely different from direct bilirubin: it is very toxic and often has bad influence on the nervous system.

The substance found in indirect bilirubin does not dissolve. When accumulated in the body it causes characteristic features, namely: the color of the skin and mucous membranes changes. In order to avoid this, the liver needs to convert the product from the breakdown of red blood cells and modify it. This occurs when it combines with the protein albumin.

Exceeding the normal norm often occurs if children:

• born prematurely;
• from multiple pregnancy.

The bilirubin level is also greatly influenced by the mother’s difficult pregnancy (with various abnormalities) and the presence of bad habits.

Methods for determining bilirubin in newborns and infants

On the 3-4th day of the child’s life, a thorough blood test is performed (repeated after 24 hours). A blood test reflects the accumulation of this substance, and also helps to identify the level of total and indirect bilirubin. This is very responsible and important, because with an increased level of this, big problems with health.

• Hemolytic disease of the newborn
• Jaundice in newborns

Most newborns have excessive amounts of yellow-green pigment. This is due to the fact that the functions of the biliary tract and liver are still imperfect, living conditions change dramatically, and protein is in short supply. If everything is normal, the child quickly adapts to the changes and the body performs certain functions. Blood tests, of course, will be normal. But if the deviation is very strong, it will be easy to notice with the naked eye.

What level of bilirubin should a baby have?

To determine the pathological concentration of bilirubin, there is a table of values. If the child is one month old, then due to the period, the concentration of bilirubin may change dramatically: it will either increase or decrease. Using the table, you can determine the norm based on a certain period:

Table of bilirubin norms up to 1 month

If the baby is premature, its indicators may differ. In the first period of life, the concentration should not be higher than 175 µmol/l. In general, newborns have impaired levels of direct and free bilirubin, but gradually it approaches the ratio of 1:3.

Signs of deviations from the norm

When a child cannot cope with the load and the level of the toxin becomes higher, his health worsens. To make sure, they do a blood test, but it also shows up externally.

If a child has elevated bilirubin, he:

• lethargic and drowsy;
• eats poorly;
• throws back his head;
• the sucking reflex worsens;
• convulsions appear.

As a result of disorders, the newborn develops jaundice. This disease is characterized by a change in the color of the skin and mucous membranes: they immediately turn yellow (a greenish tint is possible). Jaundice can be physiological and pathological.

With physiological jaundice, the bilirubin level is normal, but the baby exhibits excessive pigmentation. It is not life-threatening and goes away within a few weeks. But with the pathological form, the child experiences serious disorders. Indirect bilirubin is significantly higher than normal; its excess is absorbed into the blood and accumulates in brain cells. In this case, inpatient treatment is required with constant monitoring of indicators.

Causes of bilirubin accumulation

Bilirubin in children can accumulate if the liver and biliary tract systems are imperfect. During the first months of life, everything stabilizes and the problem disappears.

Physiological jaundice can manifest itself as a result of such factors:

• asphyxia at birth;
• presence of diabetes in the mother;
• illnesses during pregnancy.

Pathological jaundice is characterized by:

• lack of albumin;
• incompatibility of mother and child by blood type;
• infections;
• liver pathology;
• hormonal imbalance.

If a baby has an abnormal reaction to breast milk, lactic jaundice may occur.

Possible consequences

When bilirubin in a child’s blood is significantly increased, even after a short time the newborn may experience developmental disorders. If there is not enough albumin, the level of toxins increases and modification in the central nervous system is possible. Bilirubin is also dangerous because it accumulates in brain cells. As a result, the child may lose hearing, vision and lag behind in development. He will suffer from convulsions and subsequently paralysis. Moreover, pigmentation will gradually move to other parts of the body.

Treatment and prevention of newborns

To normalize bilirubin levels in a newborn, it is necessary to provide timely medical assistance. When examined by a doctor, a course of treatment is prescribed, because babies may have problems eliminating the toxin. Mostly natural drugs are used that stimulate liver function. The body also needs to be provided with protein and vitamins.

Phototherapy is prescribed when the indicators are significantly exceeded. In this case, the child is placed in a specialized chamber where his skin long time exposed to light. Light converts indirect bilirubin into lumirubin. This helps remove bilirubin from the body. But phototherapy has side effects: loose stools and peeling skin. Although they pass quickly.

Doctors recommend starting breastfeeding as early as possible and feeding frequently. After all, a well-fed child is not so susceptible to the manifestation of pathological jaundice. Adequate nutrition helps reduce bilirubin. When sucking, contractions of the intestinal walls are stimulated, this improves the passage of stool, which contains a large concentration of harmful substances. Children need to be fed at least 8 times a day and do not give the child sweet water, this will delay stool. Breastfeeding should also not be interrupted.

Mostly high rate bilirubin is not dangerous for children, but when untimely treatment or the mother’s inattention, complications are possible. IN early age This is a decrease in muscle tone and a sharp cry. Then respiratory arrest, hypertension and mental retardation appear.

Video: High bilirubin and prolonged jaundice in a child.

nedeli-premennosti.com

Causes of increased bilirubin and its types

Bilirubin is a pigment in the blood that appears after the breakdown of hemoglobin in red blood cells. This pigment is present in the body of any person and is excreted from the body with the help of the liver. After birth, the newborn's hemoglobin is replaced adult form. As a result, a lot of bilirubin is formed and the liver cannot always cope with such a load. As a result, bilirubin stains the skin yellow. IN acceptable standards this substance does not pose a threat to the baby. However, if bilirubin is released in large quantities, it can lead to toxic damage body and provoke pathological jaundice.

Medical experts distinguish three types of bilirubin:

1. Indirect(unrelated). This species is considered toxic - it was formed in the body quite recently and has not yet been processed by the liver. Unbound bilirubin does not dissolve in water, but easily penetrates into fats. Therefore, the pigment quickly enters the body’s cells and disrupts their functioning.
2. Straight(or related). This bilirubin has already been processed by the liver and does not pose a threat to the body.
3. General. This is a combination of the first two types.

Increased bilirubin in a newborn

Increased bilirubin in babies is a common phenomenon and leads to the development of physiological and pathological jaundice. The first type of jaundice is considered very common and in most cases does not require treatment, but if the level of indirect bilirubin is more than 200 µmol/l, then it is necessary health care. In the second case, unconditional treatment is necessary.

In most cases, signs of jaundice in a child disappear after the first month of life. However, sometimes treatment does not reduce bilirubin to optimal levels, and the doctor prescribes additional examination. To effectively fight jaundice, the doctor first determines the cause high bilirubin and, accordingly, prolonged jaundice.

Reduced bilirubin in infants

If the bilirubin level is not high, doctors advise parents not to worry. Similar feature observed only in premature newborns. At proper feeding and care, the indicators stabilize within a few months.

However, in some cases, low bilirubin indicates the development of pathology - rickets. However, it is almost impossible to accurately determine the diagnosis from the first months of life. Pathology manifests itself after a while if the child does not gain weight and develops more slowly than his peers.

Norm of bilirubin in newborns by day and week

It is considered normal if direct bilirubin is no more than a quarter of the total. Maximum performance, as a rule, are detected on the 3rd day of life. If the liver is functioning correctly and there are no pathologies, the values ​​return to normal within 14 days.

If the readings exceed the limit and are more than 300 micromol per liter, the child requires urgent hospitalization and blood transfusion. This high content bilirubin negatively affects the functioning of the brain, liver and gallbladder.

Blood test for bilirubin in a newborn and measurement of its level with a device

The most common measurement method is a blood test. Obstetricians take it in the first minutes of a newborn’s life from the cut umbilical cord. After 2-3 days, the baby’s blood is taken again. The readings are compared, and on their basis the doctor makes a conclusion about the child’s condition. If you need to take a blood test after discharge from the hospital, then you don’t need to worry about how to take a bilirubin test - on an empty stomach or not. Blood sampling is carried out at any time. For research they take venous blood from the veins on the baby’s head, since they are most visible and come closest to the surface of the skin. This procedure is absolutely safe for the baby.

Another effective remedy to determine the level of bilirubin - a digital bilirubinometer. This is a special device that measures bilirubin levels in subcutaneous tissues. In fact, the device evaluates the degree of yellowness of the skin and subcutaneous tissues. The measurement takes place at the level of the baby's forehead, bridge of the nose or sternum.

What to do if bilirubin is elevated

If the levels are elevated, doctors prescribe the baby several treatment methods that will reduce bilirubin.

1. Complex therapy, which includes choleretic drugs and vitamins.
2. Enterosorbents. These are medications to prevent the reabsorption of harmful substances into the blood through the intestines.
3. Light therapy under a medical lamp. When exposed to light, bilirubin is actively removed from the body.
4. Infusion effect. Used after phototherapy, as under ultraviolet rays The baby's body loses a lot of moisture. Therapy helps make up for losses. To do this, the child is injected with saline solution and glucose. Instead of infusion therapy you can simply give your child 20-30% more fluid with plain water.
5. Blood transfusion. Used only in very severe cases.

Why is elevated bilirubin dangerous?

The effects of unconjugated bilirubin on the body can be dangerous. After all, it is known that it is toxic. If bilirubin rises rapidly, it destroys the blood-brain barrier and affects internal organs or central nervous system. If treatment is not started on time, increased bilirubin leads to paralysis, deafness, dementia or mental retardation.

So, increased content of this pigment is a common problem in newborns. As a rule, ordinary jaundice does not pose any particular danger to the child. However, it is important that the doctor carefully monitors bilirubin levels so as not to miss the critical moment and prescribe effective treatment in time.

topotushky.ru

What can jaundice lead to?

Threat to the baby, with increased bilirubin due to the fact that this pigment does not dissolve in water. And this means it is impossible to remove it from child's body naturally. But it is fat soluble, and is quite capable of settling in the subcortex of the brain. Deposition in the zone of the subcortical nuclei can lead to bilirubin encephalopathy, in other words, kernicterus. This happens due to intoxication of the subcortex of the brain. And it is extremely dangerous, as it can lead to disability of the baby, and sometimes ends in death.

Symptoms of kernicterus are:

• drowsiness, lethargy of the baby;
• the baby does not suck well at his mother’s breast;
• convulsions;
• loud, incessant crying;
• neck muscle tension.

It is precisely because of the danger of kernicterus that the level of bilirubin in the baby’s blood is thoroughly checked by doctors while he is in the maternity hospital. If the level is elevated, even slightly, bilirubin levels are tested three times a day.

How to independently recognize harmless jaundice:

• the skin becomes colored within 2-3 days, but never earlier than the first days of life;
• the level of pigmentation increases gradually in the first 3-4 days of life;
• jaundice begins to disappear from the first week to the 10th day of life, and completely disappears by the second or third week;
• the baby feels well;
• the liver and spleen are not enlarged;
• stool and urine are of normal color.

Clinical signs of physiological jaundice in newborns (recognized by doctors). At birth, bilirubin taken from the umbilical cord is less than 51 µmol/l; the level of hemoglobin, red blood cell count and hematocrit corresponds to the norm; Bilirubin in the first day increases by 5.1 µmol/l per hour; The maximum permissible total bilirubin, estimated on days 3-4 of life, is not reaches a value of 256 µmol/l in children born during; and the indicator is 171 µmol/l in children born earlier than expected. The average bilirubin analysis is 103 - 137 µmol/l;

The indicator of skin colorability is usually assessed using the Cramer system:

Treatment of jaundice

If the level of pigmentation does not exceed the above indicators, then it is not reduced, since by 3-4 weeks of the baby’s life it will stabilize on its own. But if the level is elevated, then it is brought back to normal with phototherapy or transfusion donated blood. Phototherapy is indicated for readings of no more than 285 µmol/L for a full-term baby, and for a baby weighing less than 2 kg - 240 µmol/L. For more severe cases, doctors use blood transfusions.