Infantile jaundice: symptoms, treatment methods, consequences for newborns. Clinically, this manifests itself

Jaundice in newborns is a physiological or pathological condition that is caused by an increase in the level of bilirubin in the blood and is manifested by an icteric color of the skin and mucous membranes.

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According to statistics, in the first weeks of life, jaundice develops in about 60% of cases in full-term and in 80% of cases in premature babies. Most often (60-70%) is diagnosed physiological jaundice in newborns, which occurs when the level of bilirubin in the blood rises to 70–90 µmol/l in full-term babies and more than 80–120 µmol/l (depending on the weight of the child) in premature babies. In most cases, jaundice appears in the first three days of a child's life and does not require treatment.

In the case of timely adequate treatment of pathological jaundice, the prognosis is favorable, it worsens with the development of neurological complications.

Bilirubin is one of the main bile pigments in the human body. Normally, it is formed during the breakdown of proteins (cytochrome, hemoglobin and myoglobin) that contain heme. In the blood, bilirubin is contained in two fractions - free and bound. Approximately 96% of bilirubin in the blood is represented by insoluble indirect bilirubin, which forms complexes with albumin. The remaining 4% bind to polar molecules, in particular glucuronic acid. Indirect (unbound) bilirubin is formed mainly during the destruction of erythrocytes and the breakdown of hemoglobin, it does not dissolve in water, dissolves in lipids and is quite toxic due to the ability to easily penetrate cells and have an adverse effect on their vital activity. Indirect bilirubin binds to blood albumin and is transported to the liver. Direct (bound) bilirubin is a low-toxic fraction total bilirubin which is produced in the liver. Connecting with glucuronic acid, bilirubin becomes water-soluble. Most of direct bilirubin enters the small intestine, glucuronic acid is split off from it, bilirubin is restored to urobilinogen. AT small intestine part of the urobilinogen is reabsorbed and enters the liver through the portal vein. The rest of the urobilinogen enters the large intestine, is reduced to stercobilinogen, in lower sections the large intestine is oxidized to stercobilin and excreted from the body with feces, giving it a characteristic brown color. A small amount of stercobilinogen is absorbed into the blood and then excreted in the urine.

The excretory function of the liver of a newborn child is significantly reduced due to anatomical immaturity and reaches the elimination (i.e., excreting, removing) ability of the adult liver by the end of the first month of life.

To the consequences of jaundice in newborns, which developed against the background of one or another pathological process, include nuclear hyperbilirubinemia with toxic damage brain, deafness, children cerebral paralysis.

Features of the intestinal metabolism of bile pigments in newborns cause a partial return of indirect bilirubin to the blood and an increase or preservation advanced level bilirubin. 80-90% of bilirubin in newborns is represented by an indirect fraction. When the enzyme systems of the body begin to function in in full, the color of the skin of the child returns to normal.

Causes of jaundice in newborns and risk factors

The immediate cause of jaundice in newborns is an increase in the level of bilirubin in the blood.

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Physiological jaundice may be due to the following reasons:

• rapid destruction of fetal hemoglobin;
• insufficient transfer of bilirubin through the membranes of hepatocytes;
• immaturity of liver enzyme systems;
• low elimination capacity of the liver.

The causes of pathological jaundice in newborns are:

• severe course of diabetes in a pregnant woman;
• asphyxia, birth trauma;
• thyroid disease;
• infectious lesions of the child's liver (viral hepatitis, herpes, toxoplasmosis, cytomegalovirus, listeriosis, etc.);
• sickle cell anemia, thalassemia;
• erythrocyte membraneopathy;
• cystic fibrosis;
• toxic-septic damage to the liver;
• impaired excretion of bilirubin (bile thickening syndrome, intrauterine cholelithiasis, intestinal obstruction, pyloric stenosis, compression of the bile ducts by a neoplasm or infiltrate from the outside);
• presence in breast milk maternal estrogens that prevent the binding of bilirubin;
• unsteady lactation and relative malnutrition of the child;
• taking certain drugs (sulfonamides, salicylates, large doses of vitamin K).

Jaundice is usually determined by a neonatologist during the child's stay in the maternity hospital.

Risk factors are too long intervals between feedings infants, prematurity, labor induction, delayed clamping of the umbilical cord.

Forms of the disease

Jaundice in newborns can be physiological (transient) and pathological. Pathological on the basis of etiology are divided into the following types:

• conjugative- develop against the background of a violation of the processes of transformation of indirect bilirubin;
• hemolytic- due to intense hemolysis of erythrocytes;
• mechanical (obstructive)- occur when there are mechanical obstacles to the outflow of bile into the duodenum;
• hepatic (parenchymal)- develop with lesions of the liver parenchyma in hepatitis various etiologies, hereditary metabolic disorders, sepsis.

By origin, jaundice is hereditary or acquired.

Depending on laboratory criteria, jaundice in newborns may be with a predominance of direct (more than 15% of total) or indirect (more than 85% of total) bilirubin.

Degrees of jaundice in newborns:

Symptoms of jaundice in newborns

Physiological jaundice in newborns occurs on the second or third day after birth and reaches a maximum on the fourth or fifth day. The skin and mucous membranes of the newborn are stained in yellow (mild degree jaundice), urine and feces of normal color, liver and spleen are not enlarged. Yellowness of the skin does not extend below the level of the umbilical line and is noticeable only in bright natural light. The general well-being of the child usually does not worsen, however, in the case of a significant increase in the level of bilirubin in the blood, lethargy, lethargy, drowsiness, nausea and vomiting (regurgitation) may be observed. When organizing proper feeding and care, the symptoms of jaundice in a newborn completely disappear by about two weeks of age.

Physiological jaundice in newborns passes without complications, however, in case of violation of adaptation mechanisms, physiological jaundice can be transformed into pathological.

Jaundice in premature newborns, as a rule, appears earlier (the first or second day), reaches its peak by the seventh day of life and disappears by three weeks of age. Due to the longer maturation of liver enzyme systems in premature newborns, there is a risk of developing kernicterus, as well as bilirubin intoxication.

With hereditary conjugative jaundice in newborns, there is a slight increase in the level of indirect bilirubin, while anemia and splenomegaly are absent. The pathological process occurs in the first days of a child's life and is steadily increasing. There is a risk of developing nuclear jaundice with subsequent death.

Jaundice on the background endocrine pathology manifests itself on the second or third day of a child's life and subsides by three to five months. In addition to icteric skin, lethargy, arterial hypotension, a decrease in heart rate, pastosity, and constipation are noted.

The severity of jaundice that developed in a newborn against the background of asphyxia and birth trauma depends on the level of bilirubin in the blood and the severity of the hypoxic-asphyxic syndrome.

Jaundice in children who are breastfed may occur in the first or second week of life and persist from one to one and a half months.

With the progression of hyperbilirubinemia in newborns, bilirubin penetrates the blood-brain barrier and is deposited in the basal nuclei of the brain (nuclear jaundice), leading to the development of bilirubin encephalopathy. At the same time, on initial stage pathological process in clinical picture symptoms of bilirubin intoxication predominate (monotone cry, apathy, drowsiness, regurgitation, vomiting). Then, to these symptoms are added stiffness of the muscles of the neck, bulging of the large fontanel, muscle spasms, convulsions, intermittent excitation, nystagmus, bradycardia, reflex extinction.

According to statistics, in the first weeks of life, jaundice develops in about 60% of cases in full-term and in 80% of cases in premature babies.

At this stage, which can last from several days to several weeks, irreversible damage to the central nervous system occurs. Over the next two to three months, children show an imaginary improvement in their condition, but already in the third or fifth month of life, neurological complications may develop in such children.

Indicators of physiological and pathological jaundice:

Diagnostics

Jaundice is usually determined by a neonatologist during the child's stay in the maternity hospital.

A visual assessment of the degree of jaundice in newborns is carried out according to the Cramer scale, it has five degrees:

1. The concentration of bilirubin is approximately 80 µmol/l, yellowness of the skin of the face and neck.
2. Bilirubin about 150 µmol/l, jaundice extends to the navel.
3. Bilirubin reaches 200 µmol/l, yellowness of the skin up to the knees.
4. Bilirubin about 300 µmol/l, yellowness of the skin of the face, trunk, extremities (except for the palms and soles).
5. Bilirubin 400 µmol/l, total jaundice.

Laboratory diagnosis usually includes.

Treatment of jaundice in newborns

Physiological jaundice in newborns does not require treatment. Feeding is recommended 8-12 times a day without a night break, the daily volume of fluid intake should be increased by 10-20% compared to the physiological need of the child.

Jaundice in premature newborns, as a rule, appears earlier (the first or second day), reaches its peak by the seventh day of life and disappears by three weeks of age.

Treatment of pathological jaundice in newborns depends on etiological factor and primarily aimed at its elimination. In order to accelerate the excretion of bilirubin, enterosorbents, choleretic drugs, B vitamins can be prescribed. The method of phototherapy is used in intermittent or continuous mode. In some cases, the treatment of jaundice in newborns includes infusion therapy, plasmapheresis, hemosorption, and exchange transfusion.

Possible complications and consequences of jaundice in newborns

Physiological jaundice in newborns passes without complications, however, in case of violation of adaptation mechanisms, physiological jaundice can be transformed into pathological.

The consequences of jaundice in newborns, which developed against the background of a particular pathological process, include nuclear hyperbilirubinemia with toxic brain damage, deafness, cerebral palsy, mental retardation.

Forecast

The prognosis for physiological jaundice in newborns is favorable

In the case of timely adequate treatment of pathological jaundice, the prognosis is also favorable, it worsens with the development of neurological complications.

Prevention

Specific prevention of jaundice in newborns has not been developed.

To measures of non-specific prevention pathological condition relate:

• adequate and timely treatment somatic diseases in a woman during pregnancy;
• rejection bad habits during pregnancy;
• rational nutrition of a pregnant woman;
• early attachment of the newborn to the breast;
• prevention of Rhesus conflict.

Video from YouTube on the topic of the article:

Jaundice of newborns- the appearance of icteric staining of the skin and mucous membranes in children in the first days of their life due to a violation of bilirubin metabolism. In healthy children, physiological jaundice of newborns occurs due to the immaturity of the liver enzyme systems. There are also genetically determined (hereditary) enzymopathies - transient familial hyperbilirubinemia, etc. Newborn jaundice can also occur due to increased breakdown of erythrocytes: congenital (hereditary) hemolytic jaundice of newborns, resulting from changes in erythrocytes (microspherocytosis), which are more easily destroyed (Minkowski's disease - Chauffard, named after the physiologist O. Minkowski and the French physician A. Chauffard, who described this pathology in 1900), jaundice with massive hemorrhage during childbirth (cephalohematoma, retroperitoneal hematoma, etc.), with acute and chronic infections bacterial and viral origin, with congenital deficiency of the enzyme glucose-6-phosphate dehydrogenase, which is involved in the metabolism of bilirubin. This group also includes hemolytic disease of the newborn, which occurs when the blood of the mother and fetus is incompatible. Jaundice in newborns may be due to mechanical retention of bile (congenital atresia of the biliary tract, tumors of the liver and pancreas, etc.) or damage to the liver parenchyma (hepatitis, cytomegaly, sepsis, syphilis, toxoplasmosis, etc.). Treatment is carried out depending on the cause that caused jaundice. Physiological jaundice of newborns does not require treatment.

Sometimes yellowness of the skin is called icterus (from ikteros - jaundice). Often, parents hear from the attending physician that the child's skin and sclera of the eyes are "icteric", which means that they have an icteric color. The development of jaundice is associated with high content in the blood of a special substance from the group of bile pigments, which is called bilirubin (from bilis - bile and rubin - red). This red bile pigment is the main bile pigment and a hemoglobin metabolism product, and it is this red bile pigment that gives bile its characteristic golden yellow color. After the iron molecule is cleaved from the hemoglobin molecule, globin (the protein part of the substance) is also cleaved off. Under the influence of oxidizing agents, a series of biochemical reactions occur, as a result of which bilirubin remains, which does not contain protein in its molecule. Such bilirubin is called indirect, or free. This fraction of bilirubin enters the blood plasma, “attaches” to the albumin protein and circulates in the blood in this form. Indirect bilirubin is insoluble in water, toxic and does not pass through the kidney filter and is not excreted by the kidneys. In the liver cell, two molecules of a substance called glucuronic acid join the molecule of indirect bilirubin, and another fraction of bilirubin is formed - direct bilirubin, or bound. It is non-toxic, water soluble, passes through the renal barrier and is excreted in the urine. It is direct bilirubin that penetrates well into tissues and causes icteric staining of the skin, sclera, and mucous membranes.

Physiological jaundice (jaundice of newborns)- transient (temporary) conjugative jaundice that occurs in most healthy newborns in the first days of life, due to the fact that the fetal erythrocytes contain a special type of hemoglobin (hemoglobin F - fetal) and these erythrocytes are destroyed after birth. In addition, newborns also have a deficiency of a special protein that ensures the transfer of bilirubin through the membranes of the liver cells. Promotes excessive accumulation of bilirubin delayed maturation enzymatic systems liver involved in the conversion of indirect bilirubin to direct. Another factor affecting the rate of excretion of bilirubin from the body is the low excretory capacity of the liver in newborns.
Physiological jaundice of newborns is manifested by staining the skin in yellow 3-4 days after birth. The liver and spleen do not increase, there are no signs of increased decay (hemolysis) of red blood cells and anemia. As the bilirubin excretion system improves and excess blood cells disappear from the bloodstream, jaundice disappears (usually in 1-2 weeks) and does not cause any harm to the child. With severe jaundice, intravenous infusion of glucose solutions is sometimes used, ascorbic acid, phenobarbital, choleretic agents to accelerate the excretion of bilirubin.

Jaundice in premature babies occurs more often than in full-term, it is more pronounced and lasts longer - up to 3-4 weeks. The level of direct bilirubin in this form of jaundice reaches a maximum on the 5-6th day of a child's life. In case of severe jaundice, additionally use medications and phototherapy (therapy with light from a special lamp). Under the influence of light, structural isomerization of bilirubin occurs and the so-called “lumirubin” is formed, which has a different route of excretion, quickly penetrates into bile and urine.
The severity of the increase in the level of bilirubin in the blood of preterm infants does not depend on body weight at birth, but is directly dependent on the degree of maturity of the fetus and the presence of maternal diseases during pregnancy.

Hemolytic disease of the newborn, fetal erythroblastosis (erythroblasts - young forms of red blood cells), a disease that manifests itself from the moment of birth or from the first hours of a child's life, most often with incompatibility of the blood of the mother and fetus according to the Rh factor. Hemolytic disease of newborns manifests itself in edematous form (the most severe), in icteric form and in the form of congenital anemia. The icteric form is the most common. Jaundice, which often ends in death, has been known for a long time, but the cause of hemolytic disease of newborns was established only in 1931-1940, when the Austrian doctor K. Landsteiner and american doctor A. Wiener found in 85% of people in erythrocytes a special substance, which is also present in all monkeys of the Rhesus breed and therefore called the Rh factor.

If a woman whose blood does not contain the Rh factor (Rh negative), pregnancy occurs Rh positive spouse and fetus will inherit Rh positive blood father, then the content of Rh antibodies gradually increases in the mother's blood. Penetrating through the placenta into the blood of the fetus, these antibodies destroy the erythrocytes of the fetus, and then the erythrocytes of the newborn. Hemolytic disease of the newborn can also develop with group incompatibility of the blood of the spouses, when the child inherits the father's blood group; usually in these cases, the mother has group I (0), and the child has II (A) or III (B). With the incompatibility of the blood of the mother and child according to the Rh factor, hemolytic disease of the newborn is usually observed in children born from the 2nd-3rd and subsequent pregnancies, tk. the content of Rh antibodies in the mother's body increases slowly. However, the disease can also develop in a child born from the first pregnancy, if mothers during pregnancy received blood transfusions or injected blood intramuscularly without taking into account the Rh factor. Hemolytic disease of the newborn develops on average in 2-5 out of 1000 newborns. severe form hemolytic disease newborns are also promoted by previous abortions. Abortion during the first pregnancy already leads to the formation of antibodies and increases the possibility of developing hemolytic disease of the newborn. The icteric form of hemolytic disease of the newborn is characterized by the early onset of jaundice (in the first hours or the first day after birth) with an intense increase in staining in the following days (the so-called physiological jaundice of the newborn, observed in healthy children, usually appears on the 3-4th day after birth). Jaundice is caused by the release of bilirubin into the blood plasma, which is formed during the destruction of the child's red blood cells. In the following days, the child's condition usually worsens, anemia increases, the child becomes lethargic, sucks poorly, convulsions may often appear due to damage to the nervous system. Children who have had hemolytic disease of the newborn in the form of severe jaundice, with insufficient treatment, sometimes lag behind in development. With an edematous form (general congenital edema of the fetus), the fetus is more often born prematurely, dead, or dies in the first hours of life. The disease is manifested by swelling of the skin, subcutaneous tissue, accumulation of fluid in the chest and abdominal cavities, enlargement of the liver and spleen, severe anemia. Most mild form hemolytic disease of the newborn - congenital anemia of the newborn is manifested by pallor of the skin in combination with a low amount of hemoglobin and red blood cells, usually proceeds favorably and, with timely treatment, ends in recovery.

Treatment. For fastest removal from the body of a newborn toxic products formed during the destruction of erythrocytes, and at the same time Rh antibodies, exchange blood transfusion is used on the first day after birth (replacement of 70-80% of the child's blood with the blood of a Rh-negative donor), which is sometimes repeated. Prescribe drugs that improve liver function. Babies with hemolytic disease of the newborn are usually fed with the expressed milk of another woman for the first 2 weeks. It is at this time that mother's milk contains Rh antibodies that are harmful to the baby. After the disappearance of antibodies, they switch to feeding the child with mother's milk. Children suffering from hemolytic disease of the newborn need careful care, proper feeding.

Prevention. All pregnant women are given a blood test to identify Rh-negative women who should be registered with the antenatal clinic. Rh-negative pregnant women once a month, and if necessary more often, carry out the determination of Rh antibodies in the blood. It is important to keep the pregnancy. In the presence of antibodies in the blood, women are recommended longer intervals between pregnancies, because. with each subsequent pregnancy in the blood increases the titer of antibodies. Every child born to an Rh-negative mother must be closely monitored and compulsory examination in the first hours of life for the content of bilirubin in the blood, Rh factor, blood group.

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More than half of newborns have a yellowish tint to the skin and eyeballs varying degrees expressiveness. Many mothers begin to sound the alarm, noticing the first changes. Is it dangerous? Should I be worried or is this a common occurrence? What are the causes of jaundice in newborns and can it be treated at home? Let's figure it out together.

Physiological and conjugative jaundice in newborns: symptoms

Many pediatricians claim that jaundice (icterus or hyperbilirubinemia) in infants is a natural condition. temporary(transient jaundice). The yellowish color of the skin is due to an excess of bilirubin in the blood, a substance that is formed during the breakdown of red blood cells. Physiological jaundice in a newborn usually occurs 2-6 days after birth. The duration of this condition in a premature baby is 10-14 days, in a full-term baby - 7-10 days.

The main symptoms of physiological jaundice:

1. Yellowish skin tone.
2. The general condition of the baby is stable.
3. Feces and urine of natural color.
4. The concentration of hemoglobin in the blood is within the normal range.

Conjugational jaundice occurs when enzymes in liver cells do not bind and process bilirubin in sufficient quantities. Constitutional hepatic dysfunction (or Gilbert-Meulengracht syndrome) refers to hereditary diseases, the symptoms of which are similar to physiological jaundice. This type of hyperbilirubinemia is very common. The reason for the inferior metabolism of bilirubin lies in the violation of its binding due to the hereditary inferiority of the liver enzyme systems. Usually this disease requires treatment and observation by a doctor.

Jaundice in newborns: the norm of bilirubin

At increased rate pigment in the baby appears icterus of different types and severity. A yellowish tint is primarily acquired by the skin of the face, eye sclera, the lower surface of the tongue and the palate. In the case when red blood cells in the blood break down at a high speed, and the liver does not have time to bind bilirubin, indirect bilirubin accumulates in the bloodstream, which causes a yellowish coloration of the skin.
Bilirubin is a pigment that is formed due to the destruction of protein structures in the blood, which has a yellow color.

In newborn babies, the norm of this pigment is always higher than in a baby who is one month old. At birth, its norm should not exceed a concentration of 60 µmol / liter of blood. Already on the third or fourth day of life, the level of bilirubin can rise to 205 µmol / liter. This figure is considered normal. Premature babies have up to 170 µmol/liter of blood. The blood of a baby who is one month old has from 8.5 to 20.5 µmol / liter.

Jaundice in newborns with Rh conflict

In order to better understand this issue, let's recall what is Rhesus conflict. It occurs when the mother, for example, is Rh-negative (that is, has blood with a negative Rh), the father is Rh-positive, and the baby inherits the father's Rh-positive gene. In other words, this is the incompatibility of the mother and fetus for the D-antigen.

Rh conflict does not develop if the woman is Rh-positive or both parents are Rh-negative.

Rh-conflict during pregnancy occurs due to the penetration of Rh-positive erythrocytes of the fetus into the bloodstream of an Rh-negative mother. In turn, the woman's body reacts to the erythrocytes of the fetus as foreign and begins to produce antibodies.

When the mother's immune Rh antibodies enter the fetus's bloodstream, they react with its Rh-positive erythrocytes, as a result of which the erythrocytes of the unborn baby are destroyed and hemolytic disease occurs. This process leads to a decrease in the amount of hemoglobin in the fetus, as well as damage to its brain and kidneys.

Most frequent symptoms hemolytic disease is early jaundice, enlargement of the liver and spleen, and anemia. The general condition of the newborn worsens as the breakdown product of hemoglobin, bilirubin, accumulates. The baby becomes drowsy, lethargic, he has an inhibition of physiological reflexes and a decrease in muscle tone. If appropriate treatment is not carried out, then on the 3-4th day the level of bilirubin can rise greatly, in which case nuclear jaundice may occur. The symptomatology of this condition is as follows: the baby is not able to tilt its head forward, it cries, opens its eyes wide, sometimes convulsions are possible. After 5-6 days, bile stasis syndrome may develop. In this case, the skin acquires a yellowish-greenish tint, the feces are discolored, and the urine resembles dark beer. The level of bilirubin in the blood rises. As a rule, the icteric form of hemolytic disease is accompanied by anemia.

How long does it take and when does jaundice in newborns go away?

Gradually, the process of pigment release returns to normal, and the disease usually disappears in 6-7 days, a maximum of 14-21 days. The yellow color of the skin decreases every day, and it gradually acquires a natural color. If the newborn is breastfed, then the process of excretion of bilirubin occurs more intensively.

Complications are also possible. Often they are associated with toxic effect indirect bilirubin on the central nervous system of the baby.

Sometimes icterus in a newborn is observed for a long period, mothers complain that jaundice in a newborn has not gone away for a month (or even longer). This is a protracted form of the disease that requires treatment in a hospital.

Protracted jaundice: does not pass more than a month

If your baby is full-term, the birth went without complications, and the symptoms of jaundice do not disappear for 2-3 weeks, this is a protracted form of the disease. In premature newborns, prolonged jaundice lasts for 4-5 weeks. Such a long process of the course of the disease indicates that the fetus was infected while still in the womb. Icteria develops due to damage to liver cells by toxic substances. In this regard, the liver is unable to fully bind bilirubin.

Sometimes the yellow color of the skin and whites of the eyes appears in infants due to vaccination against hepatitis. The pediatrician must distinguish between different types of jaundice and prescribe the appropriate treatment. When protracted illness parents should consult a doctor. The baby may need hospital treatment.

Physiological (usual) jaundice in infants can also last more than three weeks. This is due to the fact that in some children, liver enzymes quickly process bilirubin, while in others it is slower, because each organism is individual.

What is dangerous jaundice and what are its consequences

Physiological icterus is not dangerous for the child. The level of bilirubin in the blood plasma gradually decreases, the yellow color of the skin disappears, and the baby feels normal.

Sometimes jaundice becomes more severe forms of the disease. Its consequences depend on the causes of the disease and on how quickly the parents went to the doctor. If the disease is detected in the early stages and appropriate treatment is carried out on time, then complications can be avoided.

Possible consequences of the disease:

1. Albuminemia is a decrease in the level of albumin in the blood, which occurs due to a high level of bilirubin.
2. Penetration of the pigment in a small amount into the tissue.
3. The possibility of irreversible processes when bilirubin enters the baby's brain. The consequence of this process may be nuclear jaundice, which can lead to deafness, the occurrence of convulsive conditions, and even mental retardation.
4. Jaundice for more late stage sometimes leads to involuntary muscle contractions or loss of motor control.

How to treat jaundice in babies

Talking about the treatment of icterus is not entirely correct. After all, jaundice is a symptom of the disease, and the cause lies elsewhere. The doctor must determine the cause of the "icteric symptoms" and prescribe the appropriate treatment. Physiological icterus does not require treatment. Doctors say that the most the best medicine with this type of jaundice - this is mother's milk.

In case of Rh-conflict, specialists use a replacement blood transfusion. In just one procedure, a newborn can replace up to 70% of total blood. In more severe cases, blood is transfused several times.

This method helps to reduce bilirubin, but also helps to weaken the body of the baby. Then the doctor prescribes physical procedures.

Surgical intervention is sometimes required by the mechanical appearance of icterus. Such treatment and rehabilitation, of course, takes place in a hospital.

Lamp treatment

One type of treatment for physiological jaundice is treatment with a lamp (phototherapy). This method allows you to quickly get rid of excess bilirubin without the use of injections and other medications.

The treatment takes several days, it is absolutely harmless and very effective and collects favorable reviews. Ultraviolet rays, when penetrating the skin to a depth of 2-3 mm, cause chemical reaction, as a result of which bilirubin is destroyed and converted into a non-toxic substance lumirubin, which is freely soluble in the blood and excreted in the bile and urine. Relief of the child's condition comes as early as 3-4 days after applying the lamp. The pigment level returns to normal and no longer increases. This procedure is carried out in a hospital and at home.

Medications

One of the effective medicines that is prescribed for the treatment of jaundice in infants is cholagogue Hofitol. No less effective is the domestic drug Essentiale forte. Considering age, weight and features physical condition baby, dosage and duration of admission medicinal product determined by the doctor.

With a pronounced effect of indirect bilirubin, in order to prevent nuclear jaundice, doctors attribute the drug Phenobarbital.

In addition to the main treatment, the pediatrician may prescribe an increase in fluid intake, as well as the intake of 5% glucose, the dosage of which is also determined by the doctor.

Folk methods

For many years, jaundice has been successfully treated at home using folk methods. This allows not only to get rid of the disease, but also to improve general state baby health.

If the child is breastfed, then first of all, the mother must observe special diet. You should eat at least four times a day. The diet should include steamed dishes, vegetables, fruits and dairy products. Fatty, spicy, fried, pickled and smoked foods should be avoided.

In order to remove toxins from the body of the baby, it is recommended to use rosehip broth. He will also provide beneficial effect on the digestive system baby.

With pronounced symptoms of icterus, the use of 5-10% glucose is recommended. But this procedure must be prescribed by a doctor.

An excellent absorbent that absorbs well toxic substances, is an Activated carbon. Depending on the weight of the baby, he is prescribed activated charcoal dissolved in water. It is safe and very effective method in the fight against jaundice.

Komarovsky

The famous pediatrician Yevgeny Komarovsky claims that jaundice does not apply to independent diseases. This is a symptom of diseases of the liver, biliary tract and other organs. AT modern medicine there are about 50 diseases that are accompanied by the appearance of a yellow pigment on the skin. The only kind of icterus that does not require medical intervention, - physiological. Other types of this disease are not normal.

1. Phototherapy - exposure of the skin to ultraviolet rays. The essence of the treatment is to convert bilirubin into a water-soluble form and remove it from the body with bile and urine.
2. Infusion therapy, which is used to prevent disorders water balance body during phototherapy. At the same time, the physiological need for liquid increases by 0.5–1.0 ml/kg/h. The basis of such therapy are glucose solutions.
3. The use of enterosorbents (Smecta, Enterosgel, Polyphepan, Agar-agar, etc.). These agents are included in therapy to interrupt the hepato-intestinal pigment circulation.
4. Exchange transfusion. The procedure is carried out in case of ineffectiveness of conservative methods of therapy, with a rapid increase in the level of bilirubin, when there is a threat of developing kernicterus.
5. Sunbathing. Under the influence sun rays the level of bilirubin on the skin decreases, which has a beneficial effect on the child's body.

Jaundice and breastfeeding

AT medical terminology there is a term "jaundice breastfeeding". The baby, feeding on mother's milk, receives some substances that inhibit the binding and excretion of the bilirubin pigment from the body. The baby's liver does not function properly and slows down its binding process. As a result, a large amount of bile pigment accumulates in the blood of the baby, which causes a change in the color of the skin and sclera.

Common jaundice usually goes away in 1-2 weeks. If during this time it has not passed, then, perhaps, hyperbilirubinemia is due to breast milk and is pathological character. What is characteristic is that there are no symptoms of the disease. The child is actively developing, eating and gaining weight well. The only thing that the baby acquires a golden hue of the skin is due to the increased level of bilirubin. The peak of this type of jaundice falls on days 10-21, and the pigment level can reach 300-500 µmol / l. Then its level gradually decreases, the yellow color of the skin disappears - and the baby recovers. With breastfeeding jaundice, you should not stop breastfeeding your baby. Although there is such a method of getting rid of the disease: stop breastfeeding for two or three days. The level of bilirubin during this time returns to normal - and breastfeeding continues. Treatment medicines is also not required. It is only necessary to observe the condition of the child. Usually by the end of the third month the disease disappears.

Parents need to carefully monitor the condition of the child. If a yellow skin color has appeared, but the baby feels normal, his stool and urine are without any changes in color, then his condition should not cause concern - it means that he has a physiological appearance of jaundice. The best medicine for such a disease is breast milk.

If the child is lethargic, often cries and screams, then he has a different, more complex type of hyperbilirubinemia. In this case, it is necessary to consult a doctor, analyzes and treat the child with medication and other methods.

Especially for - Ksenia Manevich

Jaundice in newborns occurs in 50-60% of babies in the first days of life. Most often, physiological jaundice develops, which does not cause severe consequences. Yellowness of the skin associated with elevated bilirubin in the blood, passes without medical intervention.

When signs of jaundice in newborns are detected, parents and doctors should carefully monitor the condition of the crumbs, monitor blood counts. The danger lies in the transformation of a physiological form into a pathological one. Doctors warn: inattention to the problem causes dangerous complications with high levels of bilirubin.

Causes

A change in the skin tone of newborns provokes bilirubin, a breakdown product of hemoglobin. In adults, the coloring matter is constantly excreted from the body. But in newly born babies, especially premature ones, the mechanism is poorly adjusted, the indicators often exceed the norm.

Reasons for the slow breakdown and excretion of bilirubin:

• immediately after birth, the blood contains an excess of red blood cells. When they are split, free bilirubin is formed;
• the liver, which binds excess substances in older children and adults, is unable to process them in the first days;
• The excretion of bilirubin occurs through urine and feces under the action of beneficial bacteria in the intestine. But correct microflora will appear a little later. Early in life beneficial microorganisms too little to deal with free bilirubin.

Physiological jaundice

Signs:

• a yellowish tint appears on the face, chest, neck. Below the navel, the changes do not apply;
• symptoms occur no earlier than 36 hours after the birth of the crumbs;
• the most pronounced signs of jaundice appear on the third - fifth day;
• despite the yellowness of the skin, there is no deterioration in well-being: the newborn actively eats, temperature, reflexes are normal;
• when measured, bilirubin values ​​​​are above the natural limits, but do not exceed the value of 200 μmol / l;
• in premature babies, the level of bilirubin stabilizes after 3 weeks, in full-term babies - 2 weeks after the onset of vivid symptoms.

Pathological form

Types of jaundice:

• conjugative jaundice. Hereditary pathologies violate the process of utilization of erythrocyte decay products;
• hemolytic jaundice. Rh factor incompatibility, maternal and fetal blood type;
• mechanical jaundice. Cysts, abnormal structure of the bile ducts provoke problems with the outflow of bile;
• hepatic jaundice. The problem arises due to toxic / infectious liver damage.

The main causes of the development of pathological jaundice:

• hepatitis, underdeveloped bile ducts, blood poisoning;
• general weakness of the body;
• hemolytic disease;
• violation of the production of enzymes;
• poor flow of bile.

Problems arise under the influence of various factors:

• pathology during fetal development;
• birth ahead of schedule(prematurity of the child);
• use by expectant mother a large number medicines, exceeding the dosage of permitted drugs;
• critical body weight of the newborn;
• hemorrhages, cephalohematomas;
• difficult childbirth with the use of drug stimulation, a large amount of drugs;
• artificial feeding from the first days of life.

Symptoms of jaundice in children:

• the pathological form develops on the first day after birth;
• in addition to a high level of bilirubin, weakness, loss of appetite are often noted;
• the daily increase in the level of bilirubin is from 85 µmol / l or more;
• the baby is often excited or, conversely, depressed;
• doctors identify an immunological conflict in the mother and newborn by the Rh factor or blood type;
• urine acquires dark color, stool discolor;
• yellowness appears below the navel, there is also a change in shade on the palms and feet;
• symptoms are noticeable throughout three weeks and longer.

milky look

The scientific name is Aries syndrome. The reason is breast milk. It’s a paradox, but a product that is difficult for a newborn to do without sometimes causes specific manifestations on the skin.

The problem appears 7 days after birth. With frequent feeding, the symptoms disappear after 14-20 days.

Provoking factors:

• an increase in the level of certain hormones in the mother's body;
• excess in breast milk certain types fatty acids.

The combination of these factors disrupts the activity of the liver, inhibits the conversion of indirect bilirubin to direct. Severe complications with milk jaundice do not occur, specific treatment no.

How to determine the shape of the jaundice

Parents often panic when they detect signs of excess bilirubin. It is important to understand whether this is a norm or a pathology. Doctors will check the indicators, take a blood test.

To assess the degree of pathology, the Cramer scale is used. Special control of the condition of a baby born with a negative Rh factor in a woman is important.

The doctor takes blood for research:

• checking the level of bilirubin;
• determination of blood group;
• detection of Rh-affiliation;
• direct Coombs test is recommended.

Advice! Did the yellowness of the skin appear after discharge from the hospital? Visit a pediatrician as soon as possible, find out the cause, eliminate (if possible) provoking factors. Delay at pathological jaundice often causes complications.

Possible consequences

The physiological phenomenon is most often not dangerous for the baby. The problem disappears without special therapy, side effects do not appear.

Natural jaundice becomes pathological under the influence of certain factors:

• improper outflow of bile;
• genetic pathologies;
• damage to the liver by the hepatitis virus during fetal development;
• development of a hemolytic form of pathology;
• different blood type with mother plus incompatibility of Rh factors.

How and what to treat a child? Learn effective methods.

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The pathological form is dangerous with complications. Lack of treatment causes problems with various organs.

Most often, doctors diagnose the following complications:

• bilirubin encephalopathy;
• lethargy, general weakness;
• decrease in the amount of albumin;
• poisoning with brain toxins;
• damage to the nervous system, impaired reflex functions;
• nuclear jaundice, which provokes deafness, convulsions, mental retardation;
• in severe cases, involuntary twitching facial muscles, impaired coordination of movements.

The consequences of jaundice largely depend on the timely diagnosis and treatment of the disease. If a problem is detected at an early stage, there is a high probability of a favorable course, complete elimination of unpleasant symptoms.

Methods and rules of treatment

Parents should not panic at the first sign of jaundice in a newly born baby. It is easier in the maternity hospital: doctors will immediately take action, take blood, urine for analysis. After discharge, it is important to immediately contact the pediatrician for timely therapy.

Therapy for Rh conflict

The problem arises if the father is Rh positive, and the mother is Rh negative. During pregnancy, antibodies in the body of a woman destroy the red blood cells in the baby, hemolytic disease develops. The level of indirect bilirubin rises sharply, dangerous pathological jaundice quickly develops.

Treatment of jaundice is carried out in the maternity hospital, then - at the hospital of the children's hospital:

• choleretic drugs;
• vitamins;
• hemosorption - blood purification;
• phototherapy (light therapy to destroy excess bilirubin);
• glucose droppers to feed a weakened body;
• in case of severity of the case - blood transfusion.

Important! Timely treatment prevents the development of dangerous nuclear jaundice, which causes toxic poisoning gray matter of the brain.

What to do with a physiological view

With bilirubin levels below 200.0 µmol / l, special therapy is not required, the symptoms will gradually disappear. Exceeding the standards of indirect bilirubin is a signal to start therapeutic measures.

• intravenous administration of ascorbic acid;
• daily droppers with glucose;
• phototherapy in a special apparatus with blue, daylight or white light. Mandatory protection of the genitals (in boys) and eyes from light fluxes;
• choleretic drugs plus (or instead of them) Phenobarbital. The task is to convert indirect bilirubin into direct, rather remove it from the body;
• doctors recommend plentiful drink, accelerating the process of cleansing the body.

It is important to constantly monitor the level of bilirubin in the blood. Do not refuse examinations and tests, follow the doctor's instructions. Wrong treatment natural jaundice often leads to the development of a more severe, pathological form of the disease.

Treatment of the milk form of the disease

• doctors suggest mothers to feed the newborn more often, but portions of breast milk should be small;
• more frequent feedings will provoke an increase in the number of bowel movements per day, large quantity"Excess" bilirubin will leave with feces;
• gradually the situation will improve, the symptoms will disappear;
• doctors recommend constantly monitoring the level of bilirubin, to monitor when the indicators return to normal;
• until the symptoms disappear completely, periodically show the baby to the pediatrician;
• weakness, restlessness, colorless stools, or dark urine consult a doctor immediately: a pathological form of jaundice may develop.

You can prevent problems with the level of bilirubin if the expectant mother follows certain rules:

• takes only approved medications in the correct dosage;
• eats right, avoids foods that are heavy for the liver;
• does not smoke, does not drink alcohol;
• controls health.

When planning pregnancy, take tests for the "liver complex", hepatitis, Rh factor to avoid complications in the future. Research is a must for expectant mothers: do not ignore the advice of a gynecologist.

Helpful Hints:

• pathological jaundice often develops when breastfeeding is refused, the child is consciously turned into an “artificial”. Even the highest quality milk formula will not replace mother's milk;
• do not ignore the needs of the crumbs, do not consciously stop breastfeeding;
• in case of problems with quantity / quality, try to establish milk production: you will strengthen the baby's immunity, prevent the development of many diseases;
• if you are worried that your breasts will sag, you will lose attractiveness, think again about the health of the baby;
• if the previous arguments did not convince you, remember one more thing important aspect. By breastfeeding, you will make your life easier, save a large amount: infant formulas from well-known manufacturers are not cheap.

When identifying signs of jaundice in a newborn, do not panic, follow the doctor's recommendations. It largely depends on the correct behavior of the parents whether the physiological phenomenon disappears without complications or turns into a pathological form with serious consequences.

Video. Dr. Komarovsky about jaundice:

Don't be scared! With all the severity of the name "jaundice in newborns" - this is by no means a disease, but just a physiological symptom of certain processes that occur in the baby's body while it adapts to new living conditions. What to do with the "golden" child, how exactly physiological jaundice occurs in infants, are there possible Negative consequences this phenomenon and whether jaundice in newborns requires any treatment - we will understand.

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 that 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 romantic pink to hysterically yellow, it makes sense to recall some paragraphs. school course anatomy:

Mechanism of jaundice. In the blood of a person there are special red blood cells - erythrocytes, the task of which is to carry oxygen throughout the body and carbon dioxide. Every day, approximately 1% of all red blood cells that rush through our body die (the lifespan of each red blood cell blood cell no more than 120 days). When destroyed, these cells release a substance contained inside red blood cells - bilirubin - a special yellow pigment that is actively involved in hemoglobin metabolism. By itself, bilirubin is a rather dangerous and toxic substance for internal organs, therefore, normally, as soon as the blood brings it to the liver, special liver enzymes immediately neutralize it there. In medical language, the process of neutralizing the harmful yellow pigment in the liver is called "bilirubin conjugation." The detoxified bilirubin then passes through bile ducts and is excreted from the body by the excretory system.

If any link in this chain of formation and excretion of bilirubin is broken, the level of this substance rises, the yellow pigment penetrates the skin, coloring the face and body in “autumn tones”. And if we weren’t talking about newborns, but about older people, then we should consider jaundice precisely as a clear symptom of a serious illness (for example, liver diseases like hepatitis, acute poisoning, intoxication, inflammation of the gallbladder, stagnation of the bile ducts, etc.).

Physiological jaundice in newborns - within the normal range

But jaundice in newborns is most often physiological norm. The bottom line is that a child, barely born, has a very high level of hemoglobin, which begins to decline sharply in the new conditions of the baby's life. In addition, a newborn baby has not yet fully formed "army" of liver enzymes. In other words, the new baby in the first days of life is simply not physically able to cope with high level bilirubin in your 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 “stained” in yellow. This is normal and does not threaten the child with any troubles. In medicine, there is even a term - physiological jaundice of newborns. Physiological means natural, normal, without pathology.

So, even if you are in these 60%, there is no reason to be afraid. And if it so happened that the child was born prematurely (which means that he has even less capable liver enzymes than a healthy toddler), then you have even more chances to admire him yellow - 80-90% of all babies born prematurely survive physiological neonatal jaundice.

The company at risk for jaundice in newborns are babies whose mothers are sick diabetes, as well as twins (twins, triplets, etc.)

Normally, in a newborn baby, jaundice should pass in two to three weeks. And what to do in cases where the child turned yellow naturally, but to turn pink, even after three weeks, as if he is not going to?

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

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

• 1 As a result of any disease of the child, the destruction of the erythrocytes of his blood occurs intensively and constantly (for example, with hemolytic disease, which often develops in children whose Rh factor differs from that of the mother). Accordingly, the level of bilirubin in the blood is constantly elevated.
• 2 Liver function never 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 gallbladder and excreted from the body through the bile ducts. Often, jaundice in a newborn does not go away due to a malfunction of this particular organ. For example, a crumb may have an obstruction of the 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 tests and tests, doctors will determine and prescribe this. adequate treatment, in which not the symptom itself, but the disease itself, will be treated.

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

Jaundice in newborns can last more than 21 days and for no reason at all. After all, each baby is individual and predict exact dates when he learns to walk, when - to speak, and when - his liver learns to process bilirubin, not a single children's "esculapius" is able to, even if he is the most outstanding genius from medicine.

As a caring and sensible parent, you must understand that a newborn child (like an older child) is in itself an excellent indicator of its physical condition. Simply put, if your baby has turned yellow and continues to stick to this sunny tone for more than three weeks, but at the same time he does not show any signs of anxiety - does not cry, eats with appetite, gains weight, fills his diapers regularly and sleeps soundly, then there is no reason to worry about prolonged jaundice, you should not have.

The only thing that needs to be done is with the help of an experienced and observant pediatrician, start regularly monitoring 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 blood of the newborn was elevated and his skin shone with “golden” hues, nothing bad could happen to the child. Although bilirubin is toxic, its quantity (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 dragged on and gone beyond 21 days (which means that the level of bilirubin in the body continues to remain high), it is imperative to contact the pediatrician and put the baby's bilirubin "on the counter" - that is, it must be constantly measured and monitored. If the level of bilirubin is kept above the norm, but does not tend to increase, you should not be afraid, under the systematic supervision of a reasonable doctor, such jaundice does not threaten the child with any serious consequences.

Jaundice in newborns can threaten with 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 upward trend. In such cases, damage to the central nervous system baby, his liver, etc. But if you turned to the pediatrician in time, no responsible doctor will simply allow such a development of the event.

Critical indicators of bilirubin in the blood are for full-term and premature babies, respectively: 324 µmol/l and 250 µmol/l. You, the parents, do not need to know these numbers, the main thing is that the doctor who monitors 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, as has already been said fifty times, this is not a disease, but only a symptom.

If jaundice is a symptom (indicator or consequence) of some serious disease, then, of course, it is not jaundice that is being treated, but this disease itself. But not a single disease is treated overnight and there are situations when, simultaneously with therapy, it is necessary to reduce the level of bilirubin in the blood, which dangerously “creeps” to a critical level.

Even 15-20 years ago, in a situation where the level of bilirubin became threateningly dangerous and could cause irreparable damage to the baby's central nervous system, the child underwent 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 recent decades practice another effective method of dealing with elevated bilirubin - a bright lamp!

Phototherapy for jaundice: let there be light!

Scientists made this discovery by chance - during medical research it was found that toxic bilirubin in human skin begins to actively break down under the action of bright light rays, turning into a non-toxic isomer. Thus, the most common method of treating jaundice in newborns today was “born” - phototherapy.

The bottom line is simple: if the baby's bilirubin level is elevated and there is no positive dynamics, he - naked, but with protection in front of his eyes - is laid out under a bright lamp: sometimes for several hours a day, sometimes for several days (around the clock with interrupted only for feeding, hygiene and massage).

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

Breastfeeding jaundice: mom gilded

There is another kind of, fortunately, completely harmless jaundice, which can be observed in newborns and which can last more than three weeks. This is the so-called jaundice breastfeeding. As the name suggests, it only happens to babies who are breastfed.

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

Not a single “health specialist” has yet been able to find 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 the milk of their mothers "slows down" the activity of enzymes in the child's liver.

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

If you are scared and you want to make sure at all costs that your "orange" baby has safe breastfeeding jaundice, and not a symptom of some dangerous disease- Stop breastfeeding for 1-2 days (give formula). If the yellow color of the skin noticeably brightens - this is it, 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 if 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 - all these questions can only be solved by a pediatrician. Your task is to present your newborn to him for examination and analysis.

Because in the case of jaundice in newborns, the probability of making a mistake is very high: you can mistake a completely normal physiological state for 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?