home All hormones How does jaundice occur in newborns? Why does bilirubin increase? During exchange transfusion

How does jaundice occur in newborns? Why does bilirubin increase? During exchange transfusion

In this article:

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 normal condition 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 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;
diabetes at the mother's;
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.

Reason physiological jaundice is an increase in bilirubin levels due to the production of “new” hemoglobin and the disposal of “old”. 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 of mucous membranes and skin yellow;
change in indicators biochemical analysis blood, excess normal level 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 becomes pale or brown, specific smell, 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 on breastfeeding, traces of physiological jaundice pass faster.

Why does jaundice not go away for a month? This indicates 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 a normal condition and not a 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 enlargement of the liver or spleen, an ultrasound examination of the organs is performed abdominal cavity.

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.

In premature infants, 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 are 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. Elcar 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.

In case of urolithiasis 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, and the child's eyes are covered with protective 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 against jaundice, direct ones are suitable Sun rays. 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. High level 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 illness 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 on fresh air with baby;
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

- a physiological or pathological condition caused by hyperbilirubinemia and manifested by icteric discoloration of the skin and visible mucous membranes in children in the first days of their life. Jaundice of newborns is characterized by an increase in the concentration of bilirubin in the blood, anemia, icterus of the skin, mucous membranes and sclera of the eyes, hepato- and splenomegaly, in severe cases– bilirubin encephalopathy. Diagnosis of jaundice in newborns is based on visual assessment of the degree of jaundice using the Cramer scale; determining the level of red blood cells, bilirubin, liver enzymes, blood type of mother and child, etc. Treatment of jaundice in newborns includes breastfeeding, infusion therapy, phototherapy, and replacement blood transfusion.

General information

Neonatal jaundice is a neonatal syndrome characterized by a visible icteric discoloration of the skin, sclera and mucous membranes due to increased levels of bilirubin in the baby's blood. According to observations, in the first week of life, neonatal jaundice develops in 60% of full-term and 80% of premature infants. In pediatrics, physiological jaundice of newborns is the most common, accounting for 60–70% of all cases of the syndrome. Neonatal jaundice develops when bilirubin levels increase above 80-90 µmol/l in full-term infants and more than 120 µmol/l in premature infants. Prolonged or severe hyperbilirubinemia has a neurotoxic effect, i.e. causes brain damage. The degree of toxic effects of bilirubin depends mainly on its concentration in the blood and the duration of hyperbilirubinemia.

Classification and causes of jaundice in newborns

First of all, neonatal jaundice can be physiological and pathological. Based on the origin, newborn jaundice is divided into hereditary and acquired. Based on laboratory criteria, i.e., an increase in one or another fraction of bilirubin, a distinction is made between hyperbilirubinemia with a predominance of direct (bound) bilirubin and hyperbilirubinemia with a predominance of indirect (unbound) bilirubin.

Conjugation jaundice of newborns includes cases of hyperbilirubinemia resulting from reduced clearance of bilirubin by hepatocytes:

Physiological (transient) jaundice of full-term newborns
Jaundice of premature newborns
Hereditary jaundice associated with Gilbert, Crigler-Najjar syndromes types I and II, etc.
Jaundice with endocrine pathology(hypothyroidism in children, diabetes in the mother)
Jaundice in newborns with asphyxia and birth trauma
Pregnane jaundice of breastfed children
Drug-induced jaundice of newborns caused by the administration of chloramphenicol, salicylates, sulfonamides, quinine, large doses vitamin K, etc.

Jaundice of mixed origin (parenchymal) occurs in newborns with fetal hepatitis caused by intrauterine infections (toxoplasmosis, cytomegaly, listeriosis, herpes, viral hepatitis A,), toxic-septic liver damage due to sepsis, hereditary diseases metabolism (cystic fibrosis, galactosemia).

Symptoms of newborn jaundice

Physiological jaundice of newborns

Transient jaundice is a borderline condition in the neonatal period. Immediately after the baby is born, excess red blood cells containing fetal hemoglobin are destroyed to form free bilirubin. Due to the temporary immaturity of the liver enzyme glucuronyl transferase and intestinal sterility, the binding of free bilirubin and its excretion from the newborn’s body in feces and urine is reduced. This leads to the accumulation of excess bilirubin in the subcutaneous fat and discoloration of the skin and mucous membranes yellow.

Physiological jaundice of newborns develops on days 2-3 after birth, reaching its maximum on days 4-5. The peak concentration of indirect bilirubin averages 77-120 µmol/l; urine and feces are normal in color; the liver and spleen are not enlarged.

For transient jaundice of newborns mild degree yellowness of the skin does not extend below the umbilical line and is detected only with sufficient natural light. At physiological jaundice the newborn’s well-being is usually not affected, but with significant hyperbilirubinemia, sluggish sucking, lethargy, drowsiness, and vomiting may occur.

In healthy newborns, the occurrence of physiological jaundice is associated with temporary immaturity of liver enzyme systems, and therefore is not considered a pathological condition. When monitoring a child, organizing proper feeding and care, manifestations of jaundice subside on their own by the age of 2 weeks in newborns.

Jaundice of premature newborns is characterized by an earlier onset (1–2 days), reaching a peak of manifestations by the 7th day and subsiding by three weeks of the child’s life. The concentration of indirect bilirubin in the blood of premature infants is higher (137-171 µmol/l), its increase and decrease occurs more slowly. Due to the longer maturation of liver enzyme systems, premature babies are at risk of developing kernicterus and bilirubin intoxication.

Hereditary jaundice

The most common form of hereditary conjugative jaundice of newborns is constitutional hyperbilirubinemia (Gilbert's syndrome). This syndrome occurs in the population with a frequency of 2-6%; inherited in an autosomal dominant manner. Gilbert's syndrome is based on a defect in the activity of liver enzyme systems (glucuronyl transferase) and, as a consequence, a violation of the uptake of bilirubin by hepatocytes. Jaundice of newborns with constitutional hyperbilirubinemia occurs without anemia and splenomegaly, with a slight increase in indirect bilirubin.

Hereditary jaundice of newborns in Crigler-Najjar syndrome is associated with very low glucuronyl transferase activity (type II) or its absence (type I). In type I syndrome, newborn jaundice develops already in the first days of life and steadily increases; hyperbilirubinemia reaches 428 µmol/l and above. Development of kernicterus is typical, possible death. Type II syndrome, as a rule, has a benign course: neonatal hyperbilirubinemia is 257-376 µmol/l; Kernicterus rarely develops.

Jaundice due to endocrine pathology

At the first stage, the clinical signs of bilirubin intoxication predominate: lethargy, apathy, drowsiness of the child, monotonous cry, wandering eyes, regurgitation, vomiting. Soon newborns develop classic signs kernicterus, accompanied by stiff neck, spasticity of the body muscles, periodic excitation, bulging of the large fontanel, extinction of sucking and other reflexes, nystagmus, bradycardia, convulsions. During this period, which lasts from several days to several weeks, irreversible damage to the central nervous system occurs. Over the next 2-3 months of life, a deceptive improvement is observed in the children’s condition, but already at 3-5 months of life, neurological complications are diagnosed: cerebral palsy, mental retardation, deafness, etc.

Diagnosis of jaundice in newborns

Jaundice is detected even at the stage of the child’s stay in maternity hospital by a neonatologist or pediatrician when visiting a newborn shortly after discharge.

The Cramer scale is used to visually assess the degree of jaundice in newborns.

I degree – jaundice of the face and neck (bilirubin 80 µmol/l)
II degree – jaundice extends to the level of the navel (bilirubin 150 µmol/l)
III degree - jaundice extends to the level of the knees (bilirubin 200 µmol/l)
IV degree - jaundice extends to the face, torso, extremities, with the exception of the palms and soles (bilirubin 300 µmol/l)
V - total jaundice (bilirubin 400 µmol/l)

Necessary laboratory research For primary diagnosis jaundice of newborns are: bilirubin and its fractions, general blood test, blood group of the child and mother, Coombs test, IPT, general urinalysis, liver tests. If hypothyroidism is suspected, it is necessary to determine the thyroid hormones T3, T4, and TSH in the blood. Detection of intrauterine infections is carried out by ELISA and PCR.

As part of the diagnosis of obstructive jaundice, newborns undergo an ultrasound scan of the liver and bile ducts, MR cholangiography, FGDS, plain radiography of the abdominal cavity, consultation with a pediatric surgeon and pediatric gastroenterologist.

Treatment of neonatal jaundice

To prevent jaundice and reduce hyperbilirubinemia, all newborns need early start(from the first hour of life) and regular breastfeeding. In newborns with neonatal jaundice, the recommended frequency of breastfeeding is 8–12 times a day without a night break. It is necessary to increase the daily volume of fluid by 10-20% compared to physiological need child, taking enterosorbents. If oral hydration is not possible, infusion therapy: drip administration of glucose, physical. solution, ascorbic acid, cocarboxylase, B vitamins. In order to increase the conjugation of bilirubin, phenobarbital may be prescribed to a newborn with jaundice.

The most effective method The treatment of indirect hyperbilirubinemia is phototherapy in continuous or intermittent mode, which helps convert indirect bilirubin into a water-soluble form. Complications of phototherapy may include hyperthermia, dehydration, burns, and allergic reactions.

For hemolytic jaundice of newborns, replacement blood transfusion, hemosorption, are indicated. All pathological jaundice of newborns require immediate treatment of the underlying disease.

Prognosis of newborn jaundice

Transient jaundice of newborns in the vast majority of cases resolves without complications. However, disruption of adaptation mechanisms can lead to the transition of physiological jaundice in newborns to a pathological state. Observations and evidence base indicate that there is no relationship between vaccination against viral hepatitis B with jaundice of newborns. Critical hyperbilirubinemia can lead to the development of kernicterus and its complications.

Children with pathological forms of neonatal jaundice are subject to dispensary observation local pediatrician and

Sometimes, while still in the maternity hospital, on the 3-4th day, the mother notices that the baby’s skin has turned yellow and the whites of the eyes have also acquired a yellowish color. Should I worry and what are the reasons for this condition? Jaundice in newborns is a common physiological phenomenon. At this time, doctors do not vaccinate while monitoring the baby. Depending on the type of jaundice, the infant's body may need serious treatment. Often, jaundice is not contagious and should go away without a trace. But they also meet pathological cases. What causes them and what are their consequences?

Main types of jaundice

Doctors divide jaundice into: physiological (postpartum) and pathological.

Physiological jaundice of newborns (neonatal)– a short-term normal process that manifests itself in the first week of life. It lasts for full-term babies up to 10 days, for premature babies about 14 days. Behavior and general health the child does not change.
Pathological jaundice in newborns– is considered a symptom of a serious disease and occurs in one baby out of 10 cases of neonatal jaundice. The liver and spleen enlarge, the urine becomes dark, and the stool becomes colorless. A sick child requires treatment and strict medical supervision.

The following types of pathological jaundice are distinguished:

mechanical;
hemolytic;
parenchymal;
conjugative;
dairy.

Causes of jaundice in children

The blood of a child in the womb differs from the composition of the blood of a born baby. Fetal hemoglobin, which carries oxygen through the fetal vessels, is destroyed during the first breath. Live hemoglobin appears. When fetal hemoglobin is destroyed, bilirubin is produced, which the child's body tries to get rid of. It is difficult to remove this substance, and it penetrates into the liver. Reacting with enzymes, it dissolves and is excreted in the urine.

Sometimes the newborn’s liver cannot cope due to immaturity, and toxic bilirubin accumulates. Spreading throughout the body, it causes pigmentation of the mucous membranes and skin. This is how postpartum physiological jaundice occurs. When the filtering organ matures and the baby’s blood is completely renewed, the jaundice will go away on its own.

Pathological jaundice develops in a newborn for several reasons:

Rhesus conflict;
genetic pathologies;
viral liver diseases - sepsis, hepatitis;
hormonal imbalance;
hemolytic disease of newborns;
abnormal development of the bile ducts;
maternal diabetes;
intrauterine infection.

Factors contributing to the development of pathological jaundice:

premature birth;
developmental delay in the womb, fetal immaturity;
underweight;
extensive hemorrhages;
birth injuries;
artificial feeding.

Children rarely suffer from hemolytic jaundice. Most often it is caused by the following reasons:

mismatch of blood groups;
antigenic incompatibility.

Doctors quickly identify hemolytic jaundice. The whites of the eyes and skin of a newborn turn yellow 2-5 days after birth. On palpation, it is felt that the spleen and liver are enlarged. If you don't start on time correct treatment, the baby’s body condition may worsen. Bilirubin is a toxic breakdown product of hemoglobin. If it accumulates strongly, it can poison the child’s brain. This pathology is called kernicterus.

Kernicterus of newborns requires urgent provision medical care . The brain is protected by a blood barrier that prevents toxins from entering during physiological jaundice. The nervous system, tissues and brain cells remain safe, but only as long as the bilirubin level does not go beyond the limits. Exact numbers, in which toxins will damage the nervous system, no one knows. But there are standards that define the risk zone. When a three-day-old baby has an indirect bilirubin level of 380, this is extremely dangerous. Hemolytic and nuclear jaundice of newborns it is necessary to treat not at home, but in a hospital.

After 3 weeks, the child’s skin is still yellow and has acquired a greenish tint, the stool is abnormally light, and upon palpation the liver and spleen are enlarged - these are signs of obstructive jaundice. The reasons may be problems with gallbladder, obstruction of the bile ducts, liver diseases, bile duct cysts. Often, obstructive jaundice is caused by genetic pathologies and birth injuries. Such a child does not require hospitalization. But diagnostics and tests must be carried out. Based on the type of pathology, the doctor prescribes a course of treatment.

The causes of conjugation jaundice are: bad work liver. Enzymes cannot degrade bilirubin and cope with its excretion. The disease has many congenital pathological types. Conjugative forms occur in premature infants born with birth injuries, in children taking certain medications. Conjugation types of jaundice can be inherited.

Parenchymal (hepatic) jaundice in newborns occurs due to viral or bacterial infection of the liver.

Milk jaundice is rare. Appears due to a glitch in endocrine system Mom. A large number of estrogen passes into milk. The baby's liver cannot cope with the removal of the breakdown products of fetal hemoglobin, as it intensively removes the hormone from the body. Is not dangerous condition. The baby eats and sleeps normally, develops fully and the disease gradually goes away. At the same time, breastfeeding is calmly continued without weaning the baby from the breast. Mommy is recommended to express. The expressed milk is heated to 60 C, then cooled to room temperature and given to the baby. Heat treatment reduces the activity of hormones that can harm the child’s body.

Bilirubin standards and tests

When jaundice does not go away for a long time, it is necessary to conduct a diagnosis and identify the cause of this condition.

The doctor prescribes:

general blood tests;
tests that determine the level of bilirubin in serum and blood;
detection of antibodies by Coombs test;
consultation of narrow specialists.

Bilirubin levels from 8.5 to 20 micromol/liter are considered normal. When its level rises, the doctor diagnoses jaundice. The present disease occurs with levels exceeding 35 micromol/liter.

Physiological jaundice

Postpartum jaundice, called neonatal or transient jaundice, observed in a newborn, is recognized as a short-term condition. Almost all babies experience it. It is not contagious and not dangerous. Phases of neonatal postpartum jaundice:

3-5 days – rapid increase in bilirubin in the blood;
6-14 days - the bilirubin level remains the same for some time, then decreases and returns to normal.

Signs of the disease

The first signs that can be noticed without having medical education– yellowed head of a child. The face and whites of the eyes acquire a yellowish tint. Then the neck, torso, fingers and toes turn yellow. With neonatal jaundice, the doctor, having felt the baby, does not detect any changes in size internal organs. Urine and feces do not change color. The baby eats normally, gains weight and sleeps soundly.

Kernicterus, the most dangerous and severe form, is recognized by:

breast refusal or sluggish sucking reflex;
monotonous crying, throwing back the head;
convulsions, coma, difficulty breathing occur in severe cases.

Distinguish physiological jaundice from pathological form you can by:

long jaundiced skin color;
bilirubin levels are much higher than normal;
wavy yellowing – the child turns yellow, then becomes lighter. Later, the skin becomes even more yellow. Sometimes the skin may turn green;
signs of jaundice are noticed after two weeks of age;
the skin turns yellow below the navel.

TO common features added:

enlarged liver and spleen;
discolored stool, dark urine;
spontaneously appearing bruises;
poor general health, lethargy, apathy, drowsiness.

How is jaundice treated in an infant?

The pathological form must be treated depending on the type and severity of the disease. The mother and child are hospitalized, diagnosed, and prescribed a course of treatment. If the reason is a discrepancy between the Rh factor and the presence of antibodies, blood transfusions, antibiotic therapy, and physiotherapy are prescribed. Obstructive jaundice is treated surgically. A consultation is created to study the patient’s condition and treatment measures are determined. There is no need to treat neonatal jaundice.

You can help your child overcome this condition at home:

The newborn is put to the breast on demand. This stimulates the body's metabolism. The more the baby eats and poops, the more toxic bilirubin leaves the body.
Mom must follow a strict diet to avoid causing digestive problems that aggravate the liver condition. At the same time, nutrition should be balanced and correct.
It is necessary to ensure sufficient water regime in mommy's diet.
Sunbathing.
Frequent walks in the fresh air. When the weather is warm, the arms, face and legs are opened and the stroller is placed under a tree in the shade. Diffused light is very useful. It removes bilirubin from the body.

Pathological jaundice must be treated, taking into account all factors - the course of pregnancy, the mother's illness, ultrasound results, postpartum injuries, and the results of general tests.

Various therapies are used:

antiviral treatment;
antibiotic therapy;
taking choleretic drugs, hepatoprotectors (Ursosan, Ursofalk, which remove bile);
strengthening the immune system;
removal of toxins (Hepel, Enterosgel, Activated carbon);
phototherapy.

It turns out how combination treatment, and individual. Accelerate the elimination of toxic bilirubin and neutralize it destructive effect can be diuretics and choleretic drugs. Doctors prescribe Hofitol in syrup, Ursofalk, Phenobarbital, Hepel, Galstena, Ursosan.

Hepel cleanses the body of toxic substances. Prescribed by doctors along with Magnesia and Enterosgel.
Galstena – natural preparation. Includes phosphorus and sodium sulfate. Galstena reduces bilirubin, eliminates intoxication, and cleanses the liver. Consists of herbs celandine, milk thistle, dandelion.
Hofitol - in the form of syrup. Natural, herbal, vitamin-containing preparation. Chophytol stimulates the liver and is often recommended by doctors for prolonged jaundice in newborns.

You can prepare a natural, high-quality diuretic at home. This is a rosehip decoction. When breastfeeding, rose hips are brewed in a thermos, infused and drunk a glass three times a day. An infusion of rose hips will remove toxins, normalize the functioning of the gastrointestinal tract, and promote liver function. Rosehip contains vitamin C many times more than citrus fruits and vegetables. Consuming it in the spring-autumn period will be an excellent prevention. viral infections. Mommy will strengthen immune system both for yourself and for the newborn at home.

Doctors often recommend phototherapy. This is irradiation under a special green or blue lamp. Ultraviolet light decomposes bilirubin substances into forms that can dissolve in water and be excreted from the body naturally. A 2-3 day course of phototherapy, which is harmless to the baby, is enough. While he is under the lamp, the newborn's eyes are covered with a thick, light-proof bandage. It happens that they appear side effects from the radiation of the lamp - redness on the skin, diarrhea, rashes. It is important that while undergoing phototherapy, the newborn receives a sufficient amount of breast milk.

Glucose, activated carbon or Enterosgel is prescribed for severe jaundice in newborns. Glucose stimulates the liver, and charcoal removes toxins naturally and improves intestinal function.

What is the danger of jaundice (consequences)

Complications caused by jaundice depend on the form, type and treatment provided. If pathologies are not detected in a timely manner, serious consequences can occur:

toxic poisoning;
High levels of bilirubin can cause a reduction in albumin production. As a result, the baby may suffer from albuminemia;
with the development of nuclear jaundice, toxic substances, entering the brain, cause deterioration of vision, hearing, inhibited mental development, cerebral palsy, paralysis;
in the future, the risk of cirrhosis and liver cancer increases;
liver pathologies;
weakened immune system;
fatal outcome.

Postpartum physiological jaundice does not affect the development of the baby. It is not contagious and passes without a trace.

Prevention of jaundice in newborns

During pregnancy, the mother should eat well, rest and lead healthy image life. This will increase the chances of giving birth to a strong, full-term baby. The body of such children copes well with adapting to the new environment and their organs quickly remove toxic substances. Their signs of jaundice are mild or completely unnoticeable. healthy plant food supports the mother's liver, which provides normal nutrition child. You can take a tincture of alfalfa leaves with dandelion root or leaves. These are sources of minerals and vitamins that stimulate the liver and intestines.

Breast milk is considered the main medicine for the treatment and prevention of physiological jaundice. It is important to put your baby to the breast from the very first minutes after birth. Valuable colostrum contains all the substances that help the tiny body cope with the jaundice problem.

The arrival of a newborn child in a family is associated with many worries and worries for parents. New responsibilities for caring for a baby impose a very serious responsibility for the health and life of the child. For one reason or another, the adaptation of a newborn’s fragile body to new living conditions does not always go smoothly.

For example, many parents, especially those who do not have the proper experience, are frightened by jaundice in newborns, because not everyone understands whether this is a normal physiological condition or whether it is necessary to sound the alarm and find out its causes. We will try to understand this condition of babies more deeply, which will allow us to understand the physiology of the process, whether jaundice is dangerous, and how to treat it.

Many parents have to deal with a situation where their newborn child acquires an orange skin color after about 2-3 days. There is no need to be scared or alarmed about this, since physiological jaundice in newborns is not a disease. This is a normal condition for babies, and this skin color signals what is happening physiological processes in the body of crumbs associated with adaptation to new living conditions outside the mother’s womb.

The mechanism for the occurrence of yellowness is associated with a fairly high content of hemoglobin in the body of a newly born child, which tends to sharply decrease in new living conditions. In addition to this, the child has insufficiently formed liver enzymes. Thus, in the first days of his life, the baby is not able to physiologically cope with the increased level of bilirubin in the blood and, as a result, rapidly turns yellow.

Statistics show that at least 60% of all newborn healthy and full-term children have signs of jaundice on the 2-3rd day. In this regard, in medical terminology the term “physiological postpartum jaundice” even appeared, which means natural, normal or not a pathological condition.

As for premature babies, their chances of developing yellow skin increase to 90%. Children whose mothers suffer from a disease such as diabetes, as well as twins, triplets, etc. have the same chances.

Normally this is jaundice will go away without a trace after 3 weeks, and the baby regains its natural pink color.

Types of disorders in children

Types of jaundice are classified depending on the content of bilirubin fractions in the blood serum into the following types:

unconjugated or indirect hyperbilirubinemia, in which the level of indirect bilirubin is approximately 85% of the total;
conjugative or direct, which is characterized by a level of indirect bilirubin within 15% of the total.

As for conjugated hyperbilirubinemia, it can be associated with the pathological functioning of the hepatobiliary system and is determined by the morphofunctional characteristics of the bile ducts and liver of the child - the so-called transient jaundice. In addition, it may be a manifestation of any disease of the bile ducts and liver of the child, and may also have an extrahepatic origin, for example, a consequence of certain nonspecific factors perinatal period.

Also, in addition to physiological jaundice, there may be a condition of a pathological nature. This condition is medically called kernicterus. The following signs will help determine the pathological nature of the disorders:

yellow skin color appears already at the moment the child is born or literally immediately after birth;
there are signs of hemolysis, splenomegaly and pallor;
yellowness does not go away for more than 1 week in full-term infants and more than 2 weeks in premature infants;
has a wave-like course, in which the yellowness of the skin either decreases or increases significantly again;
bilirubin level is: indirect - more than 220 µmol/l and direct - more than 25 µmol/l.

If after a 3-week period the golden color of the child’s skin has not disappeared, it means that there is pathological jaundice, in which the process of neutralization of toxic bilirubin by liver enzymes has not improved. In such cases you need to see a doctor for qualified help . In this case, a number of tests and analyzes are carried out to study the cause of this condition. The main reasons for the development may be the following factors:

destruction of the newborn’s red blood cells as a result of some disease, for example, hemolytic disease;
not properly formed liver function, for example, as a result of hepatitis;
violation normal operation gallbladder or bile ducts, for example, disruption of their patency ( obstructive jaundice newborns).

In view of the individuality of each individual child's body, often jaundice can last for more than 21 days without any serious reasons. However, no doctor can predict when the child will begin to process bilirubin properly. However, monitoring the general condition and monitoring bilirubin levels in such children is mandatory. If the child long time has symptoms of jaundice, the main thing is that caring parents can clearly state that he feels fine and does not show causeless anxiety, has an excellent appetite and gains weight normally.

What consequences are possible?

Normally, within 2-3 weeks, although bilirubin is a toxic substance, it cannot cause significant harm to the child, since its amount is still considered insignificant. However, with a longer period of jaundice, in which there is increased level bilirubin, sometimes 10 times higher than normal. The consequences of jaundice can still be in the form of disturbances in the functioning of the central nervous system or liver. In such situations, parents, together with qualified specialist It is necessary to systematically measure the level of bilirubin in the child’s blood. If you seek help in a timely manner, you can completely avoid all negative consequences.

Current treatment principles

Treatment of jaundice in newborns does not quite correspond to traditional concepts of treatment, since neonatal jaundice of newborns is not considered a disease, but is only a symptom. Moreover, if the yellow color of the skin is a consequence of some serious illness of the child, then it is necessary to treat it. In this case, often in combination with treatment of the underlying disease, a decrease in the level of bilirubin in the baby’s blood is carried out, especially if it approaches a critical norm.

Neonatal jaundice, which causes excess bilirubin to accumulate in the blood, may often require immediate treatment. Indirect bilirubin can, under certain conditions, cause damage to the subcortical nuclei or even the cerebral cortex, causing so-called bilirubin encephalopathy.

Not so long ago, the only treatment in this situation was a replacement blood transfusion to the child. Today this method is also sometimes used, however, it is justified only in the most extreme cases.

More effective and gentle modern method treatment, phototherapy using a bright lamp is considered. Under the influence of bright light rays, bilirubin in the skin of newborns begins to be quite actively destroyed, transforming from toxic substance into a non-toxic isomer.

The principle of treatment is to irradiate the child under a bright lamp, only the eyes need protection. The procedure can last several hours, and sometimes several days. This method is completely safe, which is why it has become widespread.

In conclusion, it is worth noting that in a situation with jaundice in an infant, parents can do little to help their child. Here the main responsibility remains for medical workers, which must promptly determine whether the child’s jaundice is dangerous or not, whether the disease that caused it should be treated or not. The main task of parents in this situation is to timely attend the children's consultation and provide their baby for examination.

Yellowness of the skin is not an independent disease, but only acts as a syndrome characteristic of some pathological or physiological conditions. Yellowness of the skin occurs due to the accumulation of bile pigment - bilirubin. The higher its concentration in the blood, the more severe the jaundice.

In 70% of newborns this condition is considered physiological norm, which does not require close attention and fear.

What is neonatal jaundice

The accumulation of bilirubin in the body of a newborn baby occurs due to the breakdown of fetal hemoglobin, which is responsible for the transfer of oxygen molecules from mother to fetus. The result this process The skin of a newborn baby becomes yellow.

The physiological norm of pigment in newborns can be found in this table.

In the neonatal period, jaundice is classified into the following types:

Physiological type of jaundice. The incidence of this condition in newborns is 90-95%. The functional immaturity of the child's body causes the accumulation of bilirubin pigment in the blood and tissues. The physiological type of jaundice typically appears from the 3rd to the 5th day of a newborn’s life. The duration of this condition does not exceed 10 days. Well-being and general state the newborn remains unchanged. The increase in bilirubin levels reaches 223 µmol/l.
Pathological type of jaundice. This condition is very rare and is associated with diseases of the hepatobiliary system.

Yellowing of the skin is caused by the accumulation of direct and indirect fractions of bilirubin.

Causes

In this case, the pathological type of jaundice in newborns deserves special attention. The exchange of bilirubin in the body is difficult process, the course of which depends on functional state liver.

An increase in the concentration of this pigment can be acquired or congenital.

The congenital form of pathological jaundice occurs for the following reasons:

Pathological changes in the membrane of red blood cells. This condition is characterized by a gradual yellowing of the child's skin. There is an increase in the size of the spleen and liver.
Failure in the hemoglobin production system. Characteristic feature for this form of pathological jaundice is that the first symptoms make themselves felt by the first six months of the baby’s life.
Lack of erythrocyte enzymes. Development characteristic symptoms observed already on the 2nd day from the moment the child is born. The baby's skin turns yellow and the urine turns the color of dark beer.
Developmental pathologies biliary tract. In this case, we are talking about complete or partial blockage of their lumen. Violation of the outflow of bile provokes the accumulation of bilirubin in the blood. The skin of infants with this pathology acquires a greenish tint from the first days of life. Characterized by an increase in the size of the liver, as well as bulging veins of the anterior abdominal wall.
Hereditary diseases (cystic fibrosis). With this disease, mechanical blockage of the bile ducts occurs with mucous clots.

The acquired form of pathological jaundice in newborns is caused by the following reasons:

Hemorrhages in the area of internal organs, followed by the breakdown of red blood cells from the pathological focus. The result of this process is the accumulation of bilirubin.
Hemolytic disease in newborns. The cause of this condition is a Rh conflict between the blood of the mother and the fetus.
Other reasons. Such reasons include an increase in the concentration of red blood cells in the blood, as well as the entry of a portion of blood into gastrointestinal tract child during the birth process.

Symptoms

The main symptoms of this condition are:

Yellowish or yellow color of the skin, mucous membranes and eye sclera;
With physiological jaundice, the feces and urine of a newborn do not change their color, but with pathological jaundice, the urine becomes dark in color;
The physiological type of jaundice does not affect the general condition and behavior of the baby. With pathological jaundice, the child becomes lethargic, restless, and loses appetite;
With physiological jaundice, there is no change in hemoglobin concentration in the baby’s blood. If the jaundice is pathological, then the child has anemia.

In addition, with the pathological type of jaundice, there is an increase in the size of the spleen and liver, as well as dilation of the veins of the anterior abdominal wall.

Treatment

Physiological this state during the newborn period does not mean at all that help medical specialists need not. Depending on the cause of this condition, as well as the severity of the process, methods for correcting bilirubin metabolism in the newborn’s body are selected.

Phototherapy

This method is basic for the treatment of the physiological type of jaundice. Impact on skin baby rays, whose length is 440-460 nm, converts the toxic fraction of bilirubin into non-toxic chemical compounds. In infants with low body weight, this technique is used even with a slight increase in bilirubin concentration.

Phototherapy is carried out using a special lamp that emits blue or green light. The duration of a child's stay under such a lamp is 12-13 hours a day. The baby is first given protection around the eyes and genitals. Carrying out phototherapy in conditions medical institution is a safe procedure, not causing complications. Independent practice of phototherapy is strictly prohibited.

Blood transfusion

There are special indications for prescribing this procedure, which include a rapid increase in bilirubin levels, a decrease in hemoglobin, and the lack of effect from phototherapy. The material for transfusion is selected according to individually for every baby in need.

Transfusion is performed after preliminary determination of compatibility with donor blood. This technique has a number of complications, including:

anaphylactic shock;
air embolism:
disorders of the cardiovascular system;
infection.

For 3-4 hours after the procedure, the newborn is under the close supervision of medical personnel.

Drug therapy

The goal of therapy is to normalize the binding and removal of excess bilirubin. For this purpose they use choleretic agents(Allohol, Magnesium sulfate), as well as drugs such as Cholestyramine, Carbolen and Agar-Agar. Additionally used vitamin complexes and ATP.

Infusion therapy

In order to detoxify the child’s body, a drip injection of a solution of sodium chloride and glucose is used.

Consequences of jaundice

The physiological type of jaundice in newborns does not entail the development of complications. Complications of pathological jaundice include:

toxic damage to the central nervous system by bilirubin breakdown products;
motor dysfunction;
a decrease in the concentration of albumin protein, resulting in the development of edema;
the penetration of bilirubin into the structures of the brain can result in the development of seizures, complete or partial loss of hearing, as well as the formation of mental retardation.