What should the bilirubin level be after jaundice? Jaundice of newborns: insidious bilirubin

Many mothers in the maternity hospital hear the phrase “your baby has increased bilirubin.”

In order not to be afraid of these words, it is necessary to understand what role bilirubin plays in newborns and what amount of this substance is safe for the baby.

What is bilirubin?

Bilirubin is a pigment, a high concentration of which in the body can become poisonous to nervous system. This substance is the result of the breakdown of red blood cells.

Hemoglobin is released from obsolete red blood cells, which immediately becomes toxic. The immune system begins to “attack the enemy” and destroys hemoglobin, releasing hemes - compounds containing iron. Under the influence of enzymes, hemes are transformed into bilirubin.

We need to differentiate straight And indirect bilirubin. Direct bilirubin is excreted in feces and urine, while indirect bilirubin first forms a compound with albumin and is transported to the liver, where it ferments and becomes direct bilirubin, which easily leaves the body.

Bilirubin in the blood of a newborn is always elevated. The fact is that oxygen in the body of an unborn child is carried by red blood cells saturated with fetal hemoglobin. After childbirth, it loses its functions and is destroyed, leaving behind a breakdown product - bilirubin.

In the maternity hospital, the child's blood is taken several times to determine the level of this pigment. Increased bilirubin in newborns indicates the occurrence of jaundice, and thus doctors monitor its progress.

Jaundice with high bilirubin is dangerous both in itself and may indicate the development of some pathological condition in the baby.

What tests need to be taken?

• Immediately after the baby's first cry, doctors measure the level of pigment in cord blood. Two days later, the full-term baby is tested again.
• For premature babies, the amount of pigment in the blood is checked a day after birth, and it is monitored every 24 hours.
• For children at risk (difficult pregnancy, difficult childbirth, severe yellowness of the sclera and skin), blood is taken from the vein on the head.

This procedure is painless and safe for the child, although it is very scary for mothers. The sampling is carried out with a special thin needle by the hands of an experienced nurse; this analysis helps to diagnose development in time. dangerous complications, so you shouldn’t give it up in the maternity hospital.

• Children who do not have clear signs jaundice, do a bloodless test - bilitest.

The analysis device is a photocell that records the skin color on the child’s forehead and thus determines the amount of yellow pigment. The result can be seen instantly. The disadvantage of this test is that it does not show direct and indirect bilirubin, and these numbers are very important for diagnosis.

With jaundice, babies undergo control tests throughout the entire treatment period until the pigment level decreases to normal.

Once again, a test for bilirubin in newborns is done in the clinic, during medical examination in one month old. Blood is taken from a vein on the head or on the arm, in different medical institutions differently.

Bilirubin norms in children

Since the process of blood renewal occurs constantly, a safe amount of pigment is always present in the body. Normal bilirubin level one month old baby falls in the range from 8.5 to 20.5 µmol/liter. But for a newly born baby and in the next few weeks, these numbers are much higher. This situation occurs due to the breakdown of a large amount of fetal hemoglobin.

1. The pigment content in the blood from the umbilical cord is considered normal:

• 51–60 µmol/liter in children born at term;
• 71.8–106 µmol/liter in premature babies.

It's about the level total bilirubin, which is the sum of the amount of indirect and direct bilirubin. In this case, indirect bilirubin should not account for more than a quarter of general level, and the direct one, accordingly, should be less than 75%.

1. 24 hours after birth, the normal level of pigment in babies born at term does not exceed 85 µmol/l.
2. After 36 hours from birth, this figure increases to 150 µmol/l.
3. After 48 hours – up to 180 µmol/l.
4. 3-5 days after birth, bilirubin can reach its maximum: 256 µmol/l. If this limit is exceeded, then doctors talk about the development of jaundice in the child.

Then the bilirubin level decreases.

1. On the 6th–7th day of a child’s life it is up to 145 µmol/l.
2. On days 8–9 – up to 110 µmol/l.
3. On days 10–11 – up to 80 µmol/l,
4. On days 12–13 – up to 45 µmol/l, etc.
5. By the fourth week of a baby’s life, bilirubin reaches its normal value– up to 20.5 µmol/l.

Table of bilirubin norms (indirect and direct)

The norm of bilirubin in a newborn varies from day to day in full-term and premature babies. 24 hours after birth, the average bilirubin level in an “early” baby is 97.4–148.8 µmol/l. The indicator reaches its maximum value 5–6 days after birth. When the pigment level is above 172 µmol/l, the baby is diagnosed with jaundice.

Why does a child have high bilirubin and what is the danger of this condition?

When bilirubin is higher normal level(256 µmol/l in children born at term and 172 µmol/l in “hurried” babies), doctors talk about the development of jaundice. It comes in two types. Physiological jaundice most often ends on its own by the 4th week of a child’s life and does not have any consequences for his body.

However, children with this diagnosis need constant monitoring, as the disease can develop into a more severe form. Pathological jaundice requires treatment, and if it is not treated, it causes significant harm to the child’s health.

If bilirubin is increased in the blood of a newborn, the reasons may be the following:

• difficult pregnancy;
• diabetes at the mother's;
• complicated childbirth;
• premature pregnancy;
• lack of oxygen in the child during pregnancy or childbirth - for example, when the umbilical cord is entangled.

With pathological jaundice, bilirubin in the blood of children goes through the roof. The reasons for this increase may be the same problems that lead to physiological jaundice. Also, an extremely high level of pigment may indicate:

1. liver problems in the baby;
2. hormonal disorders;
3. Rh conflict between mother and child;
4. intestinal obstruction;
5. a genetic disease leading to the destruction of red blood cell membranes;
6. obstruction biliary tract.

Also, pathological jaundice can be caused by drugs that the mother received during pregnancy and childbirth.

When this condition is detected in a child, doctors treat not only the symptoms themselves, but also eliminate the cause of the disease.

Conditions that can cause pathological jaundice are themselves very dangerous and sometimes fatal. But high bilirubin in newborns cannot be ignored. This pigment is poison for the baby’s nervous system. When its level in the blood is high, bilirubin encephalopathy develops. Signs of this condition are:

• enlarged liver and spleen;
• decreased blood pressure;
• convulsive syndrome;
• the baby sleeps a lot or, on the contrary, is constantly on the move;
• The child practically does not take the bottle and breast.

Failure to receive treatment on time (or complete absence help) with bilirubin encephalopathy can have the following consequences:

1. hearing loss;
2. developmental delay;
3. motor paralysis

Sometimes bilirubin in a baby increases due to mother’s milk: the so-called “breastfeeding jaundice” develops. Present in milk fatty acid, which prevent the liver from converting indirect bilirubin into direct bilirubin, and the toxin accumulates in the body. In this case, the children are transferred to formula feeding for two days.

If bilirubin decreases, then the child is left on artificial feeding. Or it is possible to feed the baby mother's milk. To do this, you need to express it into a bottle and warm it up to a temperature of 70°, then cool it and give it to the baby. >>>

When heated, fatty acids are destroyed, and the milk will not harm the baby.

Medical assistance for elevated bilirubin

How to reduce bilirubin in a newborn? If physiological jaundice is diagnosed, no special measures are needed other than observation. Usually the disease subsides after a few weeks.

Help to reduce bilirubin in a newborn faster sunbathing. If you have a “spring” or “summer” child, then during walks you can move the hood of the stroller, exposing the baby’s face and arms to the sun. Winter and autumn sun are more difficult to catch. But if it’s a clear day, go out onto the balcony with the baby and let the rays shine on the baby’s face.

The baby should not be in the sun for more than 10 minutes. In this case, it is necessary to ensure that the sun does not fall into the open eyes. In late spring and summer, keep your child out of direct sunlight from 11 a.m. to 5 p.m.

Phototherapy is the most effective way treatment of pathological jaundice. It can be carried out in a maternity hospital if it has the necessary equipment. Otherwise, mother and baby are transferred to a children's hospital. The baby is placed under a special blue lamp.

With the help of light, bilirubin is converted into lumirubin, which quickly leaves the body. You need to lie under the lamp for a total of 96 hours, with breaks for feeding.

Children are put on a special bandage or a cap over their eyes, since the light from the lamps is harmful to their eyesight. The procedure is painless and effective, but may also have unpleasant consequences. side effects: drying and peeling of the skin, loose stools, which will disappear after completion of therapy.

In especially severe cases, children are given IVs and even blood transfusions. An excellent prevention of jaundice is feeding with mother's milk. It is very important to get your baby to the breast as quickly as possible. Read how to do this in the article: Breastfeeding: WHO recommendations.

Feeding on demand also helps reduce the amount of harmful pigment. Colostrum provokes the excretion of meconium from the newborn’s body, along with which the a large number of bilirubin. >>>

One of the bad pieces of advice that a mother may hear is to give a baby with jaundice more to drink. Neither sweet water nor rosehip decoction will reduce bilirubin levels. It’s better to put your baby to your breast more often and follow your doctor’s recommendations.

In response to the obstetrician’s words about the presence of jaundice, many mothers ask in bewilderment: “Where could it come from if everything was fine during the prenatal examination?”. This pathological deviation is observed in a newborn if hemoglobin is destroyed in his body, which is also accompanied characteristic change skin color to olive (yellowish) tint.

Baby's body after birth

After spending nine months of pregnancy in the mother's womb, the newborn has to adapt to new conditions. Therefore, some systems and organs may experience a kind of stress. As a result, a phenomenon such as jaundice is observed against the background higher level bilirubin in the blood.

The fact is that the composition of hemoglobin in a fetus and a newborn baby is slightly different. And during the breakdown of fetal hemoglobin after the birth of a child, side effect in the form of a secreted pigment. This substance is called bilirubin (direct and indirect). In newborns, it is formed when the process of decomposition of red blood cells that have outlived their “lifetime” begins in the blood. Bilirubin pigment exceeding permissible level, is capable of turning a baby’s skin olive green.

We can notice the decomposition product of hemoglobin, bilirubin, on the body in the form of dirty yellow halos that form after 7-9 days around the injury. In newborns, physiological jaundice manifests itself in 80% of cases and can go away on its own in 7-14 days without causing harm to health.

Usually the pigment is eliminated from the body on its own. However, which way bilirubin is released will depend on the type of hemoglobin breakdown products. There are two types of pigments:

• direct bilirubin - dissolved by enzymes produced by the liver and excreted from the body in urine and feces;
• indirect - is not able to dissolve in water, therefore it is excreted through the bloodstream into the liver together with the protein albumin, where it turns into direct. Only after this will it be excreted through the gallbladder.

Bilirubin indicator: acceptable values ​​and elevated

At the time of birth of a child, the level of bilirubin in his blood is always higher than in children who are 1 month old. At the same time, the norm will depend on the period at which the pregnant woman gave birth. If at the time of the birth of the newborn normal indicator bilirubin should be from 51 to 60 mmol per 1 liter (umbilical cord blood), then after two days the normal value should be no more than:

• 205 mmol/l – in children born on time;
• 171 mmol/l – in prematurely born (premature) infants.

A month later, these indicators will also be different. So, in a baby who is one month old, the level of bilirubin in his blood should vary between 8.5 and 20.5 mmol/l. If the norm exceeds the permissible limit (256 and 172 mmol/l for full-term and premature babies, respectively), you will need to take a blood test to identify and eliminate them.

Important tests

The very first test for newborns is a blood test. Immediately after cutting the umbilical cord, blood is taken from it for general analysis. Thus, not only the blood type is determined, but also the level of various substances in it (including bilirubin in a newborn).

Based on the results of the baby's blood test, bilirubin in newborns should be detected:

• general – level of total pigment concentration (direct + indirect);
• direct (the norm for the indicator is no more than 25%);
• indirect (more than 75%).

The table below shows what the acceptable bilirubin should be in newborns from the first minutes of life to 7 days.

If a blood test in a newborn shows values ​​exceeding the limit of 256 mmol/l (171 mmol/l), a doctor can diagnose it. At the same time, such a condition, when the level of direct or indirect bilirubin is more than permissible, can have three forms of manifestation.

Physiological jaundice

Physiological, occurs in 7% of newborns. Physiological jaundice occurs 2-3 days after the baby is born and disappears on its own after 14-20 days. This form of jaundice, which is caused by increased bilirubin, is not at all dangerous for children. As a rule, there are several reasons for its appearance. This could be prematurity, intrauterine oxygen starvation, fetal asphyxia, maternal illnesses during pregnancy.

There are cases when there is an excess level of bilirubin in a newborn baby seven days old. This phenomenon most often occurs in children natural feeding, which gain weight very quickly. The fact is that in such a food product as breast milk, there is a high level of estrogen, which interferes with the natural excretion of bilirubin from the tiny body of the newborn.

Pathological jaundice

Pathological is a form of jaundice that poses a certain danger to the health of newborns. The following factors may be prerequisites for the occurrence of pathological jaundice:

• incompatibility of blood groups between a new mother and her baby;
• in a pregnant woman during the period of gestation;
• an infectious disease affecting the child's liver, or liver dysfunction;
• destruction of red blood cells that occurs against the background genetic characteristics body;
• mechanical jaundice;
• intestinal obstruction in a newborn;
• premature birth;
• stimulation of active labor activity special substances;
• violations hormonal levels in a newborn;
• minor hemorrhages in the baby.

Pathological jaundice lasting 2.5-3 weeks with discoloration of feces and intense coloration of urine indicates serious problems in the body associated with the biliary tract.

What is the danger of deviation?

If we talk about how long jaundice can last, it is also important to clarify what its danger is. If a blood test of a newborn baby shows a high level of bilirubin, this may be fraught with negative impact on the nervous system. In this case, the excess hemoglobin breakdown product, without being completely blocked by proteins in the blood, is able to penetrate the nervous system. As a result, against the background of extraneous interference with bilirubin, bilirubin encephalopathy can develop, the symptoms of which can make themselves felt already in the first days after the birth of the child (enlarged spleen, liver big size, convulsions, drowsiness, etc.).

If the pathology is not detected in a timely manner and jaundice in a newborn is not treated, then by 5-6 months the pediatrician can diagnose developmental disorders in the child. These may include hearing problems, vision loss, or paralysis. A table of acceptable values ​​by month will help you monitor the level of pigment in the baby’s blood in the future (see below).

As you can see, a newborn blood test to determine the level of bilirubin in it is mandatory for all children. Its results make it possible to assess whether bilirubin levels (total, direct and indirect) do not exceed the permissible limit in order to eliminate deviations in time.

Among the important health indicators of recently born babies is the level of bilirubin. Norm and pathology in newborns are the subject of close attention of neonatologists and pediatricians.

The breakdown of fetal hemoglobin in newborns causes physiological jaundice. Serious excess of standards during long period talks about development dangerous phenomenon– pathological jaundice.

Norm of bilirubin in infants

The tables indicate valid values bilirubin level. These indicators indicate the correct or disturbed course of hemoglobin breakdown processes and affect the functioning of the liver.

Normally, direct bilirubin makes up no more than a quarter of the total volume. The maximum values ​​were detected on the 3rd day from birth. With absence pathological changes, proper operation liver, intestinal tract, the level of direct bilirubin gradually decreases, no later than after 2 weeks it returns to the norm. During this period, physiological jaundice disappears, which does not pose a threat to the life and health of the newborn.

The process of fetal hemoglobin breakdown is accompanied by characteristic signs:

• V mild degree a jaundiced color appears on the face and neck of the newborn;
• at grade 2, the tiny body above the navel acquires a yellowish tint;
• Stage 3 development is accompanied by yellowing upper sections arms, legs;
• with an active process, the newborn’s body turns completely yellow, even the hands and feet change shade.

Table. Norm of bilirubin in a newborn by day

Table No. 2. Standard indicators bilirubin in the first weeks of life

Important! Parents should remember: at levels above 300 µmol/l, a negative effect on the brain, liver, and gall bladder was noted. Urgent hospitalization and exchange blood transfusion are required. Consult a doctor immediately if your newborn's skin suddenly changes color or acquires an intense yellow-brown tint. The health of the baby depends on the decrease in indicators to normal. High levels of bile pigment negatively affect the liver, developing toxic poisoning body.

Deviations of indicators in newborns

Doctors take a bilirubin test immediately, in the first minutes after the baby is born (from the cut umbilical cord). The second time the study is carried out on the third day.

Many newborn babies' skin turns yellow, mothers worry and paint scary pictures. Under medical supervision no need to worry: permissible excess bilirubin is a natural phenomenon. It is important not to miss the moment when high bilirubin levels approach a critical level.

After discharge from the maternity hospital, the mother needs to monitor the process of reducing the level of bile pigment to standard values. It is not difficult to recognize safe and pathological phenomena. Pay attention to the causes and signs of both types of jaundice: you can easily determine when to sound the alarm.

Physiological jaundice

Causes:

• natural breakdown of fetal hemoglobin after birth, replacement with normal. Bilirubin is a breakdown byproduct.

Signs of increased bilirubin in newborns:

• yellowness of the epidermis appears on the second day after birth, in some babies later - on the third or fourth day;
• the shade varies from dark, orange to slightly orange;
• the baby behaves as usual, eats well, there is no restlessness or lethargy;
• the color of stool and urine does not change.
• after 10–14 days, the strange color of the skin disappears, and the newborn’s body acquires a normal shade.

Pathological jaundice

Provoking factors:

• premature birth;
• previous infections during pregnancy;
• incompatibility of Rh factors, blood type of mother and baby;
• various genetic diseases.

Signs of high bilirubin in newborns:

• a characteristic icteric tint is noticeable already on the first day after birth;
• the baby is lethargic or restless, does not breastfeed well;
• during analysis, doctors detect Rh conflict in the newborn and mother;
• the increase in indicators is up to 85 µmol/liter in 1 day;
• a yellowish tint appears on the feet, palms, and areas below the navel;
• feces become discolored, urine acquires a rich, dark shade;
• characteristic symptoms of pathological jaundice last 3 weeks or longer.

Doctors distinguish four forms of the disease:

• conjugative;
• mechanical;
• parenchymal;
• hemolytic.

In severe cases, bilirubin levels are much higher than normal. A high concentration (more than 324 µmol per liter) leads to penetration of the substance through the blood-brain barrier, and kernicterus develops.

The tiny brain suffers, apathy, lethargy, convulsions appear, and reflexes noticeably decrease. Sometimes the consequences can be very serious.

Among the complications of kernicterus:

• deafness;
• paresis;
• paralysis;
• mental development disorder.

The technique depends on the form of the disease. When jaundice is detected, doctors conduct tests to determine the cause of the phenomenon. Recommendations for the treatment of jaundice are given by a neonatologist or pediatrician.

It is forbidden to prescribe medications yourself. You cannot refuse therapy, hoping that it will “go away on its own.” Even if the older child had similar phenomenon, it is not worth focusing on treatment methods and the timing of the disappearance of symptoms: each case is individual.

Often bad advice neighbors and experienced mothers give advice about jaundice. You shouldn’t joke about the level of bile pigment: critical indicators harm the tiny organism and provoke brain damage.

How to reduce bilirubin levels in the blood

At breastfeeding Mommy should reduce the load on the liver as much as possible:

• completely avoid fried, spicy, too sweet foods;
• more permitted vegetables, fruits, not causing allergies in a baby;
• Non-carbonated water is required - up to 2 liters per day;
• you cannot go on a diet, overeating is prohibited;
• bake or steam dishes;
• stick to fractional meals: eat 4-6 times throughout the day, small portions;
• light soups, porridges are useful, recommended boiled beef in the form of steam cutlets;
• fresh White bread mash it with gray and bran, discard the baked goods. Eat crackers to prevent fermentation in the stomach and intestines.

Methods of treatment and prevention of physiological jaundice:

• early breastfeeding. The sooner the original stool (meconium) passes, the sooner the intestines are cleansed and beneficial microflora begins to form;
• feeding a newborn on demand with a gradual transition to six or seven meals a day;
• placing the baby in an incubator under a special lamp. Phototherapy – effective method against jaundice. Under the influence of light, “harmful” bilirubin is converted into non-toxic. Breastfeeding more frequently will help prevent dehydration.

On the page read about possible consequences salmonellosis in children.

Treatment of pathological jaundice

Doctors prescribe for a newborn:

• Elkar. The medicine contains L-cartinine. The drug in the form of drops destroys excess bile pigment and cleanses the liver of toxins. Medicine approved for use from birth.
• Hepel. The drug fights the symptoms of diarrhea, accelerates the flow of bile, supports the liver and gall bladder.
• Enterosgel or Smecta. Effective sorbents do not directly affect bilirubin levels. Doctors prescribe medications to interrupt the chain of circulation of the substance through intestinal tract and liver;
• Ursofalk. The drug is recommended when weakness is detected gallbladder. For ease of use in the first days, the composition is produced in the form of a suspension. The drug has a noticeable choleretic effect.

At severe form jaundice, high levels of bile pigment require an exchange transfusion. Indicators that are much higher than normal over a long period cause bilirubin encephalopathy - a condition health threatening, mental development baby.

Jaundice in newborns is a sign of a change in the level of bilirubin in the blood. Follow your doctor's instructions exactly and eat properly while breastfeeding. Be aware of serious complications during development severe forms pathological jaundice of newborns. With timely treatment, the disease goes away without a trace.

Or the gallbladder. You need to immediately be alarmed and consult a doctor for help. However, this only applies to adults. Jaundice in a newborn is a normal physiological phenomenon. Usually it goes away quickly and does not cause any harm to the baby.

Jaundice is a symptom of increased bilirubin

Bilirubin in newborns, the norm of which is clearly defined, may increase on the second or third day of the child’s life. A newly born baby has a fairly high level of hemoglobin in the blood, which begins to actively break down. Red blood cells, when destroyed, release a yellow pigment that is involved in the formation of hemoglobin. Normally, bilirubin travels with the blood to the liver, where it is destroyed and then excreted from the body. If this process in the body is disrupted, the level of bilirubin in the blood increases, and the skin acquires a characteristic yellowish tint.

Newborn jaundice may have a mass possible reasons. If it's normal physiological process, it is most often associated with the fact that the baby’s liver is not yet working at full capacity and simply cannot cope with high level bilirubin in the blood. There is also breastfeeding jaundice. This type of jaundice occurs naturally breastfeeding, when the amount of milk is not too large, but the concentration of hormones in it that reduce the activity of liver enzymes is quite high. Such jaundice should not cause any concern, even if it lasts longer than expected.

There is no need to interrupt breastfeeding. However, if the mother is very worried, suspecting that the child has some kind of disease, you can suggest that she switch the baby to formula for a couple of days. If at this time the yellowness of the skin has subsided, then there is no reason for concern and you can return to breastfeeding.

Jaundice can also be hereditary. She is connected with congenital pathologies in the child's body. This may be hereditary hepatitis and other liver disorders, blood problems (anemia, weak red blood cell wall). Such jaundice is essentially a symptom of a more serious disease, and treatment begins with it. Genetic jaundice can also occur when mother and child are incompatible according to the Rh factor or blood group. Impaired function can cause jaundice thyroid gland. In this case, the mother is prescribed Iodomarin (if breastfeeding), and the child is prescribed L-thyroxine.

The norm of bilirubin in the blood and deviations from it

Normally, bilirubin in a baby’s blood is up to 20 mg/l. However, this does not mean that after this mark your baby will begin to turn yellow. In a healthy full-term baby, jaundice will begin to appear when the concentration of bilirubin in the blood is more than 85 mg/l, in premature babies - more than 105-120 mg/l. Doctors in maternity hospitals closely monitor the level of bilirubin in the blood of newborns. Mom can ask about the result of a blood test to be aware of whether bilirubin is increasing and at what level it is currently located.

In addition to constantly monitoring the level of bilirubin in the blood, doctors monitor liver indicators to understand what is preventing its destruction. The level of bilirubin is determined as a result of a blood test, but the mother herself can conduct the so-called bilitest. To do this, just undress and carefully examine the child in good lighting:

1. Yellowness covered only the head and neck - the approximate bilirubin level was 100 mg/l.
2. If icteric skin also occupies top part torso – bilirubin level 150 mg/l.
3. The yellowness has spread to the abdomen and below - the bilirubin level is 200 mg/l.
4. The arms and legs turned yellow - the bilirubin level reached 250 mg/l.
5. If your feet and hands turn yellow, it’s time to sound the alarm - bilirubin is off the charts. This is a critical indicator that requires immediate intervention medical staff.
6. When the level of bilirubin in the blood rises above 300 mg/l, doctors diagnose bilirubin encephalopathy, or kernicterus. The fact is that bilirubin itself is quite toxic and dangerous for internal organs. If it exceeds the norm by more than 10 times, the nervous system suffers. This can lead to serious consequences. However, if you consult a doctor in time, a competent specialist will simply not allow such a dangerous excess of the norm.

Even if you conducted a bilitest yourself, you cannot do without a blood test. It is necessary to take into account not only the level, but also the ratio of direct and indirect bilirubin. These two indicators together make up the picture of total bilirubin. Direct (bound) bilirubin should be no more than 25% of total number. Indirect (free) bilirubin is formed during the breakdown of hemoglobin; it is more toxic than direct bilirubin. Direct bilirubin is formed in the liver and excreted from the body with bile.

Treatment of neonatal jaundice

Jaundice affects more than 60% of full-term babies and more than 80% of premature babies, as well as twins and children whose mothers suffer from diabetes. With adequate and timely treatment, jaundice goes away in 2-3 weeks without consequences. If your baby's skin is still yellow after 21 days, it may be due to the following:

• Diseases that provoke active destruction of hemoglobin. Usually these are various hemolytic diseases.
• For some reason, liver function is impaired (hereditary hepatitis, etc.).
• The functioning of the gallbladder is impaired.
• Sometimes prolonged jaundice occurs without a reason, so there is no need to be alarmed right away. The liver works differently in children, in some cases it just takes longer.

When the doctor has done everything necessary tests and identify the cause of jaundice, he will prescribe treatment. This should only be done by a pediatrician or neonatologist in the maternity hospital. Refusal of treatment or self-treatment a newborn baby is dangerous. Moms need to come to terms with the fact that the doctor still knows the situation better. There is no need to ask other mothers for advice or refer to older children. Sometimes the situation changes, so jaundice must be kept under strict control and all doctor’s recommendations must be followed:

1. Lamp. This is the most effective treatment for jaundice. When exposed to bright light, bilirubin in the skin is destroyed. For these purposes, an undressed baby is placed in an incubator under a lamp with special glasses or a blindfold so that bright light did not harm vision. Usually they lie under such a lamp from several hours to several days continuously. The lamp can only be removed for feeding, washing or massage.
2. Elkar. This is a drug containing L-carnitine. Pediatricians often prescribe it for jaundice, poor appetite, metabolic disorders. Elkar increases the liver's ability to detoxify, which allows it to break down bilirubin faster. This drug is released in drops. It can be taken from the first days of life.
3. Smecta or Enterosgel. These drugs do not affect bilirubin levels, but they play a supporting role. They are designed to interrupt the chain of circulation of bilirubin through the liver and intestines.
4. Ursofalk. This drug is prescribed if jaundice is associated with insufficient gallbladder function. Ursofalk has a choleretic effect. For newborns, it is available in the form of a suspension.
5. Hepel. It is antidiarrheal and choleretic drug, prescribed during jaundice to support the functioning of the liver and gallbladder.

Possible complications

Most often, jaundice goes away without consequences, but if the child already has congenital problems, complications are possible. In the case of Rh conflict between mother and child, the level of bilirubin in the blood rises quickly, which affects the brain. The most common complication of kernicterus is damage to the central nervous system, leading to childhood cerebral palsy, as well as encephalopathy, expressed by increased intracranial pressure, cerebral edema, cysts, cerebral hemorrhages, as well as brain immaturity.

Quite rare and most undesirable consequence is death. Kernicterus occurs in 4 stages:

• Oppression. The child becomes lethargic, apathetic, and does not breastfeed well.
• Excitation. The baby screams, arches his back, throws his head back.
• Imaginary well-being. There comes a period of calm when mothers think that everything is over and the child has finally recovered. However, this is not the case.
• Complication. Last stage it is most severe when the bilirubin attack affects brain cells, often resulting in cerebral palsy.
• Kernicterus requires effective treatment and constant monitoring. In the most severe cases, a replacement blood transfusion is performed. Such children need constant supervision by a neurologist, as well as rehabilitation and therapy that will help restore impaired body functions as much as possible.
• If a mother and child have a Rh conflict or a blood group conflict, complications such as deep violation metabolic processes may appear even before birth, in some cases leading to intrauterine death.

One of possible complications severe jaundice is caused by intravascular hemolysis, or in other words, decreased blood clotting, which is dangerous due to bleeding. If caused by biliary atresia (complete blockage) and was detected on early stage, the only method The treatment will be surgery.

Jaundice in a child is the topic of the video, from which you can learn more about this condition:

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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. ABOUT high rates First of all, it is indicated by a yellow tint of the skin.

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

What is bilirubin

This substance is a pigment that is formed in 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:

• hormonal imbalances;
• 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 be caused by certain medications, which 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 a ultraviolet device. 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 reverse suction bilirubin into 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 allergic reaction in a 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 flow of bile and eliminate symptoms loose stool, maintaining 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 may distort study results, including ascorbic acid and antibiotics.

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 diseases infectious nature.

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 the use of products traditional medicine only possible as 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;
• decline 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 preventive measures or in the absence of suspicion of jaundice.

Carry out this test special device who explores 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.