Obstructive jaundice in newborns: causes and consequences. Jaundice in newborns

At the moment of birth, the baby, entering a new environment, experiences severe stress. In the fragile children's body Minor disruptions may occur, leading to the phenomenon of jaundice in newborns. What is this, and should parents panic?

Why does jaundice appear?

Causes of jaundice in newborns

Most often, pathological jaundice affects children whose mothers had a difficult pregnancy, say, they were in danger of miscarriage, or had early or late toxicosis.

What else, besides this, can be the cause of the disease?

Hemolytic disease, which was caused by incompatibility of the blood of the baby and the mother according to the Rh factor.
Heredity.
Infection of a child's liver with a virus in the womb.
Underdevelopment of liver cells.
Reduced function thyroid gland- hypothyroidism.
Abnormalities in the bile ducts.
Premature birth in women with diabetes, including diabetes that only appears during pregnancy (gestational diabetes).
Introduction of oxytocin into the mother's body.
Giving the child antibiotics such as cefazolin or ampicillin.

How does the disease manifest? Tests for jaundice

In infants to change skin Additional manifestations of jaundice may appear. The baby's urine becomes dark in color, and the feces, on the contrary, become discolored. Bruises may appear on the baby’s body for no reason. The child’s general well-being worsens, while the liver and spleen enlarge.

If the baby's skin does not acquire a normal shade 2-3 weeks after birth, you need to consult a doctor for laboratory tests.

Before starting treatment, a test is prescribed to determine the amount of bilirubin in the blood. In full-term babies, the critical indicator is 324 µmol/l, and in premature babies it is only 150-200 µmol/l.

Since this value depends on several reasons, the doctor will prescribe treatment based on general condition baby. In addition, ultrasound is performed abdominal cavity in order to determine the condition internal organs, and also take samples for hemolysis.

How to treat jaundice in a newborn

If a child is diagnosed with a physiological form of jaundice, then we are not talking about treatment, but only about helping the little man.

What needs to be done to help the child cope with the problem that has arisen faster?

We need to start breast-feeding as soon as possible to promote improvement metabolic processes in the baby's body.
To prevent your baby from having digestive problems , mom must stick to a diet.
The baby needs to visit more often fresh air and, if possible, sunbathing.

Methods for treating jaundice in newborns

If pathological jaundice is detected, treatment of the infant should be started immediately.

Lamp against jaundice in a baby

This is a treatment based on the influence ultraviolet rays on the baby's skin. When irradiated with light under the skin of a child at a depth of 2-3 mm, chemical reactions, which convert indirect fat-soluble bilirubin into its water-soluble form - lumirubin. It dissolves freely in the blood of the newborn and is excreted from the body in the urine.

Phototherapy is carried out in a hospital under the supervision of a doctor and compliance with certain rules...

The baby's eyes are covered with special glasses or a bandage.
Time treatment session strictly regulated; for this purpose, the lamp is equipped with a timer.
The procedure can cause peeling of the skin and dehydration of the body, so it is carried out under the constant supervision of a medical professional.

After phototherapy sessions, the child's stool color and character may change. This is normal, as excess bilirubin is excreted from the body in the baby's stool.

Together with phototherapy, the doctor may prescribe infusion therapy. It will be needed to restore water balance. This may be a glucose solution, membrane stabilizers, electrolytes and drugs that improve microcirculation.

Medicines to help with treatment

One of the medicines is Hofitol - a preparation that contains an extract from the leaves of the field artichoke. It improves liver function, promotes the rapid removal of bile and a significant reduction in the level of bilirubin in the baby’s body. Ursofalk has a similar effect on the body. Little babies are prescribed medicine in the form of a suspension.
As aids enterosorbents are prescribed, such as Polyphepan, Smecta or Enterosgel . The drugs limit the circulation of bilirubin between the liver and intestines.
To stimulate metabolic processes and strengthen the immune system, children are prescribed Elkar - a product consisting of carnitine. The drug breaks down fatty acid, helping to produce additional energy in the baby’s body.

When is a blood transfusion necessary?

Blood transfusions are used for severe forms of pathological jaundice. If indirect bilirubin levels quickly increase and significantly exceed the norm, then an exchange blood transfusion cannot be avoided. Most often, the procedure is performed when a Rhesus conflict occurs.

Exchange blood transfusion involves replacing a small amount of a child's blood with donor blood. This helps flush bilirubin from the baby’s body.

Folk remedies in the treatment of jaundice

Under no circumstances should you risk the health of your newborn and self-medicate! Folk remedies can only be used as an addition to treatment prescribed by the attending doctor and only with his approval.

To improve the general condition of the newborn, you can resort to a strengthening agent, the role of which can be played by a weak rosehip decoction. Can be given to a child as an absorbent Activated carbon by dissolving in water an amount of powder corresponding to its weight.

You should not give your baby any medicinal fees as a diuretic and cholagogue. No one can say for sure how the child’s body will react to them.

Why is jaundice dangerous - the consequences of the disease

If physiological jaundice passes quickly, leaving no trace in the little person’s body, then the pathological form of the disease can cause serious consequences.

For kernicterus The child’s nervous system is affected, which leads to serious neurological abnormalities. In addition, the child may experience deterioration in hearing and vision, and in the most severe cases, develop cerebral palsy. In rare cases, the disease can lead to paralysis of the sick baby.

If the jaundiced color of the baby’s skin does not subside in due time, consult a doctor immediately. If a baby has jaundice in a pathological form, it needs to be treated immediately.

Video about jaundice, Komarovsky:

Don't be scared! Despite the severity of the name, “jaundice in newborns” is by no means a disease, but just physiological symptom certain processes that occur in the baby’s body while he adapts to new living conditions. What to do with a “golden” child, how exactly physiological jaundice occurs in infants, is it possible Negative consequences We will look into this phenomenon and whether jaundice in newborns requires any treatment.

Jaundice in newborns: why did my baby turn yellow?

For the sake of your maternal peace of mind, let us repeat: the fact that your newborn baby suddenly turned orange on the second or third day of life should in no way make you nervous or frightened. Jaundice in newborns is not a disease! This is just an indicator (a kind of marker) of certain physiological processes, which occur in the child’s body due to his “moving” from the mother’s womb into the light of day.

In order to understand exactly how the skin of a newborn changes color from romantically pink to hysterically yellow, it makes sense to recall some paragraphs school course anatomy:

The mechanism of jaundice. In human blood there are special red blood cells - erythrocytes, whose task is to carry oxygen and carbon dioxide throughout the body. Every day, approximately 1% of all red blood cells that rush through our body die (the lifespan of each red blood cell no more than 120 days). When these cells collapse, they release a substance contained inside red blood cells - bilirubin - a special yellow pigment that is actively involved in hemoglobin metabolism. Bilirubin itself is a rather dangerous and toxic substance for internal organs, so normally, as soon as the blood brings it to the liver, it is immediately neutralized by special liver enzymes. Medical language The process of neutralizing the harmful yellow pigment in the liver is called “bilirubin conjugation.” The neutralized bilirubin then passes through the bile ducts and is eliminated from the body by the excretory system.

If any link in this chain of formation and excretion of bilirubin is disrupted, the level of this substance increases, the yellow pigment penetrates the skin, coloring the face and body in “autumn tones.” And if we were talking not about newborns, but about older people, then we should consider jaundice as an obvious symptom of a serious disease (for example, liver disease like hepatitis, acute poisoning, intoxication, inflammation of the gallbladder, stagnation bile ducts and so on.).

Physiological jaundice in newborns is within normal limits

But jaundice in newborns is most often physiological norm. The point is that a child, as soon as he is born, has a very high level hemoglobin, which begins to sharply decrease in the new living conditions of the baby. In addition, a newborn baby has a not yet fully formed “army” of liver enzymes. In other words, in the first days of life, the newly born baby is simply physically unable to cope with the high level of bilirubin in her blood. That is why the baby is rapidly turning yellow.

At least 60% of absolutely healthy full-term newborn babies on the second or third day of life are “colored” in yellow. This is normal and does not threaten the child with any harm. In medicine there is even a term - physiological jaundice newborns. Physiological means natural, normal, without pathology.

So, even if you are in this 60%, there is no reason to be afraid. And if it so happens that the child was born premature (which means that he has even fewer capable liver enzymes than a healthy toddler), then you have an even greater chance of admiring his yellow color - 80-90% of all babies born ahead of schedule, experience physiological jaundice of newborns.

Those at risk for jaundice in newborns include babies whose mothers have diabetes, as well as twins (twins, triplets, etc.)

Normally, jaundice in a newborn baby should go away within two to three weeks. But what to do in cases where the child turns yellow naturally, but doesn’t seem to be going back to pink, even after three weeks?

Why does a baby's jaundice not go away after 21 days?

If the “golden” color of the baby’s skin has not disappeared in three weeks (which means the process of neutralizing toxic bilirubin by liver enzymes has not improved), it is necessary to mandatory consult a doctor who, with the help of analyzes and tests, will determine at what stage of the bilirubin “existence” cycle in the baby’s body malfunctions occur and why. The reasons can be, relatively speaking, dangerous. For example:

1 As a result of any disease in the child, the destruction of the red blood cells of his blood occurs intensively and constantly (for example, with hemolytic disease, which often develops in children whose Rh factor differs from the maternal one). Accordingly, the level of bilirubin in the blood is constantly increased.
2 The liver’s function has not developed properly (for example, due to hereditary hepatitis). In this case, jaundice is rightly called hepatic.
3 Normally, after bilirubin is neutralized in the liver, it enters the gallbladder and is excreted from the body through the bile ducts. Often, jaundice in a newborn does not go away due to disruption of the functioning of this particular organ. For example, a baby may have an obstruction biliary tract- in this case, jaundice is called mechanical.

If the cause of jaundice in a newborn lies in one of these serious diseases, then with the help of special analyzes and tests, doctors will determine this and prescribe adequate treatment, in which it will not be the symptom itself that will be treated, but the disease.

Physiological (that is, absolutely normal, harmless) jaundice in newborns can also last more than three weeks - in some babies the liver enzymes quickly “master their purpose”, in others - more slowly.

Jaundice in newborns can last for over 21 days and for no reason at all. After all, every baby is individual and you can’t predict exact dates, when he learns to walk, when he learns to talk, and when his liver learns to process bilirubin, not a single child’s “aesculapian,” even the most outstanding genius from medicine.

As a caring and intelligent parent, you must understand that a newborn baby (as well as an older child) is in itself an excellent indicator of its physical condition. Simply put, if your baby has turned yellow and has continued to stay that sunny tone for over three weeks, but he is not showing any signs of distress - not crying, eating with appetite, gaining weight, regularly filling his diapers and sleeping soundly, then there is no reason You shouldn’t have to worry about prolonged jaundice.

The only thing you need to do is, with the help of an experienced and observant pediatrician, begin to regularly monitor the level of bilirubin in your baby’s blood.

Jaundice in newborns - consequences for everyone

During those couple of weeks, while the level of toxic bilirubin in the newborn’s blood was elevated and his skin had a “golden” tint, nothing bad could happen to the child. Although bilirubin is toxic, its amount (even though it is elevated in the baby during this period) is still not enough to cause significant harm to the baby.

But if the jaundice has prolonged and gone beyond 21 days (which means the level of bilirubin in the body continues to remain high), it is imperative to contact a pediatrician and put the baby’s bilirubin “on the counter” - that is, it must be constantly measured and monitored. If the bilirubin level remains above normal, but does not tend to increase, there is no need to be alarmed; under the systematic supervision of a reasonable doctor, such jaundice does not threaten the child with any serious consequences.

Jaundice in newborns can pose real problems only in those situations in which the level of bilirubin in the blood rises 10 times higher than normal and has a progressive tendency to increase. In such cases, damage may be caused to the baby’s central nervous system, his liver, etc. But if you consulted a pediatrician in time, no responsible doctor would simply allow such a development.

Critical indicators of bilirubin in the blood are for full-term and premature infants, respectively: 324 µmol/l and 250 µmol/l. You, parents, do not need to know these numbers; the main thing is that the doctor observing the condition of the newborn remembers them.

Treatment methods for jaundice in newborns

It is not entirely correct to talk about the treatment of jaundice itself in the context of newborns - since this, as has already been said fifty times, is not a disease, but only a symptom.

If jaundice is a symptom (indicator or consequence) of some serious disease, then, naturally, it is not jaundice that is treated, but this very disease. But no disease can be cured overnight, and there are situations when, simultaneously with therapy, it is necessary to reduce the level of bilirubin in the blood, which is dangerously “creeping” to a critical level.

Even 15-20 years ago, in a situation where the level of bilirubin became alarmingly dangerous and could cause irreparable damage to the baby’s central nervous system, the child was given an exchange blood transfusion.

Today, this method of treating jaundice in newborns is also used, but only in extreme cases. And in less severe situations last decades practice another effective method fight against increased bilirubin- a bright lamp!

Phototherapy for jaundice: let there be light!

Scientists made this discovery by accident - during medical research It was discovered that toxic bilirubin in human skin begins to actively break down under the influence of bright light rays, turning into a non-toxic isomer. This is how the most common method of treating jaundice in newborns today was “born” - phototherapy.

The point is simple: if the baby’s bilirubin level is elevated and no positive dynamics are observed, he is laid out naked, but with protection over his eyes, under a bright lamp: sometimes for several hours a day, sometimes for several days (around the clock with breaks only for feeding and hygiene and massage).

The phototherapy method is good, safe and very common. He returned many children to their usual skin color, and their parents - peace of mind.

Breastfeeding jaundice: mother gilded

There is another type, fortunately, completely safe jaundice, which can be observed in newborns and which can last more than three weeks. This is the so-called jaundice natural feeding. As the name suggests, it only happens to babies who are fed their mother's milk.

The bottom line is this: there is a substance in mother’s breast milk that blocks the action of liver enzymes in the baby.

Not a single “sane scientist” has yet managed to figure out why nature came up with this mechanism. Nevertheless, it works and is very active - many infants turn noticeably yellow in the first days of life precisely because their mothers’ milk “slows down” the activity of enzymes in the child’s liver.

Moreover, this type of jaundice, as a rule, smoothly “takes over” from physiological jaundice and can last much longer than 21 days completely safely for the baby.

If you are scared and at all costs want to make sure that your “orange” baby has safe breastfeeding jaundice, and not some kind of symptom dangerous disease- Stop breastfeeding for 1-2 days (give formula). If the yellow color of the skin noticeably brightens, this is what it is, you can calm down and return your baby to his natural nutrition.

Jaundice in newborns: Epilogue

Despite the fact that the child is entirely yours, it is not you who should decide what to do with him if he turns yellow. And the health workers. And deal with it.

Find out whether your baby’s jaundice is dangerous (that is, is it a symptom of a serious illness?) or completely harmless, treat it or be patient and just wait, and if treated, then in what way - only a pediatrician can decide all these questions. Your task is to present your newborn to him for examination and tests.

Because in the case of jaundice in newborns, the probability of making a mistake is very high: it can be completely normal physiological state taken as a symptom of a serious illness, and vice versa. Are you really ready to guess if the health of your beloved, “golden” in every sense of the word, baby is at stake?

Jaundice appears in newborns due to the natural process of increasing the level of bilirubin, liver disease, conflict between the Rh factor and blood group, or even breastfeeding. According to statistics, jaundice occurs in approximately 60% of full-term and 80% of premature babies. Newborns turn yellow in the first 2-3 days after birth, and if they have health problems, the symptoms are delayed. Typically, physiological jaundice should go away within 10 days after onset. Jaundice can be identified by the color of the baby's skin, eyes and mucous membranes.

Symptoms, causes and signs, treatment and diagnosis of jaundice

Consequences of prolonged jaundice:

toxoplasmosis,
rubella,
herpes simplex.

Doctors carefully pay attention to the baby’s navel, check the throat, do pharyngeal swabs, advise doing a urine test, checking platelet levels, and may even apply spinal tap, chest x-ray.

List of risks for developing jaundice:

The newborn has a low birth weight, for example: premature birth may cause jaundice.
Breastfeeding is an excellent prevention of this disease.
If parents have already had newborns with jaundice, it is likely that you will not avoid it this time. Doctors, in such cases, recommend undergoing phototherapy.
It is easiest to get sick in the first days after birth.
Infants whose mothers have diabetes.
Boys get sick more often than girls, as do children from East Asia.
People living at high altitudes.

Causes

The main cause of jaundice is an increase in the level of bilirubin in the blood (a product of natural hemoglobin metabolism) of the newborn.

Without treatment, jaundice will lead to severe forms symptoms. IN healthy body substance (bilirubin) is produced in small quantities. It is then “processed” in the liver and excreted through the intestines through the hepatic and bile ducts. So, failures in bilirubin metabolism can occur at all stages.

If there is a Rh conflict between mother and newborn, jaundice may occur. The mother has Rh minus, and the child has Rh plus - this is a group conflict.

Types of jaundice disease

suprahepatic,
Hepatic,
Subhepatic.

Prehepatic jaundice

In a newborn, red blood cells are destroyed in the blood, resulting in the accumulation of bilirubin. This picture is observed in hemolytic anemia, malaria, etc.

Hepatic jaundice in a baby

It is characterized by a violation of bilirubin metabolism directly in the liver of newborns. Caused by some infectious diseases(mononucleosis, ), toxic damage liver (including medicines), and oncological processes.

Subhepatic jaundice in an infant

Physiological jaundice in newborns

Associated with increased red blood cell shortages and immature liver function in the newborn. Jaundice develops over 2 or 3 days and begins to disappear by the end of the first week. You can recover completely by the 10th day of illness.

What should be the norm of bilirubin in newborns?

The normal bilirubin level in newborns with jaundice usually does not rise above 200 µmol/l and the health status remains satisfactory. However, it can be much higher if the baby is born prematurely or if there is increased breakdown of red blood cells - for example, extensive bruising, kephalocheamatoma.

Early neonatal jaundice

Neonatal jaundice most often develops within 24 hours after the baby is born. If it develops on the first day after birth, medical workers this will be noticed, but if the mother already notices discomfort at home, then she should immediately consult a doctor. If your newborn has a yellowish skin color, you should not wait until the symptoms go away on their own.

Causes of neonatal jaundice

Hemolytic: for example, disease (Rh factor), ABO incompatibility, glucose-6-phosphate dehydrogenase, spherocytosis. Infection: Congenital (eg, toxoplasmosis, rubella, cytomegalovirus (CMV), herpes simplex virus, syphilis) or postpartum infection.

Increased hemolysis due to hematoma.
Maternal autoimmune hemolytic anemia: for example, lupus erythematosus.
Crigler-Najjar syndrome or Dubin-Johnson syndrome.
Gilbert's syndrome.
Neonatal jaundice appears on the face of a newborn. Progresses over time and spreads throughout the baby's body

Protracted jaundice is considered if the disease in a newborn does not go away for longer than 14 days in full-term infants, and 21 days in premature infants.

The main causes of lingering jaundice are:

Infection in the newborn, such as a urinary tract infection.
Hypothyroidism, hypopituitarism.
Galactosemia.
A breastfed baby feels fine, and the illness usually resolves by the sixth week, but sometimes lingers for an additional four months.
Gastrointestinal (GI): biliary atresia, common bile duct cyst, neonatal hepatitis.

How to treat prolonged jaundice

Pay attention to the condition of the urine - pale or brown with a film means that the newborn baby has problems.
Measure your bilirubin level.
Complete FBC.
Blood tests should also be done for both mother and baby, as well as a direct antiglobulin test (DAT, or Coombs test). Interpret the result taking into account the strength of the reaction, and also pay attention to prophylactic anti-D immunoglobulin drugs during pregnancy.
Do a urine test.
Make sure your doctor does a metabolic screening (including for congenital hypothyroidism).

Conjugation jaundice

Causes

Infection.
Parenteral nutrition.
Cystic fibrosis.
Metabolic: alpha-1-antitrypsin, galactosemia, amino and organomedicines.
GI: biliary atresia, biliary cyst, neonatal hepatitis.
Endocrine: hypothyroidism, hypopituitarism.

Signs of jaundice

In most cases, parents are encouraged to go for a medical examination by the yellowish color of the newborn’s skin. A more severe form of jaundice may also include the symptom of unexplained drowsiness.

Typically, measuring the normal level of bilirubin in the blood is the only way identify jaundice. Tests are taken from the newborn on the second or third day without fail. After the first test, even if the results are negative, parents should always be on alert and visit a doctor as soon as the first signs of jaundice are suspected.

Jaundice occurs more often in breastfed newborns than in those who are fed special formulas, but in most cases with improper feeding. You should feed your baby 8 to 12 times throughout the day.

Neurological signs of jaundice

Changes muscle tone, cramps and crying of the newborn require immediate attention to avoid the consequences of jaundice.

Hepatosplenomegaly, petechiae, and microcephaly are associated with hemolytic anemia, sepsis, and congenital infections.

Hepatitis (eg congenital rubella, CMV, toxoplasmosis) and biliary atresia appears due to increased level bilirubin in the blood of newborns. If parents notice that the child's urine has become very pale or brown, has a sharp, bad smell, this can especially often happen in the third weeks of the baby’s life, you should go to the hospital.

How to identify jaundice in a newborn baby?

Undress the newborn and place him under bright light, preferably natural. To determine jaundice during examination, doctors use sclera, make smears and check the condition of the child’s skin. Parents should not rely on visual examination, as this will not determine the level of bilirubin in the baby's blood.

Jaundice and normal bilirubin

Use the transcutaneous bilirubinometer for newborns with a gestational age of 5 weeks or more, or for babies within 24 hours of birth. If bilirubinometer measurements indicate that the bilirubin level is greater than 250 µmol/L, further check the results by measuring the serum level.

Always use serum measurement to determine bilirubin levels in newborns:

In the first 24 hours of life.
Infants are less than 35 weeks of gestation.
Always use the serum substance measurement for infants. This is one of the most universal methods and is suitable for all age categories.
Do not use an icterometer.
If there are no visible signs of jaundice, normal testing should not begin.

Treatment of jaundice

The newborn needs to increase fluid intake. The disease usually goes away naturally without drugs, but in severe cases, droppers can also be used. If you are not breastfeeding, seek help from pediatrician, nurse, or lactation specialist. Breast milk is the ideal option for feeding a baby.

Phototherapy

The indications and use of phototherapy for jaundice vary according to the level of hemoglobin in the newborn's blood, its rate of spread, and the date of birth.

Phototherapy should be started immediately, preferably within the first 24 hours after the development of jaundice. It is in such cases that it will have the greatest effect on the newborn.

The earlier the baby is born, the higher the level of bilirubin in the blood should be. Prophylactic phototherapy to prevent jaundice in preterm or low birth weight infants helps maintain more low concentration bilirubin in the blood and can have an effect on metabolism and cause the risk of developing nervous disorders.

Essential care includes ensuring maximum impact on the skin, providing eye protection for the newborn, maintaining thermoregulation at the proper level, as well as hydration.

Treatment of jaundice with LEDs

The light source in phototherapy is effective in reducing serum bilirubin levels in newborns, which is similar to conventional light such as a compact fluorescent lamp (CFL) or halogen.

The main complications of phototherapy are separation from the mother, dehydration (fluid intake should be increased) and loose stool. Usually not performed in cases of hyperbilirubinemia because this method cannot cure a newborn with very severe forms of jaundice.

Exchange blood transfusion through arteries, umbilical cord or veins; signs of jaundice depend on clinical condition(babies with health problems receive transfusions earlier), the rate of increase in bilirubin and the gestational age of the newborn. The National Institute for Health and Social Excellence (NICE) recommends using exchange transfusions twice (a double estimate of the total blood volume is removed and replaced) for treatment.

How to treat jaundice

In many cases, jaundice does not require drug treatment. A naked newborn should be placed under a special light, which will reduce the level of bilirubin in the blood. Depending on the amount of bilirubin, the procedure takes place in the hospital or at home. The disease is treated with early stages when the child’s brain is not yet damaged.

You should not place your newborn in direct sunlight - this is an unsafe way to treat jaundice. This method will help reduce bilirubin levels, but will only work if the baby is naked. The method is unsafe for treatment at home, since the little one will freeze. The baby should not be left in direct sunlight, as he will get burns.

During an exchange transfusion:

You should not use phototherapy.
It is best to do the entire transfusion at one time.
Use albumin.
Administer intravenous calcium regularly.

After exchange transfusion:

It is possible and even necessary to continue phototherapy sessions.
Measure your serum bilirubin level within two hours of the transfusion and compare results based on the values in the table.

What mom needs to know about jaundice in the first 24 hours

Jaundice occurs in newborns due to serious health problems, for example, infection, hemolytic disease or metabolic disorder. Any baby with jaundice in the first day of life should remain in the hospital until complete recovery.

If jaundice persists for more than 3 weeks, you should consult a doctor. Follow expert advice and remember that the level is more than 290 µmol/l. indicates serious liver disease in the newborn.

The whole family waits for the birth of a newborn for 9 long months. During the long 40 weeks of pregnancy, the baby was in sterile conditions under the protection of the mother’s body. It is not surprising that in the first months of birth the child’s body is in a state of constant stress. Such stress factors include newborn jaundice. Experienced parents know what this is normal condition the child’s body during the adaptation period, but there are mothers who are very worried about whether infantile jaundice is dangerous. But there are cases when the postpartum yellow tint of a baby’s skin is considered dangerous and requires treatment from an experienced pediatrician.

Classification of species

Experts highlight the following types jaundice in a newborn:

Physiological. After a certain period of time it disappears without a trace. Such a child does not need treatment.
Pathological. Occurs as a manifestation of certain diseases. Requires constant medical monitoring and treatment.

Causes

Why do newborns develop physiological jaundice?

Yellowish skin color occurs after birth and appears on the 3rd day in approximately 65% of babies. In the womb, the fetus could not breathe on its own, so erythrocytes (red blood cells) brought oxygen to its cells. After birth, the child’s body is in full swing with work in all systems and organs. But we are interested in jaundice, so we will now understand its causes step by step.

The baby is born and the red blood cells with hemoglobin that supplied him with oxygen are destroyed as unnecessary.
As a result of destruction, free (indirect) bilirubin is produced, which has an insoluble composition and cannot be excreted in the child’s urine. This type bilirubin is very toxic.
A special protein transports bilirubin to liver cells.
As a result of a series of biochemical reactions, bilirubin is converted into direct bilirubin.
The child's body is cleared of direct bilirubin through the kidneys and intestines.

Due to the immaturity of the bilirubin-conjugating system, the process that we discussed above (or rather not the entire process, but steps 3-5) can take several days or even several weeks.

What causes the skin to turn yellowish:

intrauterine fetal hypoxia;
asphyxia;
diabetes mellitus in mother;
the mother has 1 blood group, and the child has 2 or (slightly less often) 3 blood groups;
intrauterine infection;

Causes of pathological jaundice:

Incompatibility by blood group or Rh factor.
Diseases of the circulatory system.
Diseases of the liver parenchyma or biliary tract.
Hormonal disorders(in this case, treatment is carried out by an endocrinologist).
Intestinal diseases (When bilirubin from the intestines is absorbed back into the body. In this case, only surgeons can help.)
Genetically determined disorders.

Norms

If the bilirubin level in the first three weeks of a full-term baby exceeds 256 µmol/l, and in a premature baby - 172 µmol/l, then the newborn is diagnosed pathological jaundice and an examination in a hospital is necessary to determine the cause and prescribe treatment.

It is worth noting that the test results indicate 3 indicators of bilirubin:

straight,
indirect,
general.

The ratio of direct and indirect bilirubin in a newborn baby is usually disturbed and differs from the norm: direct - 1/4, indirect - 3/4.

How long does jaundice last, why is it dangerous?

The bilirubin secretion system gradually improves and usually after 6-7 days, maximum 14-21 days, the yellow color of the skin disappears without a trace. Physiological jaundice is not dangerous and there will be no consequences after it. If the child is breastfed, the process of removing bilirubin is more intense.

Complications also sometimes occur. They are associated with the toxic effects of indirect bilirubin on the CNS (central nervous system) of the newborn.

Kernicterus

Not all substances contained in the blood are sent through circulatory system into the brain. There is a brain blood barrier that is responsible for keeping the brain safe from toxic substances. Thanks to this barrier, physiological jaundice does not cause damage nervous system and brain cells are not destroyed. But when bilirubin levels are very high, it can enter the brain and cause destruction nerve cells. This process is called kernicterus. It is clear that when this state the child urgently needs medical care. There are several stages of kernicterus:

The newborn is lethargic, does not take the breast, and does not show any activity.
The head tilts back and the child screams monotonously.

The exact numbers at which the baby’s condition will definitely deteriorate are not known. There are standards, deviations from which may indicate that the risk of damage to the nervous system is very high. If the baby is more than 3 days old and the bilirubin level is 380, this is very dangerous condition! Indicators above 250 µmol/l require treatment.

IMPORTANT! If the bilirubin level is above 290, the child needs urgent medical attention.

When jaundice does not go away for more than a month, but the bilirubin level is not higher than 117 µmol/l, this condition does not require hospitalization of the baby, but it should alert parents. Such prolonged jaundice cannot be physiological and most likely has another cause, which the pediatrician must find out.

IMPORTANT! If the yellowish skin color remains for more than 3 weeks, the baby's urine is dark in color, and the stool is discolored, this is a sign congenital disease biliary tract.

Obstructive jaundice

This type occurs when there are disturbances in the functions of the outflow of bile. Causes:

bile duct cyst;
ring-shaped pancreas;
atresia (underdevelopment) of the bile ducts.

Analyzes

If jaundice persists for a long time, it is necessary to determine the cause of this condition. To do this, a number of analyzes are carried out:

general analysis blood;
level determination total bilirubin and its fractions in blood serum;
liver function indicators;
hemolysis tests (Coombs test);
Ultrasound of the abdominal organs;
consultation with a surgeon, endocrinologist or other specialist as necessary.

Treatment

Phototherapy (light therapy). On this moment the most the best remedy for the treatment of jaundice. Phototherapy is carried out continuously, the baby is given to the mother only for feeding. Possible complications which can cause this method: skin burn, lactose intolerance, dehydration, hemolysis, hyperthermia and sunburn.
Infusion therapy. Needed for recovery water balance with phototherapy. These are glucose solutions + membrane stabilizers, soda, electrolytes, cardiotrophics, preparations for microcirculation.
Inducers of microsomal liver enzymes (Phenobarbital, Zixorin, Benzonal). This therapy used for disorders of the bilirubin-conjugating system. Phenobarbital course: 5 mg/kg per day, 4-6 days. Sometimes another regimen is used: 20-30 mg/kg on day 1, then 5 mg/kg for the next up to 6 days. But high doses have a strong sedative effect and respiratory impairment, so the first regimen is more often used.
Enterosorbents (Smecta, Polyphepan, Enterosgel, etc.) are needed to interrupt the circulation of bilirubin between the intestines and liver. This helper method, How self-treatment does not apply.
Replacement blood transfusion. It is carried out when there is a threat of kernicterus.
For symptoms of cholestasis, the drug Ursofalk is used. It is available in the form of a suspension and is not contraindicated in newborns. The initial dose is 15-20 mg per kg of child weight per day. The dose can be increased to 40 mg per kg. If treatment is long-term, the dose is reduced to 10 mg/kg.
Replenishment is also sometimes necessary fat-soluble vitamins(D 3, A, E, K), microelements (calcium, phosphorus, zinc sulfate).
There is no treatment for Alagille syndrome, a nonsyndromic form of intrahepatic bile duct hypoplasia, or perinatal sclerosing cholangitis. If cirrhosis of the liver develops, a transplant of this organ is necessary.
At metabolic disorders use conservative methods treatment. If a child has galactosemia, then you need to use mixtures that do not contain galactose and lactose (for example, NAN lactose-free, Pregistimil, Nutramigen). If a baby has tyrosinemia, then he needs a diet that does not contain tyrosine, methionine and phenylalanyl (lofenolac, Aphenilac, HR Analogue, HR Analog LCP, etc.)

Every loving and attentive mother always notices even the most minor changes in her child’s body. What can we say about the change in skin color in unusual color. But don’t be immediately alarmed when you notice a yellowish tint to your child’s skin and eyes. After all we're talking about not at all about a terrible and life-threatening disease, but about a natural process in the body of a newborn - physiological jaundice.

First, let's figure out what are the causes of physiological jaundice in newborns and whether everything is really so scary. To understand the entire mechanism of occurrence (pathogenesis) of physiological jaundice in newborns, we will need to delve into biology and directly into anatomy in order to compare the functioning features of the liver of an adult and an infant.

Pathogenesis and norm of bilirubin in physiological jaundice in a newborn baby

The human body is supplied daily with oxygen and carbon dioxide, and this is done thanks to erythrocytes - red blood cells. Red cells are constantly renewed, and old red blood cells break down into molecules, releasing a special substance - bilirubin - a yellow pigment that is excreted by the liver. It is the cause of physiological jaundice. Since the liver of a newly born child is not yet functioning properly, it is not able to cope with such a high amount of bilirubin. This is why the baby's skin and eye sockets acquire such an unusual color. Indeed, any doctor will say that at a certain period physiological jaundice of newborns is considered normal.

An interesting fact is that physiological jaundice can be observed in 60-70% of healthy full-term newborns. After some time it passes without a trace and does not pose any further danger. If a child was born premature, then the opportunity to observe such a “colorful” baby is 80-90%. Twins and children whose mothers are sick have the same chances.

At the same time, the norm of bilirubin for physiological jaundice for a full-term newborn at 14-21 days is 90-120 µmol/l, for a premature one – 65-90 µmol/l.

Date of appearance and when physiological jaundice disappears in full-term and premature newborns

The timing of the appearance of physiological jaundice differs: in full-term infants it appears already on the second or third day after birth, in premature infants - on the fifth or seventh.

The signs of physiological jaundice are specific, so let’s look at what exactly in the child’s condition indicates this process:

Coloration of the skin and mucous membranes in an orange tint.
The extinction of the process occurs on the 7-10th day of life.
Disappearance of symptoms at 2-3 weeks of life in full-term infants, at 3-4 weeks in premature infants.
Absence of disturbances in the general condition of the child.
Hemoglobin and red blood cell readings are normal.

First of all, the face is painted yellow, then the neck, torso and limbs. A decrease in bilirubin levels is characterized by a change in the color of the legs first, then the torso, limbs, and lastly the face and neck. Taking into account the symptoms, we can say that it is quite simple to diagnose physiological jaundice.

The duration of physiological jaundice in newborns may vary. For example, breastfed children have an advantage; for them the process will take less time. Naturally, any parent wants to know when physiological jaundice in newborns goes away. Around day 6-7, the skin already accepts normal look, after a maximum of 14-21 days, not a trace of the yellow color of the integument is visible.

Treatment of physiological jaundice in newborns at home

Another frequently asked question is what treatment is prescribed for physiological jaundice. In fact, no drug intervention is needed. Since this is a natural and absolutely normal process, no medical assistance is not required, and all symptoms will disappear on their own. But given the full term and weight of the child, treatment of physiological jaundice of newborns is sometimes used. In rare cases, light and phototherapy is prescribed, but only when the indicators are dangerous, according to doctors. Modern specialists have practically abandoned therapy this phenomenon Therefore, parents treat physiological jaundice of newborns at home. Firstly, they increase the duration of the baby’s stay in the fresh air and try to walk with him longer. Secondly, of course, breastfeeding is used. Breast milk increases the baby's immunity and gives him the strength to improve the body's functioning.

It’s a completely different matter if after 21 days the symptoms have not disappeared and no changes are observed. Here we are talking about prolonged physiological jaundice in children of the first year of life

This term defines the preservation of this disease in a child older than 1 month and does not apply to newborns (up to 28 days of life). Normally, by about 2-3 weeks, the jaundice of the first days of life “goes away”, the baby’s skin and mucous membranes acquire a normal color. In some healthy children this does not happen, and jaundice of the skin and/or mucous membranes can last up to 1-3 months of life. In most cases, this course is not a pathology.

In short, the cause of prolonged jaundice in healthy child is the functional immaturity of liver enzymes that “process” bilirubin, which in turn is subsequently excreted with bile through the intestines. As you already understand, the causes and consequences of physiological jaundice in newborns is a broad topic of discussion.

Causes of prolonged conjugation jaundice

In children in the first month of life there are different types of this disease. One of them is conjugation. With this type of disease, the accumulation of bilirubin in the body is associated with a violation of the conversion of its indirect fraction into a direct one. Usually this type of this pathology appears on the third day of life. In this case, no enlargement of the spleen or liver is observed. Stool and urine are also colored Orange color. If your child continues to have icteric skin discoloration and unusual behavior: lethargy, drowsiness, breast refusal, poor weight gain, parents should contact their local pediatrician.

Long-term persistence of icteric skin discoloration in a newborn requires mandatory examination. It must certainly consist of a general blood test, determination of the level of total bilirubin and its fractions in the blood serum, liver function indicators, a general blood test, a hemolysis test (Coombs test), ultrasound examination abdominal organs, and, if necessary, consultation with specialists to clarify the diagnosis and timely treatment.

In case of prolonged conjugation jaundice, the child should be carefully examined. The causes can be either improper feeding or infection.

The neonatal form is one of the types of conjugation pathology. For the most part, this is a physiological manifestation, but there are also pathological cases. Exist various reasons occurrence of this condition:

heredity;
birth injury;
asphyxia;
Availability diabetes mellitus at the mother's;
, or ;
sepsis, etc.

As a rule, physiological neonatal jaundice in a child goes away on its own in the third week of the newborn’s life. If we are talking about pathological prolonged neonatal jaundice, then clinical picture will look a little different:

It appears already on the first day of the baby’s life and lasts more than 3 weeks.
The level of bilirubin in the blood is very high.
The liver and spleen often become enlarged, stool may become discolored, and urine may become dark in color.
Sometimes bruises and pinpoint hemorrhages spontaneously appear on the skin of a newborn.

Clinical manifestations of prolonged jaundice:

Body weight loss and gain per month is less than 500 g.
Unusually "big belly".
Frequent heavy regurgitation that appeared at 3-4 weeks, especially accompanied by weight loss.
Unusual skin color or shade against a background of jaundice.
Changes in the child’s consciousness, either acute or increasing: drowsiness, lethargy of the child.
Prematurity or immaturity.
The appearance of jaundice in a bottle-fed baby.
The appearance of jaundice after several weeks of its absence.
Predominance in biochemical analysis blood direct fraction of bilirubin or an equal ratio of direct and indirect fractions.
Any diseases that are identified during the examination.
, especially with a high level of reticulocytes.

Treatment and consequences of prolonged neonatal jaundice

To understand what treatment to prescribe for prolonged neonatal jaundice, it is necessary to conduct a number of studies to determine the cause of the disease. A general blood and urine test, an x-ray of the abdominal organs, consultation with a surgeon and gastroenterologist, a blood test for hormones, as well as serological diagnostic methods are prescribed. Only after receiving the results can the pediatrician prescribe appropriate therapy.

Oddly enough, due to the naturalness of its phenomenon, physiological jaundice in newborns does not cause any consequences. It passes after some time without any changes in the body. But in some cases there are also negative phenomena. Pathological prolonged jaundice in newborns can even cause the following serious complications:

Toxic poisoning of the brain and nervous system.
The emergence of a nuclear disease state.
Involuntary muscle contractions (in later stages).

All these consequences depend primarily on the cause of prolonged jaundice, the correct established diagnosis, treatment and whether the pathology was diagnosed on time. Don't miss out!

Infants with prolonged jaundice can be examined on an outpatient or inpatient basis. Such children should be hospitalized in the pediatric department. Mandatory inpatient examination(round the clock) are required only by children with significant body weight deficiency, with severe jaundice (according to a blood test, a high level of bilirubin) and identified diseases.

If a child has insufficient weight gain, the first thing to do is improve nutrition. Most often, after achieving optimal gains, jaundice goes away on its own, if it is not associated with any disease. Positive weight gain can be achieved by correcting the organization of breastfeeding (more frequent feedings, correct attachment, etc.). If this cannot be done, then it is necessary to supplement the baby with expressed milk. breast milk or adapted mixtures. If insufficient gains are associated with some disease, then the latter should be treated against the background of nutritional correction.

Methods for treating prolonged jaundice are varied: both ordinary maternal tricks (a bottle of sweet water) and procedures prescribed by a doctor are used. The most important thing is breastfeeding at least 8-10 times a day. This promotes cleansing digestive system from excess bilirubin naturally. And breastfeeding in the first hours of a child’s life generally serves to prevent the occurrence of this disease. After all, colostrum helps remove the first natural secretions. And it is not at all necessary to move to a hospital room for phototherapy; you can use a photooptical bilirubin blanket at home. The most important thing is not to panic or be nervous, because the parents’ mood is transmitted to the child.

This article has been read 8,014 times.