Why does the child's jaundice not go away? When will yellowness go away in a newborn?

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Jaundice in newborns is a common phenomenon; it appears on the second or third day after the baby is born. It is a normal physiological process and not a pathology, so parents should not worry.

Only in rare cases do newborns develop pathological jaundice; then the symptoms of the disease appear in the first 24 hours after birth and persist for more than 5 days. Treatment should only be carried out under the supervision of a doctor.

Classification

There are two types of jaundice in newborns: physiological (transient) and pathological. The first type is diagnosed in 60–70% of all newborn babies. It is not a consequence of the disease. This is a normal condition for a newborn.

Symptoms appear on the third day after birth. They do not require treatment and go away on their own within 3–5 days. Sometimes symptoms go away after 2–3 weeks. The child definitely needs an examination to prevent this condition from becoming pathological.

With physiological yellowing of the skin, the increase in bilirubin is insignificant.

More often, this type of jaundice appears due to the production of new hemoglobin, since the fetal hemoglobin is different from normal. After birth, the composition of the blood completely changes.

There are two types of physiological jaundice: neonatal and breast milk jaundice. The first one occurs most often. Is she dangerous? No. Breast milk jaundice also does not pose a threat to the health of the baby. It appears due to the fact that breast milk contains a large amount of estrogen. Instead of removing bilirubin, the baby’s body gets rid of this hormone.

Pathological jaundice appears immediately after the birth of the child. Its symptoms may subside at first and then reappear. This pathology is not contagious, it indicates health problems in the baby.

There are two types of this jaundice:

• Hemolytic . Occurs rarely, affecting approximately 1% of infants. Symptoms appear immediately, the whites of the eyes and facial skin turn yellow. Upon palpation, you can find that the baby’s liver and spleen are enlarged.
• Mechanical . Appears in diseases of the liver and gallbladder, as well as problems with the excretion of bile. Most often, this type occurs due to genetic disorders or trauma during childbirth. One of the obvious symptoms of pathology is the baby's transparent stool.

There are also other types of the disease, which are a transitional stage between normal and pathological jaundice:

• conjugation – is a consequence of poor liver function in removing bilirubin;
• nuclear – characterized by a sharp increase in bilirubin concentration in the first 24 hours after birth;
• hepatic (parenchymal) – appears when infectious lesion liver;
• hemolytic – characterized by massive destruction of red blood cells;
• subhepatic (obstructive) - appears when bile stagnates in the liver.

Causes

Causes of pathological jaundice:

• , which occurs due to the fact that the child positive group blood, but mom’s is negative;
• intrauterine infection;
• different blood groups, especially if the newborn has the second or third, and the mother has the first;
• maternal diabetes;
• antigen incompatibility;
• hormonal disorders in the baby;
• diseases of the circulatory system;
• hemorrhages in the baby, which are an additional source of bilirubin;
• administering antibiotics to a baby or using medications to a woman in labor during labor;
• diseases of the intestines, liver or gall bladder in a newborn;
• obstruction of the biliary tract.

The cause of physiological jaundice is an increase in bilirubin levels due to the production of “new” hemoglobin and the removal of “old” hemoglobin. The baby’s liver cannot cope with such a load, which is why jaundice appears.

Asphyxia and causes yellowing of the skin in newborns. Postpartum jaundice can occur as a result of trauma during the birth process.

Symptoms

The severity of symptoms depends on the concentration of bilirubin in the blood and the characteristics of the skin. The sclera of the eyes, palate and face turn yellow faster.

Signs of pathological jaundice:

• staining the mucous membrane and skin yellow;
• changes in biochemical blood test parameters, exceeding the normal level of bilirubin;
• drowsiness and lethargy.

With kernicterus, the newborn refuses to eat and is inactive. After some time, the child begins to throw back his head and screams monotonously.

If the liver and spleen are enlarged, the urine has become pale or brown, and has acquired a specific odor, then you should go to the hospital. This may indicate the development of hepatitis.

The following signs can distinguish physiological jaundice from pathological one:

• yellowness of the skin and mucous membranes;
• General blood count indicators are normal;
• the liver and spleen are not enlarged;
• feces and blood do not change color;
• The child has a good appetite, he is gaining weight.

Symptoms of physiological jaundice never appear on the first day of life; the peak of all symptoms occurs on days 3–4.

How long does jaundice last?

When should jaundice go away in newborns? The timing is individual for each baby; on average, all symptoms disappear in 5–10 days; in rare cases, this period extends to 2–3 weeks.

In infants who are breastfed, traces of physiological jaundice disappear faster.

Why does jaundice not go away for a month? This indicates a pathological condition. If symptoms persist for more than two weeks, then you should take the baby to the doctor. In rare cases, we can talk about jaundice of breast milk, then the jaundice remains for 2 months, and sometimes 3.

If we are still talking about in good condition, and not pathology, then the child should have a good appetite, nothing bothers him, he is calm, gaining weight and height according to the infant development table.

Diagnostics

The examination consists of a visual examination of the baby, as well as a series of tests.

Diagnostics include:

• general analysis blood;
• determination of bilirubin level;
• liver and kidney tests to determine the functioning of these organs;
• hemolysis tests.

If upon palpation there is a suspicion of an enlarged liver or spleen, an ultrasound of the abdominal organs is performed.

Norm of bilirubin

An increase in bilirubin concentration directly leads to the occurrence of jaundice.

Bilirubin is a yellow pigment that is involved in hemoglobin metabolism. It is released from red blood cells when blood cells die. This substance must be removed from the body, since it is toxic.

There are two types of bilirubin: direct and indirect. When diagnosing, the first type is taken into account. The norm is 8.5–20.5 µmol/l. If the readings reach 35 µmol/l, then jaundice appears.

U premature babies yellowing of the skin occurs when the bilirubin value is 85 µmol/l.

The critical level of this substance that can lead to the death of a child is as follows:

• for full-term infants – 324 µmol/l;
• for premature infants – 150–250 µmol/l.

While the child is in the maternity hospital, you need to measure the bilirubin level 2-3 times throughout the entire period to make sure that its concentration does not increase.

Treatment

A newborn requires treatment if we're talking about about pathological jaundice. All therapeutic measures carried out in a hospital setting, where the mother and child are admitted. At home, newborns can be treated only with a slight increase in bilirubin.

Treatment depends on the cause and type of pathology. The doctor takes into account diagnostic data, the course of labor, and the mother’s illness. Sometimes the help of a surgeon and endocrinologist is required.

When treating jaundice in a newborn, antiviral, antibacterial, choleretic, immunostimulating drugs and even antibiotics are used. You cannot do without detoxification therapy.

The treatment is as follows:

• Taking enterosorbents. These drugs accelerate the removal of bilirubin from the blood. Smecta, Enterosgel, Polysorb are used.
• Administration of recovery drugs water balance after phototherapy. Apply glucose solution, soda, electrolytes.
• Choleretic and diuretics. They are used if bilirubin approaches a critical level. Use Hofitol, Essentiale Forte, magnesia solution for oral administration, rosehip decoction in the form of tea.
• Hepatoprotectors. They protect and restore liver cells. Ursofalk, Phosphogliv, Ursosan, Ukrliv are suitable.
• Homeopathic remedies. They improve bile secretion, remove toxins and normalize stool. Effective medicines - Hepel, Galstena.
• Medicines to improve metabolism. Elkar drops will do. They boost immunity and improve appetite. The medicine must be diluted with glucose. The dosage will be prescribed by the attending physician.
• Antibacterial agents. Will do.

TO emergency measures In the treatment of jaundice, blood transfusions belong, especially if we are talking about a nuclear type of disease.

With ICD in a child ( urolithiasis) diuretics should be used with caution.

If the bilirubin level for a long time remains high, then phototherapy is used. The procedure is safe for babies. The newborn is placed under a special lamp, the child’s eyes are covered safety glasses. The course is 96 hours.

Phototherapy has a number of side effects. Drowsiness, peeling of the skin, and upset bowel movements may occur.

You can continue phototherapy at home. Instead of a lamp for newborns, direct sunlight is suitable for jaundice. They help the symptoms disappear. Sunbathing promotes the production of vitamin D, which accelerates the removal of bilirubin from the blood.

Consequences and complications

Why is jaundice dangerous in newborns? Only the pathological appearance poses a threat to health. A high level of bilirubin poisons the baby’s body, it affects the functioning of the brain and central nervous system, which leads to disruption of the child’s development. These are the most severe consequences jaundice in newborns.

Other dangers:

• the likelihood of cirrhosis and liver cancer increases;
• immunity decreases;
• the liver is not working well.

The most dangerous is kernicterus, in which the level of bilirubin is very high. Toxic cells enter the brain and destroy nerve cells. This type of jaundice can lead to deafness, mental retardation, and even paralysis. The most dangerous consequence is death.

Prevention

A newborn can become ill with true jaundice in the first days after birth, since the baby’s body is no longer protected and has not yet adapted to new living conditions. The best prevention of the disease is breast milk. It is necessary to put the newborn to the breast in the first minutes after birth so that he receives the most valuable drops of colostrum.

Other preventative measures:

• mother's diet;
• walks in the fresh air with your child;
• sunbathing.

It is necessary to feed the baby on demand, not according to a schedule. Breastfeeding helps the baby's body get rid of bilirubin.

Despite the fact that jaundice in newborns is often the norm, it is necessary to carefully monitor the baby’s health and bilirubin levels. If the indicators change for the worse or the symptoms of the disease increase, it is necessary to begin treatment. The line between normal and pathological conditions is very thin; it is important to prevent complications.

Useful video about jaundice in newborns

Severity of jaundice in newborns according to the Cramer scale

Bilirubin for neonatal jaundice

Indicators of bilirubin in the blood of a newborn with physiological jaundice

Hours\days after birth	Indicators
First 24 hours after birth	119 micromoles per liter, skin color unchanged.
48 hours after birth	The severity of jaundice based on the amount of bilirubin in the blood These indicators are somewhat different for premature babies. This is explained by the immaturity of the basic functions of the liver and the body as a whole. So, it is important to remember that for premature babies critical level bilirubin, in which the risk of kernicterus is lower than for full-term babies, and is 250 - 270 micromol per liter. Screening for neonatal jaundice Evaluation of a newborn baby with jaundice begins with a visual examination. As mentioned above, sometimes the severity of jaundice can be determined by the prevalence of icteric coloration. Normally, the face, neck and upper body are painted yellow. With prolonged jaundice, the staining may extend below the navel and reach the knees. A dangerous sign is the coloring of the baby's palms and soles yellow. Next, the doctor begins to palpate the liver and spleen. For hepatitis and some congenital anomalies liver, the liver enlarges; with hemolytic jaundice, the spleen enlarges. Outwardly, a child with physiological jaundice looks healthy - he is active, reacts to external stimuli, the sucking reflex is well expressed and he actively suckles at the breast. A baby with kernicterus is lethargic, reacts poorly to stimuli, and refuses to eat. Tests for neonatal jaundice In addition to determining the level of bilirubin, other tests are performed for pathological jaundice. As a rule, this is a complete blood count and a complete urinalysis, as well as liver tests. Type of analysis What does it show? General blood analysis anemia ( decrease in the number of red blood cells and hemoglobin) indicates intensive destruction ( hemolysis) red blood cells; decreased platelet count; increase in the number of young red blood cells ( reticulocytes) – also speaks of the process of destruction of red blood cells. Indicates the hemolytic nature of jaundice. Blood chemistry increased amount of cholesterol; increase in all liver enzymes ( ALAT, ASAT, alkaline phosphatase ) indicates stagnation of bile and that the cause of jaundice is liver pathology; decrease in protein levels ( hypoproteinemia) – also indicates liver problems. Coagulogram deficiency of fibrinogen and other coagulation factors - occurs due to a lack of vitamin K, which, in turn, is synthesized in the liver. Analysis of urine Results depend on the type of jaundice: with hemolytic jaundice– orange urine; with hepatic and obstructive jaundice– urine becomes very dark, taking on the color of beer. Urine and feces in neonatal jaundice Changes in the color of urine and feces with jaundice are important diagnostic criterion. This is explained by the fact that each type of jaundice is characterized by its own changes. Characteristics of urine and feces during various types jaundice Treatment of neonatal jaundice Treatment for neonatal jaundice depends on its type. Physiological jaundice of newborns completely excludes treatment, since it is not a pathological condition. Jaundice of premature babies requires only phototherapy in most cases. Blood transfusions, IVs and other invasive treatments are recommended in exceptional cases, for example when there is a risk of developing kernicterus. Droppers for jaundice in newborns IVs are rarely prescribed for neonatal jaundice. They are recommended when the level of jaundice approaches critical. As a rule, droppers with glucose solution are prescribed. Glucose is the main building and nutritional material for the brain. Therefore, it is prescribed in order to eliminate Negative influence bilirubin on the baby's brain. Glucose solution is often combined with ascorbic acid ( vitamin C) . The volume of solution administered is very individual and is calculated based on the child’s body weight. Drugs for neonatal jaundice For neonatal jaundice, medications are used very rarely. As a rule, medications from the group of sorbents, hepatoprotectors, and vitamins are prescribed. Hepatoprotectors ( medications that improve liver function), used in the treatment of jaundice Drugs such as phenobarbital and pagluferal are prescribed only if jaundice is accompanied by seizures ( sudden contractions of body muscles). The choice of a particular drug depends on the type of attacks and their etiology. Ursosan, like other drugs that help dissolve gallstones, is not prescribed to newborn children. Electrophoresis for jaundice in newborns Electrophoresis is not recommended and is not prescribed for jaundice in newborns. Blood transfusion for jaundice in newborns Blood transfusions for neonatal jaundice are recommended when the disease is caused by Rh factor or blood group incompatibility. And even then, blood transfusion is last resort, and resort to it when the concentration of bilirubin rises to 340 micromoles or more. Blood transfusion ( scientifically, blood transfusion) is a procedure during which a whole infusion of blood or its components occurs ( erythrocytes, platelets) into the recipient's vascular bed. The recipient in this case is a newborn child. Indications for blood transfusion for jaundice are: bilirubin concentration is more than 340 - 400 micromoles per liter; hourly increase in bilirubin more than 10 micromoles per liter; anemia ( decrease in the number of red blood cells and hemoglobin) second – third degree; signs of bilirubin encephalopathy ( kernicterus) - the child becomes lethargic and refuses to eat. For transfusion, “fresh” blood is used, that is, blood with a shelf life of no more than 3 days. Which sorbents are best for newborns with jaundice? Sorbents are preparations that absorb toxins circulating in the body on their surface. In other words, these are medications that cleanse the body of toxins and other harmful substances. Sorbents include drugs such as activated carbon, enterosgel, polysorb. Despite their apparent harmlessness, sorbents are recommended with caution for newborn children. Newborn children suffering from jaundice can be prescribed enterosgel and polysorb. Drops for jaundice in newborns Drops are one of the forms of drug release. As already mentioned, medications are prescribed in exceptional cases for jaundice. Of the drugs described above, galstena is prescribed in the form of drops. Treatment of jaundice in newborns at home Treatment of jaundice in newborns is a series of measures that are carried out in order to speed up the process of eliminating the substance formed during the breakdown of hemoglobin ( bilirubin) and gives the skin a characteristic shade. At home, therapy can be carried out only in cases where the pathology is physiological in nature. The following measures are available to treat jaundice in infants: ensuring proper baby nutrition; correction of the diet of a nursing mother; taking medications; sunbathing. Ensuring the correct baby food As experts note, some newborns may develop jaundice due to the fact that they do not receive breast milk in the required volume. The fact is that bilirubin, which is the cause of the characteristic shade of the skin and mucous membranes, is excreted from the child’s body along with feces. Breast milk has a mild laxative effect and the baby's stool becomes more regular and abundant. In addition, milk contains a large amount of substances necessary for proper operation liver, which also accelerates the process of bilirubin excretion. Therefore, one of the main methods of combating neonatal jaundice is complete feeding baby with mother's milk. A woman should put her baby to her breast at least every 2 to 3 hours. It should be taken into account that with jaundice, children may become more drowsy and lethargic, because of this they begin to breastfeed less actively, as a result of which they do not receive the necessary volume nutrients. Also, the cause of poor sucking may be mistakes made when caring for the baby or when organizing the breastfeeding process itself. To provide a child in this condition complete diet, the mother should consult a feeding specialist. In situations where breastfeeding is not possible, the choice of formula for feeding must be done carefully. It is important that such food does not provoke problems with bowel regularity, since in this case the course of jaundice is delayed. If the child is bottle-fed, the doctor may recommend giving him rosehip decoction. This will restore the deficiency of vitamins and other nutrients. Correction of the diet of a nursing mother If a newborn with jaundice is breastfed, the mother must follow a special diet. This will reduce the load on the child’s liver, which will facilitate faster removal of bilirubin. The following provisions of the diet of a nursing mother are distinguished: exclusion of fried foods from the daily menu; avoiding spicy and overly salty foods; limited fat intake ( emphasis should be placed on vegetable fats); controlled consumption of raw vegetables and fruits ( It’s better to boil or bake them); reduced consumption of refined products ( sugar, white wheat flour, cough instant cooking ). To ensure an adequate supply of breast milk, breastfeeding women should include fiber-rich foods in their diet ( fiber) products. Sufficient amounts of fiber are found in vegetables and fruits, which, as mentioned above, should be heat treated before consumption. Also, for normal breast milk production, you should eat porridge ( oatmeal, buckwheat), whole wheat bread. In addition to volume, a nursing woman should ensure that the milk produced is High Quality. The quality indicators of breast milk increase products with high content protein ( squirrel). The following protein products are recommended for breastfeeding: milk products ( cottage cheese, low-fat and mild cheese); dietary meat ( rabbit, turkey, chicken); lean fish ( hake, cod, pike perch). Taking medications In cases where the course of jaundice varies in duration or is accompanied by intense coloration of the skin, the newborn may be prescribed certain medications. Medicines are taken to improve the functioning of the intestines, liver and other organs that are directly or indirectly involved in the process of bilirubin excretion. There are the following groups of drugs that can be prescribed for: infant jaundice: sorbents ( colon cleansers); hepatoprotectors ( medications that improve liver function); homeopathic medicines ( means that have a complex beneficial effect); appetite stimulants. Sorbents Sorbents act like a sponge, that is, when they enter the intestines, they “absorb” toxic substances, including bilirubin. Taking such drugs allows you to accelerate the excretion of bilirubin, which helps speedy recovery little patient. The following drugs with absorbent action are distinguished: Activated carbon; enterosgel; polysorb; The optimal drug is selected based on weight and general condition child, the intensity of the icteric tint and other factors. Therefore, only a doctor should prescribe a medicine and determine the regimen for its use. Hepatoprotectors One of the most frequently prescribed drugs from this group for infant jaundice is ursofalk, which is made from an analogue of human bile. The medicine is available in the form of a suspension, which must be dissolved in breast milk or formula and given to the child before bedtime. Analogues of this remedy are drugs such as ursosan ( also in the form of a suspension) and ukrliv ( often available in capsule form). The last two drugs are not recommended for children under one month old, that is, newborns. Most often, these drugs do not cause side effects, but sometimes taking them can cause upset bowel movements or allergic reaction. In such cases, the medicine is discontinued. Homeopathic medicines Homeopathic medicines are made on the basis of natural plant components and are intended to normalize metabolism and improve the general condition of the child. There are the following homeopathic medicines from infant jaundice: Chophytol ( syrup based on artichoke leaf extract); hepel ( tablets based on celandine, cinchona and other herbal ingredients); galstena ( drops containing milk thistle, dandelion). Appetite stimulants A common drug prescribed to improve children's appetite with jaundice is elcar. The product contains the substance L-carnitine, which improves metabolism. The medicine is available in the form of drops, which must be mixed with a glucose solution. You need to give your child the drug half an hour before feeding him. Sunbathing When exposed to sunlight, bilirubin is quickly destroyed and eliminated from the body. Therefore, when treating physiological jaundice at home, the child should receive sufficient quantity sunlight. If the weather is appropriate, it is recommended to walk with your child outside more often, leaving your arms, legs, and face exposed if possible. It is important to avoid direct exposure to sunlight, as this may cause your child to get a sunburn. If the weather outside does not allow frequent walks, the newborn should be kept close to a source of natural light ( for example, near the window). Phototherapy for neonatal jaundice Phototherapy is indicated for physiological and pathological forms of jaundice. The principle of treatment is that, under the influence of light, bilirubin is destroyed, turning into a liquid form, which is excreted along with urine and feces. Light therapy requires special equipment and constant monitoring of the patient's condition. The best option is to carry out such treatment in a hospital setting, since the presence of medical personnel helps prevent possible complications. If for a number of reasons the child cannot stay in the hospital for a long time, phototherapy can be performed at home. To do this, you must purchase the necessary equipment ( bought or rented) and consult with your doctor about the rules for conducting phototherapy at home. An important condition for treatment is feeding the baby with breast milk. At artificial feeding In most cases, alternative treatment methods are selected instead of phototherapy. How is the procedure performed? Phototherapy in medical institution carried out using a special lamp emitting light, which is installed next to a transparent box ( incubator). At home, instead of an incubator, a crib or changing table can be used. An undressed child is placed in an incubator or crib, and protective bandages are put on the eyes and reproductive organs. The duration of the procedure on average reaches 2 hours. Then they pause for several hours, after which the session is repeated. In general, a child spends from 12 to 16 hours under a lamp per day. If bilirubin levels are high, sessions may be longer and pauses may be shorter. During phototherapy, the child should be periodically turned onto his back, stomach, right and left side. It is also necessary to pause for feeding. During treatment, the child's fluid intake should be increased by 20 percent to avoid dehydration. Phototherapy is carried out for 3 to 5 days. If the bilirubin level decreases before this period, treatment is stopped. Contraindications and possible side effects of phototherapy Light treatment is not carried out in cases where the child is diagnosed with serious liver disorders. Phototherapy is also not prescribed to patients who have obstructive ( mechanical) jaundice. In some cases, phototherapy may be accompanied by such side effects such as peeling and/or bronze skin tone, increased sleepiness of the child, change in consistency and/or shade of stool. As a rule, after completion of therapy, these symptoms go away on their own, without additional intervention. Sometimes phototherapy can trigger an allergic reaction in the form of hives. In such cases, treatment is canceled. They also stop exposure to light if the child’s stool darkens, the skin becomes very red due to burns or acquires a marbled tint. Photo lamp ( phototherapeutic irradiator) for the treatment of jaundice in newborns Photo lamp ( also called phototherapy irradiator) is equipment that is used to treat newborns with jaundice with light. Previously, such lamps were used only in hospital settings, and for treatment it was necessary to go to the hospital. Today, photo lamps can be purchased for private use, that is, at home. The cost of such a device is quite high, so the best option is to purchase a photo lamp for rent. Phototherapy sessions should be carried out at home only after receiving detailed consultation from a doctor. The doctor must examine the patient to determine the presence of possible contraindications. The doctor will also determine the optimal regimen ( duration and number of sessions per day) carrying out phototherapy. In addition, the doctor will inform you about how to monitor the condition of a small patient while using the photo lamp. What kind of photo lamps are there? There are several types of irradiators for phototherapy. The devices differ in several respects, among which the most important is the type of lamps used and the light they emit. Today, LED, halogen or fluorescent lamps can be installed in a phototherapy device. Each type of lamp has its own characteristics. Thus, devices with fluorescent lamps have higher power, while halogen light sources have a longer service life. Devices with LED lamps, as a rule, are compact in size and consume less electrical energy. LED lamps are the optimal choice for phototherapy at home. The light emitted by lamps can be blue, white or blue-white. The second criterion by which photo lamps differ is their design. Most devices consist of 3 parts. The following structural elements of photo lamps are distinguished: a lampshade with lamps, the number of which depends on the model and type of lamps themselves; a base that is made in the form of a tripod or other stable structure; a metal or plastic pipe that connects the lampshade and the base. The pipe is height adjustable, which allows you to install the equipment at the optimal angle. For professional use Large equipment is used in comparison with photo lamps, which are intended for phototherapy at home. Equipment parameters ( lamp power and other technical characteristics) may also differ. For professional use ( V medical institutions ) high power devices are used; for home use there are less powerful but more economical units. It should be clarified that the service life of lamps is not unlimited. Therefore, when renting equipment, you should check the life of the lamp, since if it is used up, phototherapy will not be beneficial. Another criterion by which photo lamps differ is their configuration and the presence of additional options. Thus, there are phototherapeutic irradiators, the design of which involves various timers to control temperature, session time and other factors. Some photo lamps are supplied complete with eye protection glasses, an incubator ( boxing) and other parts that facilitate the operation of the equipment. How to use a photo lamp? If light therapy is carried out in a hospital, medical personnel are responsible for organizing the conditions for treatment. When treatment is carried out at home, you should act according to the instructions that come with the equipment. It is also necessary to follow the doctor’s recommendations and a number of general rules for using a phototherapy unit. The following are distinguished: general rules Applications of a photo lamp at home: Before starting the session, the surface of the lamps must be wiped with a dry cloth, since the presence of dust significantly reduces the effectiveness of the procedure; the child should be undressed and protective bandages should be applied to the eyes and groin area; then the newborn should be placed in the incubator ( or a crib); the photo lamp needs to be rolled to the place where the child is lying and the lampshade raised to the required height; then you should connect the installation to the power source and adjust the position of the lampshade with lamps at the required angle; there is a ventilation hole on the body of the installation, and before starting the session, you should check whether it is covered; then you need to set the countdown timers and turn the toggle switch ( or press the button) to the “on” position. Light nurse in the treatment of neonatal jaundice “Svetonyanya” is a modern device for phototherapy, which is equipped with LED lamps emitting blue light. The equipment is most often used in inpatient departments, but can also be used to treat jaundice at home. The photo lamp of this brand belongs to the latest generation of phototherapeutic irradiators. Thanks to a well-thought-out design and a large number of additional options, the equipment is characterized by long and safe operation. Design features of the device The design of the device includes 364 LEDs, which have a long service life. Despite the large number of lamps, the installation is lightweight and compact, which facilitates its operation, transportation and storage. "Svetonyanya" is equipped with two shades ( top and bottom), which provides uniform distribution Sveta. The design of the device allows you to disconnect the top lamp from the connecting stand and install it, if necessary, directly on the lid of the box. Distinguish the following elements, which are included in the “Svetonyanya” device: plastic covez; flannel envelope for a child with transparent inserts on the back and chest; electronic control unit, which is mounted on the connecting pipe; autonomous sensor that controls lighting parameters. The installation has a sound notification function, and at the end of the session the device emits a signal. The cost of equipment depends on the configuration. Thus, the price of the new “Svetonyanya”, equipped only with an upper lamp, varies within 65,000 rubles. If the package includes a lower lamp, the unit costs approximately 70,000 rubles. The cost of the device increases to 80,000 rubles if it is purchased together with an incubator. Sun for jaundice in newborns Under the influence of sunlight, bilirubin is converted into liquid form and removed from the child's body. Therefore, doctors recommend sunbathing for newborns who have jaundice. It needs to be clarified that harmful effects diffused light provides bilirubin, rather than direct sunlight, which can also cause skin burns. For this reason, during procedures, the child’s skin should be protected from direct exposure to the sun. The principle of sunbathing is to provide the child with regular exposure to sunlight. In the warm season, a partially clothed or naked baby should be taken out to the balcony or other place where it penetrates sunlight. When exposed to the sun, the child should be regularly turned from one side to the other. The duration of the procedure should vary from 10 to 15 minutes. It is recommended to carry out 3 to 4 such sessions per day. Also, in the warm season, you should take walks in the fresh air, opening the hood of the stroller ( if he is) to allow light penetration. In the cold season, sunbathing can be done indoors, near a window, since the effect of light on bilirubin also extends through glass. At the same time, the glass obstacle reduces the intensity of light exposure, so sessions should be longer. It is best to move the baby's crib to the window and leave him in it throughout the daylight hours. Breastfeeding for neonatal jaundice Breastfeeding is the main method of combating neonatal jaundice. Therefore, if possible, you should not stop breastfeeding even in cases where certain difficulties arise ( for example, a child undergoes phototherapy). Until recently, it was believed that in some cases breastfeeding promotes the growth of bilirubin and many experts insisted on transferring the child to artificial nutrition. Recent research in this area refutes this theory and confirms the fact that a newborn with jaundice should receive sufficient breast milk. Feeding with breast milk jaundice Jaundice breastfeeding– a type of physiological jaundice, in which the characteristic skin tone is provoked by mother’s milk. The specific reason for this reaction of the child’s body has not been established to date. There are several theories regarding the development of breastfeeding jaundice. The most popular assumption among experts is that some fatty acids in human milk inhibit the excretion of bilirubin, and it accumulates in the child’s body. Breast milk jaundice was previously thought to be rare, occurring in only 1 to 2 percent of newborns. Newer observations show that this condition is diagnosed in one third of breastfed children. This type of jaundice can last up to three months of age and then goes away without a trace. It is not accompanied by complications, since with jaundice mother's milk A non-toxic form of bilirubin accumulates in the body. Whether to feed a baby with breast milk or not with breastfeeding jaundice is a question that interests many mothers. If earlier treatment tactics consisted of transferring the child to artificial formula, today doctors recommend continuing to breastfeed. In some cases, breastfeeding is stopped for a while ( from 24 to 72 hours). During this period, the amount of bilirubin in the child’s body decreases significantly, after which the child begins to breastfeed again. When breastfeeding stops, the little patient is transferred to artificial formula. A woman should express breast milk to avoid problems with its production. How to feed a baby milk with jaundice? First of all, it should be noted that breastfeeding should be started as early as possible. A significant amount of bilirubin is excreted in the first stool ( meconium), and colostrum ( milk that is produced after childbirth) has a laxative effect. Therefore, the baby should be put to the breast as soon as possible after birth. Subsequently, it is recommended to feed the newborn 8–10 times a day. A nursing mother must monitor whether the baby is suckling correctly, because otherwise the baby will not receive the required amount of nutrients. This recommendation is relevant for jaundice, because sometimes it causes drowsiness or weakness in children, as a result of which they do not breastfeed properly. There are a number of signs by which a nursing woman can check the effectiveness of sucking. Distinguish following signs poor quality sucking: the child spits and is capricious while eating; In addition to the sound of swallowing, the baby makes other sounds; lips turned inward; the child clicks his tongue; After eating, the baby burps profusely. To improve the feeding process, the mother needs to see a doctor who will recommend how to improve the child’s appetite. The mother can also help the newborn by following some rules when feeding. Before you start feeding your baby, if your breasts are too tight, you need to pump. Then you should lightly squeeze the nipple with your fingers and put it in the baby's mouth. If your baby keeps his mouth closed, you can run the nipple along his lower lip, this will open his lips and make it easier to insert the nipple into his mouth. After the baby takes the breast, you need to point the nipple towards the sky. Light stimulation of the upper palate will activate the natural swallowing reflex, and the baby will begin to suck. You can determine that a child eats well and with appetite based on a number of signs. If the baby does not smack his lips during feeding, and makes short pauses during which he can be heard swallowing milk, then he is eating well. With effective sucking, the baby grasps the nipple deeply and rests his chin on the chest. Should neonatal jaundice be treated? The advisability of treating jaundice in newborns depends on what cause caused the skin to turn yellow. The characteristic shade can be either a consequence of a simple physiological process or a sign of serious pathologies. In the first case, with physiological jaundice, treatment comes down to organizing the correct diet for the child and mother ( if she is breastfeeding). It is also recommended to ensure regular contact of the child's skin with sunlight. Sometimes phototherapy is indicated for a newborn. In the second case, with pathological jaundice, the newborn needs timely and adequate treatment. The nature of therapy depends on the cause of the disease, characteristics and condition of the child. As a rule, children are prescribed drug treatment in combination with phototherapy. If there is a high concentration of toxic bilirubin, a blood transfusion may be indicated for a small patient. With obstructive jaundice, when the disease is caused by pathology internal organs, the child undergoes surgery. The biggest danger with this disease in newborns is that the pathological form can be mistaken for physiological jaundice. The main difference between one type of jaundice and another, which parents focus on, is the time during which the icteric tint persists. Physiological jaundice lasts only a few days, but pathological jaundice lasts much longer. This fact helps parents consult a doctor in time. But there is a variety of physiological form ( breast milk jaundice), which lasts quite a long time. In this case, parents can accept the symptoms dangerous disease for manifestations of breastfeeding jaundice. To exclude this possibility, you should systematically take tests for bilirubin, and also monitor the behavior of the newborn. Newborn jaundice blanket The Jaundice Blanket for Newborns is a relatively new invention that was developed by 3 students. This device allows you to conduct phototherapy sessions at home, as it is lightweight, compact in size and simple to operate. Features of a phototherapy blanket Externally, this device looks like a mattress, to the outer surface of which an envelope-type coverall is sewn. From a technical point of view, this device is a 3-part design. The first element is a lamp that emits light. A coating made of a special polymer material is installed on top of the light source. An envelope is attached to the polymer, into which the child is placed during phototherapy. Since the light is supplied from below, sessions can be performed without protective eye patches. The device also emits heat, which helps prevent the child from becoming hypothermic. The mattress is installed in a crib, and built-in timers allow you to control the duration of the session. Using a phototherapy blanket there is no need to pause for swaddling, since you can change diapers directly on it. The most common equipment in this segment is the BiliBed system, produced by the Medela brand. Instead of an envelope, the kit includes a soft blanket in which you can wrap your baby if the room is cool. Lamps installed in this equipment must be replaced after 1500 hours of use. The cost of renting the BiliBed system is approximately 1000 rubles per day. Folk remedies for neonatal jaundice Many mothers are interested in whether there are folk remedies to combat jaundice in newborns. On the Internet you can find recipes for remedies based on various herbs that are recommended to treat a child. Some sources offer preparations based on vodka or alcohol, toxic plants and other components that cannot be introduced into a newborn’s diet. Many body systems of a newborn baby are immature, and the use of such drugs can lead to negative consequences. Therefore, mothers should not attempt to treat their child with such drugs. The only remedies that can be used for jaundice are decoctions made from rose hips or corn silk. You can give your child such drinks only after medical consultation. The doctor will also determine the system of use and dosage of these drugs. The doctor's recommendations must be followed, since uncontrolled use of such drugs can worsen the condition of the newborn. Corn silk for jaundice The use of corn silk for jaundice is based on the fact that they normalize the flow of bile and increase the frequency of urination. As a result of consuming the decoction, the process of breakdown and removal of bilirubin is accelerated, and recovery occurs faster. Corn silk are indicated only for physiological jaundice, since in the presence of pathological processes, the decoction can aggravate the condition of the newborn. Corn silk reduces appetite, so you should not give the decoction to children who do not eat well. It is also not recommended to use this remedy to treat jaundice in premature babies. Rosehip for jaundice Rosehip decoction helps reduce bilirubin levels, since due to its rich vitamin composition improves the functioning of many internal organs. At the same time, this drug produces a pronounced diuretic effect, which can cause stress on the kidneys. Therefore, doctors often advise nursing mothers to drink rosehip decoction so that the baby receives vitamins through breast milk. Mother's diet for neonatal jaundice Organizing proper nutrition for a nursing mother is an important condition for treating jaundice in a newborn. Mothers of children with both pathological and physiological jaundice should adhere to a special diet. A woman should eat foods that are easily digestible to reduce the burden on the baby's liver and other digestive organs. Also, a nursing mother needs to include in her diet foods that contribute to the production of high-quality milk in sufficient quantities. Exist following rules Diets for mothers with jaundice in newborns: The calorie content of the daily diet should be at least 3500 calories. The increased calorie content of the menu is due to the fact that female body spends a lot of energy to produce milk. If you are in a calorie deficit, your milk production may decrease, and poor nutrition is a factor that aggravates jaundice. Drinking alcohol and using tobacco products during feeding not only slows down the recovery of the newborn, but also negatively affects the physical and mental development child. A large amount of herbs and/or spices in the food consumed changes the taste of milk, which the child may not like. Also, a newborn may suckle with less appetite or refuse milk altogether if a woman abuses foods that contain a lot of salt. Legumes and all types of cabbage provoke excessive gas formation and bloating in a child. This not only stops the removal of bilirubin, but also negatively affects children's appetite. Instant food products, as well as those that have unnatural color, taste or aroma, contain a large amount of dyes, preservatives, and flavorings. These substances increase the load on the baby's liver, which prolongs the course of jaundice. The menu of a woman who is breastfeeding a newborn with jaundice should contain fresh natural products. The diet should be varied and balanced so that the child receives all the necessary elements. The following foods are recommended for mothers of newborns with jaundice: cereal dishes ( corn, oatmeal, buckwheat); low fat meat ( chicken, turkey, rabbit); baked or boiled vegetables ( pumpkin, zucchini, potatoes); boiled fruits or compotes made from them ( apples, white cherries, pears); vegetable oil ( olive, sunflower); dairy products ( cottage cheese, yogurt, lightly salted cheese). Complications and consequences of neonatal jaundice As has been noted more than once, the main danger of jaundice is the toxicity of bilirubin. Bilirubin is most toxic when it is in its free, unbound form. The highest concentration of such bilirubin is observed with hemolytic jaundice, that is, with jaundice caused by the breakdown of red blood cells. Why is jaundice dangerous in newborns? If a child is diagnosed with physiological jaundice, this condition rarely entails severe complications. Some children may become more capricious, passive, and drowsy. Also, in some cases, young patients lose their appetite. This condition complicates therapy and care for the child, but does not cause harm, since physiological jaundice quickly passes. Serious negative consequences pathological jaundice may result. Bilirubin, which accumulates in internal organs and tissues over the course of the disease, is highly toxic and has a detrimental effect on the vital systems of the body. The most dangerous complication of pathological jaundice is bilirubin encephalopathy. With a high concentration of toxic bilirubin, a large amount of this substance accumulates in the brain cells. As a result, the metabolic processes and brain cells do not receive proper nutrition. Gradually, damage to various lobes of the brain develops, and the function of this organ begins to fade. skin color acquires a greenish tint; bruise-like spots appear on the skin; stool loses color and urine becomes dark. Is jaundice contagious in newborns? Whether jaundice is contagious or not depends on the cause that caused the newborn's skin to turn yellow. With physiological jaundice, there is no chance of infection, since doctors do not classify this condition as a disease. In the case of pathological jaundice, the situation is different. The chance of contracting this disease depends on the factor that provoked it. Jaundice is transmitted if its cause is an infectious process, which can be either bacterial or viral. Distinguish following reasons jaundice, which can be contracted from a newborn: Botkin's disease ( hepatitis A); other types of viral hepatitis; Infectious mononucleosis ; yellow fever ( type of viral infection); leptospirosis ( type of bacterial infection). Is it necessary to have jaundice in newborns? Neonatal jaundice is common but not obligatory. Medical statistics say that yellow skin discoloration occurs in 60 percent of children born at term. In premature newborns, jaundice is diagnosed in 80 percent of cases. Among all cases of detected jaundice among newborns, approximately 65 percent are physiological jaundice. Prevention of neonatal jaundice Prevention of jaundice in newborns is the prevention of those conditions that caused its development. Therefore, there are no specific measures to prevent jaundice. Instead, there are measures aimed at preventing intrauterine infections, prematurity, and reducing the risk of developing hemolytic disease of the newborn. It should be noted that all these measures are aimed at preventing those pathologies that cause pathological jaundice. Physiological jaundice, which appears on the 3rd day and lasts up to 10, does not require preventive measures. Preventive measures for pathological jaundice in newborns include: timely treatment of infections in the mother ( First of all, these are sexually transmitted infections); prevention of prematurity - timely hospitalization of pregnant women with the threat of premature birth; prevention of hemolytic disease of newborns. Among the above measures, the prevention of hemolytic disease of newborns deserves the most attention. This is a pathology that develops as a result of incompatibility between mother and fetus according to the Rh factor or blood group. It is accompanied by extensive destruction of the child’s red blood cells, which leads to an increase in the concentration of toxic bilirubin and the development of anemia. Measures to prevent hemolytic disease of newborns include: administration of anti-Rhesus globulin serum to first-time mothers; regular ultrasound monitoring ( Ultrasound) for the condition of the fetus; avoid post-term pregnancy; blood transfusion to a child with a bilirubin concentration of 400 micromol per liter; determination of antibody titer in the child’s blood. Hepatitis vaccination for neonatal jaundice In the calendar of mandatory vaccinations ( vaccines) for newborns, only one vaccination against hepatitis is recommended - this is a vaccination against hepatitis B. This vaccine is given in the first 24 hours after the birth of the child. Revaccination ( booster vaccinations) is carried out 1, 3 and 6 months after the birth of the child. Physiological jaundice is not a contraindication for hepatitis vaccination. In case of pathological jaundice, the doctor makes a decision based on the severity of the baby’s condition. Vaccination against jaundice for newborns There is no shot or vaccine against neonatal jaundice. The reason for this is the fact that neonatal jaundice can be of various etiologies. Therefore, it is impossible to simultaneously eliminate all factors that contribute to its development. Before use, you should consult a specialist.

After the little man is born, the only concern of the parents is his health, which is so vulnerable and fragile at this very moment. Unfortunately, jaundice in newborns is something that almost 80% of young families have to deal with.

Some people take this phenomenon calmly, knowing that this is the norm. Some people go crazy, considering this symptom dangerous and requiring hospitalization and treatment. Both are wrong. In this matter, the golden mean is very important: you can’t take it too lightly, but you shouldn’t panic either. Let's figure out why.

The skin of a newborn becomes yellow due to bilirubin, a breakdown product of hemoglobin. In the womb, the fetal red blood cells are saturated a certain type hemoglobin, which after birth at pulmonary breathing begins to actively disintegrate. A huge amount of bilirubin formed (indirect and very toxic) enters the liver, so that it converts it into indirect and removes it from the body. But the liver does not always cope with such a load.

Doctors call the following causes of jaundice in newborns:

• pathogens that attack the liver;
• disturbances in the structure or functioning of the bile bladder and bile ducts;
• natural restructuring of the body as a result of its adaptation to a new environment;
• a large amount of carotene in the diet of a nursing mother;
• premature birth: jaundice in premature newborns occurs in 80%, since the liver is not yet sufficiently formed;
• maternal diabetes;
• genetics;
• diseases of the circulatory system;
• asphyxia;
• hormonal disorders (the child will be treated by an endocrinologist);
• incompatibility: blood group I in the mother, blood group II or III in the child;
• intrauterine infection;
• stomach problems, when bilirubin is constantly absorbed back into the body - in such situations, only surgery can save you;

These are the main causes of jaundice in newborns. Each of them has its own characteristics. In some cases, bilirubin is gradually eliminated by the body without consequences. But there are forms of the disease that require immediate medical attention. Depending on the factors that provoke the development of jaundice, doctors name risk groups.

Medical terminology. The concept of "bilirubin" dates back to Latin words bilis, which means bile, and ruber - translated red.

At-risk groups

Even during pregnancy, doctors include in the risk group special categories of women whose children at birth have a high chance of having jaundice. These include:

• age less than 18 and more than 40 years;
• early abortions, miscarriages;
• previous premature birth;
• smoking, alcoholism, drug addiction during pregnancy;
• negative Rh factor;
• intrauterine infections;
• jaundice in previous children.

Women who are at risk are under the constant supervision of a doctor throughout pregnancy and undergo additional tests. And yet, it is impossible to 100% prevent jaundice in a newborn, even if you constantly take care to prevent the disease. It is very important to recognize it in time by characteristic features, which will help distinguish one type of jaundice from another.

The truism. If a woman leads a healthy lifestyle during pregnancy, she reduces the risk of jaundice in her baby.

Types of jaundice

Doctors diagnose different types jaundice in newborns who, under normal conditions, without laboratory research, difficult to install. This is very important point, since the need for further treatment and the risk of possible complications.

Physiological

Physiological jaundice is the norm for newborns; it occurs due to the natural restructuring of the body as a result of its adaptation to the new environment. It appears in the first month of the baby’s life, but not immediately after birth. Represented by the following types.

• Carotene

Carotene postpartum jaundice occurs due to a large amount of carotene in the diet of a nursing mother. There is a lot of this substance in orange foods: pumpkin, carrots, oranges.

• Breast milk jaundice

This postpartum jaundice occurs when the mother has a lot of estrogen in her breast milk. The liver removes it first and only then - bilirubin. The baby remains yellow for about 3 months. But at the same time he develops according to the norms of his age. This condition is not dangerous and does not require cancellation of lactation.

• Neonatal

Neonatal jaundice is the most common type. It is not a pathology and does not require treatment. It goes away on its own and does not cause complications.

Pathological

Associated with serious diseases of the baby’s internal organs. It appears within a few days after birth. Presented in different types.

• Hemolytic

Caused by problems with the circulatory system: due to Rh conflict between mother and baby, mismatch in blood groups, incompatibility in antigens. Occurs only in 1% of cases. This is birth jaundice in newborns, as it is recognized instantly, in the first days and even hours after birth.

• Mechanical

Bile is not separated from the liver due to disturbances in the structure or function of the bile bladder and bile ducts. Most often the cause is birth trauma or. It appears only 2-3 weeks after birth.

• Nuclear

There is a special barrier in the circulatory system that does not allow access to the brain toxic substances, filtering them out. But if the level of bilirubin is too high, it may not cope with the load. In this case, destruction is possible nerve cells. Symptoms: lethargy, refusal to eat, monotonous screaming, throwing back the head.

• Conjugative

Caused by poor liver function. Enzymes do not bind bilirubin and do not remove it from the blood.

• Hepatic

Diagnosed after liver cells are damaged by bacteria or viruses.

The physiological jaundice of newborns, which is not dangerous and goes away on its own, should not frighten parents. Everything is much worse if it is dictated by serious pathologies inside the body. Symptoms of the disease allow you to suspect something is wrong and promptly consult a doctor.

Educational program for parents. Why is conjugation jaundice? This word is derived from the Latin “conjugation”, which means “conjugated”. That is, this disease is associated with liver pathology.

Symptoms

Depending on the type of disease, the symptoms of jaundice may vary. If they do not go beyond the norm and indicate only the physiological form of the disease, there is no need to sound the alarm. After 3 weeks everything will end happily. But if alarming signs of a more serious pathology are added to them, you need to inform your doctor about this - and as quickly as possible.

Signs of physiological jaundice

• The skin and whites of the eyes acquire a yellow, almost orange tint;
• minor stool disturbances.

Symptoms of pathological jaundice

• More intense yellow skin color;
• pinpoint hemorrhages, bruises;
• wave-like course of the disease: the skin color periodically recovers to pink, and then returns to icteric;
• the child is lethargic and lethargic, refuses food;
• increased muscle tone;
• monotonous or strong high-pitched crying;
• dark urine;
• discolored stool;
• convulsions;
• slow heart rate;
• stupor or coma.

Clinical picture of specific pathologies

• Lethargy, refusal to eat, monotonous cry, throwing back the head, convulsions, attenuation of the sucking reflex - symptoms of kernicterus;
• persistence of yellowness of the skin after 3 weeks, dark urine and discolored feces indicate serious pathologies of the bile ducts;
• if the skin and sclera turn yellow immediately after birth, the child is lethargic and sleepy, and diagnosis reveals an enlarged spleen and liver - this is hemolytic jaundice;
• the skin acquires a yellow tint with a greenish tint 2-3 weeks after birth, the stool is abnormally light, the liver is compacted, the spleen is enlarged - symptoms of a mechanical type of disease.

The sooner parents recognize dangerous guy jaundice in a newborn, the faster doctors will prescribe treatment and be able to help. Very often, precious time is lost, and complications that affect the child’s entire subsequent life cannot be avoided. To prevent this from happening, mandatory diagnosis of the disease is necessary.

Distinguish jaundice from hepatitis! With hepatitis, the newborn's temperature rises, and the skin turns yellow suddenly and unexpectedly.

Diagnostics

Only laboratory indicators can accurately determine which jaundice a newborn has - harmless physiological or dangerous pathological. To obtain them, the following studies can be carried out:

• blood test: general and bilirubin;
• Coombs test for hemolysis;
• Ultrasound of the abdominal cavity;
• consultations with an endocrinologist, surgeon and other specialists.

Table of bilirubin norms in newborns

Table of normal indicators of direct and indirect bilirubin

According to standards, direct bilirubin should be no more than 25% of overall indicator, indirect - at least 75%. Depending on the results obtained, a accurate diagnosis(not only jaundice, but also the disease that provoked it) and treatment was prescribed.

Helpful information. The Coombs test is performed immediately after birth using blood from cutting the umbilical cord.

Treatment

All parents are concerned about how to treat jaundice so that it goes away as quickly as possible. Such children are under constant medical supervision, but if this is a physiological disease and proceeds within normal limits, no therapy is required. If pathology is detected, treatment can take on different directions: antiviral, antibacterial, choleretic, detoxification or immune.

Medications

If bilirubin levels are off the charts, special medications for jaundice are prescribed.

1. Ursofalk is a medicine for jaundice for newborns in the form of a suspension aimed at protecting and maintaining normal operation liver. Prescribed for prolonged jaundice. Dosage - 10 mg per 1 kg of weight.
2. Hofitol - another one effective medicine for jaundice in the form of a solution based on natural artichoke extract, which activates the flow of bile and simplifies the functioning of the liver. Prescribe 1 to 3 drops 3 times a day.
3. Infusion therapy during phototherapy to restore water balance: glucose solutions, electrolytes, soda, membrane stabilizers, cardiotrophics. Protracted jaundice necessarily requires such treatment.
4. To normalize liver function, Zixorin, Phenobarbital, and Benzonal may be prescribed.
5. When bilirubin is absorbed by the intestine, sorbents are used: Enterosgel, Polyphepan, Smecta, Activated carbon.
6. Fat-soluble vitamins: cholecalciferol (D3), retinol (A), tocopherol (E), phylloquinone (K).
7. Microelements: phosphorus, zinc sulfate, calcium.

Interesting fact. The drug for jaundice Urosofalka is based on ursodeoxycholic acid, which is found in bear bile. Today they have learned to produce it in laboratory conditions.

Procedures and phototherapy

For this disease, a decision may be made on the following procedures:

• blood transfusion in the diagnosis of kernicterus;
• liver transplantation for cirrhosis.

Also, with jaundice, the child needs sunlight, but in this at a young age they can be dangerous, so treatment with a lamp is prescribed - phototherapy. Under influence bright light harmful bilirubin is actively eliminated. This procedure is absolutely safe. The baby is placed under it for several hours a day if there are no complications. If the disease is severe, he will be under it for almost the whole day.

Phototherapy device for the treatment of jaundice in a newborn

Parents should understand that jaundice in a newborn does not always require therapy. Therefore, there is no need to be surprised and indignant if the child turns yellow, and he and his mother are discharged from the maternity hospital. But this is only possible in cases where blood tests are in order, the bilirubin content in the body is not off the charts, and doctors have not found any internal pathologies. Accordingly, the baby does not need to be healed at home.

Folk remedies

Self-treatment at home for jaundice in a newborn is carried out only with the permission of a doctor. Even the most harmless, at first glance, remedy recommended by a neighbor or mother can be very dangerous for a small organism, many of whose systems are still adapting to the new environment. Among the most recommended drugs approved by pediatricians are the following:

• dandelion root tincture: 3 drops 4 times a day;
• a good remedy for jaundice is alfalfa tincture: 2 drops 4 times a day;
• activated carbon solution: dilute 10 grams of powdered charcoal in 50 ml of boiled warm water, give the baby 1 pipette every 2 hours;
• rosehip decoction;
• infusion of corn silk;
• after feeding, apply a bandage soaked in a magnesium solution to the newborn on the liver side;
• tea “Collection for a nursing mother”: drink 1 liter daily.

You cannot use several remedies from this list at once, because many of them are mutually exclusive or their combination will have too powerful an effect on a small organism. A newborn suffering from jaundice will benefit greatly from proper care.

Secrets of herbal medicine. Lucerne - medicinal plant, rich in vitamin K, which improves liver function.

Care

It was not possible to avoid jaundice, they were discharged home with such an unpleasant diagnosis - what should worried parents do in such a situation? Proper care of a newborn will ease his condition and speed up recovery. Here are the points it includes.

1. For a few minutes a day, place the undressed child in the sun's rays.
2. Frequent feeding and drinking plenty of fluids normalize liver function.
3. For galactosemia, feed the child with formulas without lactose and galactose: Nutramigen, Pregistimil, lactose-free NAN.
4. For tyrosinemia, a diet is required: mixtures without phenylalanine, methionine, tyrosine (HR Analog, Afenilak, Lofenolac).
5. Complete breastfeeding.
6. Mom's diet: exclusion from the diet yellow products, spices, pepper and salty dishes.
7. Daily walks in the fresh air.
8. Phototherapy at home.

If any of the points of care for a jaundiced newborn are in doubt, it is better to consult a doctor, but do not do anything on your own or experiment. Particular care must be taken when treating sun rays, which in summer are fraught with burns. At the right approach this issue can speed up recovery and avoid complications.

You should know it. Galactosemia is a hereditary genetic disease, lactose intolerance.

Complications

Parents are worried about the danger of jaundice in newborns, and how this disease can end in the end, other than recovery. The physiological form is rarely fraught with complications. But pathology can lead to the following consequences:

1. Sometimes prolonged jaundice in newborns can cause complications that subsequently affect the nervous system, since indirect bilirubin has a toxic effect on the central nervous system.
2. Phototherapy with an incorrectly chosen treatment regimen can lead to burns, dehydration, hemolysis, lactose intolerance, etc.
3. Consequences of kernicterus - deafness, complete or partial paralysis, mental retardation.
4. Toxic poisoning and intoxication.
5. Albuminemia is a decrease in albumin protein.
6. Bilirubin encephalopathy is a brain lesion.

Knowing why jaundice is dangerous in newborns, parents will be able to assess the full extent of the risk and take appropriate measures to ensure that nothing terrible happens. It is much easier to prevent a disease than to treat it - if you constantly think about prevention during pregnancy, the baby will be able to avoid problems with bilirubin after birth.

Forecasts for the future. The modern level of medicine will make it possible to cure even bilirubin encephalopathy. True, when timely diagnosis and compliance with all medical requirements.

Prevention

The expectant mother should be involved in the prevention of jaundice even while carrying the baby and after his birth. To do this, it is enough to follow the following rules.

1. Adequate nutrition for the mother during pregnancy.
2. Her refusal of bad habits.
3. Prevention and treatment of any diseases.
4. Refusal of vitamin K injections to newborns, which are practiced in maternity hospitals.
5. Sunbathing.
6. Frequent breastfeeding.
7. Drinking plenty of fluids for a nursing mother.
8. Cutting the umbilical cord in the second hour after birth, when the pulsation at the base of the navel stops. This will allow blood circulation to normalize.

By preventing jaundice, you can prevent the disease so that nothing overshadows the baby’s first days. If you have any additional questions about this phenomenon, it is better to find out all the information from your pediatrician in advance.

Controversial issue. Doctors are still arguing about how the timing of cord cutting affects the manifestations of jaundice. There is no scientific evidence about the direct relationship between these two facts.

FAQ

• When should jaundice go away in newborns?

The answer to the question of how long it takes for jaundice to go away in newborns depends on the type of disease and individual characteristics body. Normally, physiological jaundice disappears after 2-3 weeks.

• What lamp is used to treat jaundice in newborns?

These are special lamps that emit bright ultraviolet light, the spectrum of its rays accelerates the breakdown of bilirubin.

• Is jaundice contagious in newborns?

Unlike the hepatitis virus, jaundice in newborns is not contagious.

• Can jaundice return in newborns?

Yes maybe. But if the disease recurs, an urgent consultation with a doctor is required to rule out complications.

• On what day does jaundice appear in a newborn?

It can begin 4-5 days after birth.

• Whynewborn's jaundice does not go away 1or even2 months?

There may be several reasons for lingering jaundice:

• the bilirubin excretion cycle has failed;
• liver dysfunction due to a birth defect or hepatitis;
• stagnation of bile due to disturbances in the functioning of the biliary tract and gallbladder;
• the formation of more and more new bilirubin due to blood diseases.

In any case, prolonged jaundice requires diagnosis of the causes and immediate treatment.

If a newborn becomes ill with jaundice, parents should closely monitor his condition. If he feels good, it’s physiology and nothing more. The best medicine in this case is breast milk. If he is lethargic and cries often, this is already a pathology that requires consultation with a doctor, tests and treatment.

Often, new mothers, looking at their newborn treasure, even in the maternity hospital notice the unusual yellowness of its skin. The pediatrician also pays attention to this.Newborn jaundice makes a young mother worry. Should we sound the alarm? Where does yellowness come from? Why do babies turn yellow? Does this need to be treated and how?

Types of newborn jaundice

Jaundice in a newborn is a fairly common occurrence. It is caused by an increased level of bilirubin in the baby’s blood and skin. Bilirubin is a reddish-yellowish pigment formed during the breakdown of hemoglobin. If it is deposited in excess in the child’s tissues, then the baby’s skin and mucous membranes acquire a typical yellow color.

First of all, mothers should know that there are 2 types of jaundice in newborns: physiological and pathological. Let's try to learn as much as possible about each type of jaundice.

Signs of physiological jaundice

The baby's skin becomes colored 2-3 days after birth. Such jaundice in a newborn does not go beyond normal limits and usually disappears without a trace after a few days. In some children, the jaundiced skin color is barely noticeable, in others it is quite pronounced. The degree of manifestation of jaundice depends on the rate of formation of bilirubin, as well as on the ability of the small organism to remove it. TO this species Jaundice also includes the so-called “breastfeeding jaundice.” In this case, the child’s general well-being does not suffer, urine and feces retain their natural color, the liver and spleen do not enlarge.

You need to know that normally the skin acquires its natural color in the third week in full-term babies and after 4 weeks in premature babies; this is the main sign of a physiological phenomenon. This condition passes in children without medical intervention and does not have any harmful consequences for the baby’s body. The yellowness should begin to decrease at the beginning of the 2nd week of life. Normally, physiological jaundice lasts no longer than 3 weeks and completely disappears by the end of the 1st month of the child’s life.

Attention: if the yellowness of the child’s skin lasts a month or longer, the stool is colorless, the urine is dark, but the bilirubin level does not exceed 115 µmol/l - this is not physiological jaundice. Most likely, there is a congenital pathology of the biliary tract. This condition of the child requires a thorough examination to make a correct diagnosis.

Pathological jaundice: how to quickly recognize the danger?

This type of jaundice requires close attention from the mother and doctors. The norm of bilirubin in the blood of such children is greatly exceeded, and since the pigment is toxic, gradual poisoning of the body occurs (more details in the article:). You should be wary if your baby has the following symptoms from the first days:

• darkening of urine and feces to an unnatural color;
• jaundice appears already in the first day of life;
• the baby is lethargic, inactive, sucks poorly;
• high level of bilirubin in the blood;
• yellowness of the skin lasts longer than 3 weeks;
• enlarged spleen and liver (we recommend reading:);
• the child often spits up;
• pathological yawning.

Then the classic manifestations of the so-called “nuclear” jaundice appear:

• increased muscle tone;
• protrusion of a large fontanel (more details in the article:);
• convulsive twitching;
• the baby screams monotonously;
• eye rolling;
• breathing problems until it stops.

After a few days, the symptoms of jaundice decrease, but it is too early to rejoice: later, ominous signs of cerebral palsy, hearing impairment, and retardation in mental and physical development develop. Pathological jaundice should be treated immediately in a specialized hospital.

Remember: the main symptom of this pathology is early date its manifestations! A baby's skin turns a bright yellow color almost immediately after birth.

Fortunately, the pathological form of jaundice is rare. Such jaundice is diagnosed in only 5 out of 100 newborns. Parents should carefully monitor the condition of their baby in the first days of his life so as not to be late with treatment.

Why does physiological jaundice occur?

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During intrauterine life, the baby's tissues were supplied with oxygen by red blood cells (erythrocytes), but after birth the baby breathes on his own and now red blood cells with hemoglobin are no longer needed. They are destroyed and in the process of their destruction bilirubin is produced, which turns the newborn’s skin yellow (we recommend reading:). Bilirubin is excreted in feces and urine.

The baby’s body is just learning to function correctly and does not yet know how to fully cope with all its responsibilities. Jaundice in a newborn is a natural phenomenon that occurs as a result of insufficient liver function. Since the newborn’s liver is still immature, in the first days of his life it does not have time to process all the bilirubin that is formed, so the pigment partially enters the blood. It stains the mucous membranes and skin yellow. When the child's liver grows a little, it will more thoroughly process the bilirubin that enters it. As a rule, the liver begins to function fully by the 5th-6th day of a baby’s life. From this moment on, physiological jaundice gradually fades away and there is no reason for concern.

In some children, liver function improves faster, in others slower. What determines the rate of bilirubin excretion? A child has every chance of being “yellow-skinned” for a couple of weeks if:

• Mom is too young and she has the highest level of bilirubin;
• diabetes mellitus in mother;
• he was born in a pair with a twin brother or sister;
• he was born prematurely - the liver of a premature baby is even more immature than that of babies born on time;
• mother experienced iodine deficiency during pregnancy;
• the mother ate poorly, smoked or was sick while she was carrying the baby;
• took some medications.

Where does pathological jaundice come from?

Most often, this terrible phenomenon happens for the following reasons:

1. Incompatibility of the blood of mother and fetus according to the Rh factor ( hemolytic disease newborns). Currently, it is extremely rare, since all women with Rh negative get special preventive treatment already from the 28th week of pregnancy.
2. Congenital diseases or underdevelopment of the baby's liver.
3. Genetic or hereditary abnormalities.
4. Congenital pathologies of the circulatory system or intestines of a newborn.
5. Inappropriate antibiotic therapy.
6. Severe pregnancy of the mother, toxicosis, threat of miscarriage.
7. Mechanical disturbance of the outflow of bile: blockage of the bile ducts by a tumor, narrowing of the bile ducts or their underdevelopment.

Norm of bilirubin for a newborn

How much bilirubin is in the blood determines biochemical analysis. If the bilirubin level is above 58 µmol/l, then noticeable jaundice of the skin appears. With physiological jaundice it is never higher than 204 µmol/l.

If the level of bilirubin in the blood of a full-term baby in the first three weeks of life is above 255 µmol/l, and in a premature baby – 170 µmol/l, then this indicates a serious pathology and requires urgent examination and treatment. It must be prescribed by a doctor.

The upper limits of normal bilirubin content in a baby’s blood can be found in the table:

If the yellowness of a baby’s skin due to breastfeeding does not go away even in the third week after birth, then doctors talk about “breast milk jaundice.” It is believed that the presence of mother's milk in the baby's body increases the bilirubin content in his liver. In this case, the bloom of jaundice occurs on days 11–23 of life. This condition goes away very slowly; in many of these babies, the jaundice completely disappears by the third month, only sometimes by the second. In such cases, a thorough examination of the child to identify more serious causes of jaundice is recommended.

There is an opinion that bilirubin levels increase during breastfeeding. For this reason breastfeeding stops when signs of jaundice are detected in the child, however modern research confirmed the fact that breastfeeding is an important measure in the treatment of neonatal jaundice. Most of the yellow pigment is excreted from the baby's body in feces. Breast milk has a mild laxative effect, which helps eliminate bilirubin and prevents the development of jaundice.

Indeed, a jaundiced skin tint often appears in breastfed infants. However, there is a high likelihood of developing breast milk jaundice in those babies who began to breastfeed late or too rarely and too little, due to a lack of milk from the mother.

There is no evidence that breast milk jaundice causes any harm to the baby. If a baby who is only breastfed has a slight jaundiced skin tint, this is not scary and should not worry parents.

Treatment of jaundice

Treatment pathological process, which can cause serious consequences, must be performed in a hospital under strict medical supervision. Physiological yellowness in most cases can go away on its own without treatment. With a pronounced degree of physiological jaundice, you can help the child with the following measures:

1. The main and main medicine is maternal colostrum, which has a laxative effect and helps remove bilirubin from the newborn’s blood.
2. Phototherapy is often prescribed. After exposure to a special lamp, bilirubin is eliminated from the child’s body after 10-11 hours.
3. The sun's rays are also an excellent remedy treatment. When walking with your child in warm weather, leave him naked for a while in the lacy shade of trees. At home, it is advisable to place the baby's crib closer to the window.
4. If the child has pronounced jaundice, more intensive treatment is necessary. Doctors usually prescribe activated carbon or Smecta internally (more details in the article:). Activated carbon absorbs bilirubin, and Smecta stops its circulation between the liver and intestines.

In conclusion, it can be noted that jaundice in newborns is quite common and in the vast majority of cases goes away spontaneously. Children's doctor Evgeny Komarovsky believes that the main thing is to monitor the symptoms. Let's listen to what Komarovsky says about this phenomenon in the next video.

The skin of a newly born baby quite often acquires a yellow color in the first days of life - in more than 50% of full-term babies and in 70-80% of premature babies. For every mother, such changes will cause anxiety, but jaundice of the skin is not always evidence of a disease. Why can a newborn’s skin turn yellow and how can one determine whether this is a normal stage of development or a disease?

If you notice that the baby’s skin has turned yellow, do not panic. In most cases this goes away quite quickly

What is this?

The yellow tint of the skin is associated with excess bilirubin, a pigment formed during the breakdown of hemoglobin. In its free form, it is toxic to the body and can penetrate brain cells, so in healthy people, the liver converts this pigment into a bound form (soluble in water), which safely leaves the body with feces and urine.

Types of jaundice

Jaundice in infants in the first month of life is divided into physiological and caused various pathologies(pathological). Depending on the cause, pathological jaundice occurs:

• Hemolytic. It is caused by the breakdown of large numbers of red blood cells.
• Parenchymatous. It is caused by liver diseases that affect hepatocytes.
• Conjugation. It is caused by problems with the binding of bilirubin.
• Obstructive. It is caused by obstructions in the biliary tract.

Separately, jaundice is caused by estrogens and special fatty acids in breast milk - it is called breastfeeding jaundice. It is not dangerous, appears in the second week of life and can last up to 2-3 months of age, appearing only as a yellow tint to the skin. A toddler with such jaundice gains weight well, suckles with appetite and sleeps normally.

Causes

The appearance of a physiological form of jaundice in infants on the second or third day of life is associated with:

• The breakdown of large amounts of hemoglobin. We are talking about fetal hemoglobin, which was needed during intrauterine development, and after birth is replaced by regular (adult) hemoglobin.
• Immaturity enzymatic system liver, as a result of which it is not possible to bind all the pigment formed during the breakdown of hemoglobin.
• Long passage feces through the intestines and unformed microflora, which is why some of the bilirubin enters the bloodstream back.

Hemolytic jaundice in infants in the first days of life is most often caused by incompatibility of the baby's blood with the mother's blood according to the Rh factor or group.

The causes of parenchymal jaundice in a newborn are:

• A viral disease that affects the liver.
• Hereditary liver disease.

The causes of conjugation jaundice can be a hereditary disease, a hormonal disorder, or the baby’s treatment with certain medications.

Obstructive jaundice can be caused by mechanical damage to the biliary tract and gallbladder diseases, for example, genetic ones.

Factors that increase the risk of jaundice in newborns include:

• Prematurity.
• Delayed fetal development.
• The expectant mother takes many medications.
• Significant weight loss after birth.
• Hemorrhages that appeared during childbirth.
• Asphyxia during childbirth.
• Intrauterine infection.
• Diabetes mellitus in an expectant mother.
• Refusal of breastfeeding.

Symptoms

The main symptom of jaundice in a newborn baby is yellowing of the skin. If the jaundice is physiological, it appears on the second or third day of life and in most children does not fall below the navel (the head and upper part of the body turn yellow). The skin tone is bright, most pronounced on the 3-5th day of life, and then begins to fade.

With pathological jaundice, the skin may change its color earlier (sometimes the child is already born yellow) and later, while the symptom may last longer and appear in periods (wave-like). A greenish tint to the skin may indicate possible obstructive jaundice.

Other manifestations of jaundice in a newborn are presented in the table:

Treatment

In every specific case jaundice in a newborn, the question of the appropriateness and tactics of treatment should be decided by the doctor. Physiological jaundice In most babies there is no treatment at all, as it goes away on its own.

If the bilirubin level is alarmingly high, the child is given phototherapy. This is the most common, simple and safe way to get rid of free bilirubin in the baby’s blood. It involves staying under special lamps, the light of which converts toxic bilirubin into a harmless form.

Other treatments that may be given to a baby with jaundice include:

• Infusion therapy. It is often prescribed in cases where the child cannot be breastfed. The baby is given intravenous glucose, saline solutions, proteins and vitamins.
• Blood transfusion. This treatment method is used when the baby’s condition is serious, for example, if the baby has a Rhesus conflict.
• Medicines with a choleretic effect. Usually prescribed for cholestasis and conjugation jaundice, when the liver does not cope well with its function of binding bilirubin.
• Sorbents to prevent reverse suction pigment from feces.
• Surgical intervention in case of obstructive jaundice.

Physiological jaundice is usually not treated, but other forms of infant jaundice must be treated as prescribed by a doctor.

Possible consequences

One of the most dangerous complications of jaundice, caused by excessive high level bilirubin, is damage to the subcortical nuclei of the brain. This complication is called kernicterus. At the first stage of its development, the baby becomes lethargic, sleeps a lot, refuses to suckle, arches, and throws back its head.

If measures are not taken to reduce the level of bilirubin, the child’s liver becomes enlarged, the body temperature rises, convulsions, a loud cry, and tension in the muscles of the neck appear. In especially severe cases, the baby may die from apnea or coma. Children who have suffered from kernicterus may subsequently experience problems such as paralysis, deafness, and mental retardation.