Norm of bilirubin in premature newborns. Jaundice in newborns. What is the reason for such strong differences in norms?

Everyone has probably heard about jaundice, but not every one of us has any idea what kind of disease it is. Jaundice is the yellow coloration of the skin, visible mucous membranes and sclera of the eyes. This is a consequence and visible manifestation of an increase in the level of bilirubin in the blood. Bilirubin is a substance formed in the body during the breakdown of red blood cells - erythrocytes, or more precisely, the hemoglobin contained in them. Aged and worn-out red blood cells are destroyed mainly in the spleen, resulting in the formation of bilirubin, called indirect or unbound. It is insoluble in water (hence, cannot be excreted by the kidneys) and therefore, for transport in the bloodstream, it binds to albumin, a low-molecular-weight protein in the blood plasma. But the most important thing is that indirect bilirubin is a tissue poison, most of all it is dangerous for the central nervous system, in particular the brain. Being bound to albumin, it reaches the liver, where its transformation occurs: it binds to a glucuronic acid residue and is converted into direct (bound) bilirubin. In this new state, it is non-toxic to body cells and tissues, is soluble in water, and can be excreted by the kidneys. It is also excreted in bile and enters the intestines. In cases where the rate of breakdown of red blood cells exceeds the binding capacity of the liver, indirect bilirubin begins to accumulate in the bloodstream and causes the skin, mucous membranes and sclera of the eyes to turn yellow.

Neonatal jaundice develops when the level of bilirubin in the blood exceeds 35–50 µmol/L in full-term babies and 85 µmol/L in premature babies. The severity of jaundice in newborns is determined not only by the concentration of bilirubin in the blood, but also by the characteristics of the skin (initial color, depth and tone of capillaries, etc.) and therefore is not an objective indicator of the level of bilirubin. The easiest areas to stain are the sclera of the eyes, the lower surface of the tongue, the palate, and the skin of the face.

In babies in the first month of life, various types of jaundice may occur: conjugative (i.e. associated with low binding capacity of the liver), hemolytic (due to increased destruction of red blood cells - hemolysis), parenchymal (associated with toxic or infectious damage to liver cells) and obstructive (due to mechanical obstruction to the outflow of bile).

Let's look at each type of jaundice in more detail.

Conjugation jaundice

Physiological (transient) jaundice - this condition rightfully belongs to the so-called borderline conditions of newborns (this group includes conditions that occur normally in most newborns, but require close monitoring, since in the event of an unfavorable development of events, many characteristics of body functions may go beyond the limits normal).

Attention!
Transient jaundice occurs in 60–70% of all newborns.

By its nature, this type of jaundice is classified as conjugative. This process is based on the restructuring of the hemoglobin system, which takes place after the birth of the baby. The fact is that the fetal hemoglobin differs from that of an adult: during intrauterine development, hemoglobin F (HbF) predominates in the body (it binds oxygen better), compared to the “regular” adult hemoglobin A (HbA), due to which and oxygen transfer occurs from maternal red blood cells to fetal red blood cells. Soon after the baby is born, his body begins to intensively destroy HbF in order to synthesize HbA. Naturally, the process of hemoglobin breakdown leads to the formation of indirect bilirubin. Since the binding capacity of the liver at this age is low, the concentration of bilirubin in the blood begins to gradually increase. Usually, the first manifestations of physiological jaundice can be observed by the end of the 2nd, and more often on the 3rd–4th day of life. The intensity of the yellow color may increase slightly until the 5th–6th day. As a rule, the process has a benign course and everything ends well: by the end of the 1st week of life, the activity of liver enzymes increases, the level of bilirubin begins to gradually decrease until it reaches normal, and by the end of the 2nd week the symptoms of jaundice disappear. But if there are “aggravating circumstances” (prematurity, fetal immaturity, previous hypoxia and/or asphyxia, hereditary defects in liver enzyme systems, the use of certain drugs that displace bilirubin from its connection with glucuronic acid - for example, vitamin K, non-steroidal anti-inflammatory drugs, sulfonamides , chloramphenicol, cephalosporins, oxytocin for newborns and mothers), the level of bilirubin in the blood can increase to dangerous levels. In this case, jaundice from a physiological state becomes a threatening condition. Accordingly, a distinction is made between jaundice of prematurity, drug-induced jaundice, jaundice of children with asphyxia, etc.

Billirubin is at a critical level

In full-term newborns, the critical level of bilirubin in the blood is considered to be 324 µmol/l, in premature infants – 150–250 µmol/l. This difference is due to the fact that premature babies have increased permeability of the blood-brain barrier (a natural chemical-biological barrier between the lumen of blood vessels and brain tissue, due to which many of the substances present in the blood plasma do not penetrate into brain cells), and even immature brain cells are more sensitive to any kind of adverse effects. Toxic damage to the subcortical nuclei of the brain by indirect bilirubin is called kernicterus, or bilirubin encephalopathy. Its symptoms are severe drowsiness or, on the contrary, a high-pitched cry, convulsions, decreased sucking reflex, and sometimes stiffness (tension) of the neck muscles.

That is why doctors in maternity hospitals carefully monitor the level of bilirubin in the blood of all newborns. When jaundice appears, newborns should be given this test 2-3 times during their stay in the hospital to determine whether there is an increase in the concentration of bilirubin in the blood. The mother may ask whether such tests were taken from the child.

For the treatment of hyperbilirubinemia (increased levels of bilirubin in the blood), intravenous transfusions of a 5% glucose solution (it is a precursor of glucuronic acid, which binds bilirubin in the liver), ascorbic acid and phenobarbital (these drugs increase the activity of liver enzymes), choleretic agents ( they accelerate the excretion of bilirubin with bile), adsorbents (agar-agar, cholestyramine) that bind bilirubin in the intestine and prevent its reabsorption. However, today more and more researchers prefer phototherapy as the most physiological and effective method. During phototherapy, the baby's skin is irradiated with special lamps. When exposed to light of a certain wavelength, bilirubin transforms into its photoisomer (it is called lumirubin), which has no toxic properties and is highly soluble in water, due to which it is excreted in urine and bile without prior transformation in the liver. The procedures are usually carried out in the maternity hospital. The indication for phototherapy is the concentration of bilirubin in the blood above 250 µmol/l for full-term newborns and above 85-200 µmol/l for premature infants (depending on the weight of the baby).

The conjugation group also includes jaundice in newborns fed breast milk (Aries syndrome). Until now, the reason for the development of this condition remains poorly understood. Perhaps maternal estrogens (female sex hormones) present in milk are to blame for this, since they can displace bilirubin from its connection with glucuronic acid. Perhaps the fact is that the sum of all calories received per day, with unsteady lactation, will be lower than with formula feeding (it is known that with relative malnutrition, bilirubin can be reabsorbed in the intestine and re-enter the bloodstream). Be that as it may, during the first week of life, children fed with breast milk (including donor milk) are 3 times more likely to develop transient jaundice than their peers who are transferred to artificial nutrition for one reason or another. But you should not be afraid of these statistics: it has been proven that early breastfeeding and subsequent 8-time feeding in general reduce the incidence and degree of hyperbilirubinemia in newborns. A diagnostic criterion for this type of jaundice is a decrease in bilirubin levels of 85 µmol/L or more when breastfeeding is stopped for 48–72 hours. More often, for this test, the child is not transferred to artificial nutrition even for these two or three days, it is enough to offer him expressed milk, preheated to a temperature of 55-60ºС and cooled to body temperature - 36-37ºС. With this treatment, the biological activity of estrogens and other substances in breast milk that can compete for liver enzymes is significantly reduced. This test is sometimes used to rule out other possible causes of jaundice. The course of this condition is benign, cases of bilirubin encephalopathy against the background of Aries syndrome have not been described, so treatment is usually not required, and children may well be breastfed.

Hemolytic jaundice

This jaundice occurs due to increased hemolysis (breakdown of red blood cells). It may be one of the manifestations of hemolytic disease of newborns (HDN), which develops in Rh-positive children with Rh-negative mother's blood. In such cases, the mother's body can produce antibodies against the fetal red blood cells, which destroy them. The clinical picture of hemolytic disease includes anemia (decrease in the level of hemoglobin and red blood cells), hyperbilirubinemia, enlargement of the liver and spleen, in severe cases - swelling of tissues, accumulation of fluid in body cavities, a sharp decrease in muscle tone, suppression of reflexes. Hemolytic jaundice most often appears immediately after birth or on the first day of life; the level of bilirubin quickly increases to alarming levels. Surgical methods are most often used to treat tension-type headache. These primarily include exchange blood transfusion (RBT), and sometimes hemosorption is also used. In case of PCD, blood containing an increased level of bilirubin and a reduced number of formed elements (cells) of blood is taken from the newborn, and the blood of a donor is transfused. In one procedure, up to 70% of the blood volume is replaced. Thus, it is possible to reduce the concentration of bilirubin and prevent brain damage, as well as restore the required number of red blood cells that carry oxygen. The procedure is often required to be repeated if the bilirubin level again begins to reach critical levels. Hemosorption is the purification of blood from bilirubin, maternal antibodies and some other substances by precipitating them in a special installation. In mild cases of HDN, treatment methods used for transient jaundice can be used.

In addition, hemolytic jaundice can develop with hereditary diseases accompanied by defects in the structure of membranes or enzymes of erythrocytes or hemoglobin molecules. Any of these reasons leads to increased destruction of red blood cells and, as a result, to an increase in bilirubin levels. Jaundice is noted from the first days of life. Associated symptoms are anemia and enlarged spleen. The diagnosis is made by a combination of symptoms and a general blood test, sometimes additional studies are required.

Parenchymal jaundice

Parenchymal jaundice develops when liver cells are damaged by infectious or toxic agents, which leads to a decrease in their ability to bind bilirubin. In the first place in this series are intrauterine infections: cytomegalovirus (it is the cause of approximately 60% of all cases of prolonged jaundice in infants), toxoplasmosis, listeriosis, rubella, and viral hepatitis. As a rule, the idea of ​​an intrauterine infection arises with the development of prolonged jaundice (when its duration exceeds 2-3 weeks in full-term newborns and 4-5 weeks in babies born prematurely), as well as in the presence of other symptoms (enlargement of the liver, spleen and peripheral lymph nodes , anemia (decrease in hemoglobin level in the blood), darkening of urine and discoloration of feces, signs of inflammation in a general blood test (increased number of leukocytes, increased ESR), increased levels of liver enzymes in a biochemical blood test). To make a diagnosis, serological reactions are used (detection of antibodies to viruses or bacteria in the blood), detection of RNA or DNA of the pathogen by PCR (polymerase chain reaction - a method that allows you to “recreate” DNA or RNA from small fragments that are found in biological fluids or tissues of the body After this, the resulting RNA or DNA is examined for species identity (i.e., the type of pathogen is determined).

Obstructive jaundice

This condition occurs due to severe disturbances in the outflow of bile, obstruction (blockage) of the bile ducts. This jaundice develops with malformations of the bile ducts (atresias, aplasias), intrahepatic hypoplasia, intrauterine cholelithiasis, compression of the bile ducts by a tumor, bile thickening syndromes, etc. A characteristic sign of obstructive jaundice is a yellowish-greenish tint of the skin, enlargement and hardening of the liver, constant or periodic discoloration of stool. Jaundice appears at 2–3 weeks of life. For diagnosis, X-ray methods and biopsy are used (examination of a piece of tissue under a microscope, as well as using various biochemical methods). Treatment is most often surgical.

In this article, we tried to talk about some of the most common causes of jaundice in newborns. We hope it will allow you to avoid unnecessary worries, and in cases where your fears are not unfounded, you will quickly find your bearings and show your baby to a specialist in time.

In the course of growing up, a person goes through five periods of development, according to experts. The first and second are newborn children and the period of breastfeeding, the third is the stage of teething, the fourth is junior school age and the fifth is senior school age. Let's talk about the very first period of development - newborn children.

Newborn children undergo significant adaptation and restructuring of the body within 28 days (this is how long this period lasts). All organs begin to function, although many of them began to function in utero. A newborn switches from an endogenous method of nutrition to an autonomous endogenous one. At the same time, some natural processes in the body require careful monitoring by the child’s mother and medical staff.

Diseases of the newborn period also have fundamental features. Let's talk today about physiological jaundice or, in other words, high bilirubin in a newborn. Physiological jaundice occurs in 60-70% of newborns. Appears after birth on the third day and begins to fade away on days 8-10. In some cases, icteric discoloration is observed for 2 or even more weeks. The relative immaturity of the liver and the rapid breakdown of red blood cells determine the production of bilirubin.

What is bilirubin in newborns

Bilirubin is one of the elements of hemoglobin decomposition (fetal hemoglobin is dominant in the newborn’s body, at the time of birth 80-85%). The vector of the process is as follows: during the period of decay, red blood cells contribute to the release of hemoglobin, which, as a result of this decay, takes the form of toxicity. The body begins to prevent toxins and, under the action of enzymes, removes bilirubin.

Norm of bilirubin in newborns

The bilirubin coefficient in newborns changes from the moment of the first birthday; its norm and limit shows what level of icteric pigment is present in the blood. The value of bilirubin in newborns determines whether drug treatment should be used.

The first thing the attending physician should do is take blood for bilirubin in newborns. If the indicators significantly differ from the norm, then this fact indicates the presence of pathological types of jaundice.
The composition of bilirubin in the blood is always present, but if it increases, measures should be taken into account that can help reduce it. So, let's look at bilirubin in newborns in the table of its norms.

For the period of prematurity in a child, special conditions are characteristic and bilirubin indicators will differ from the indicated norm above in the table. This whole process requires hygienic conditions and careful care of the newborn, as well as the correct organization of breast or artificial feeding.

Usually, the general condition of premature babies with an elevated bilirubin is more difficult than that of a full-term baby. This is because bilirubin is more toxic for a premature baby, this is due to the underdeveloped nervous system. The upper level limit for them is 171 µmol/l.

Bilirubin norm values ​​by day and month. Table

The level of bilirubin in a newborn may vary depending on the days and months lived. Bilirubin is divided into two types: direct (soluble) and indirect (insoluble). Insoluble bilirubin is not excreted in the urine. Combining with protein, albumin enters the bloodstream into the liver, where it is completely absorbed and, as a result, direct bilirubin is formed, which is already excreted in the urine.

Most children experience relatively physiological jaundice in the first days of life. If the indicators are too high, this indicates that physiological jaundice is not a diagnosis here. Treatment should involve a more thorough examination of the newborn.

Methods for determining bilirubin

When determining bilirubin, parameters are examined according to three criteria: general, direct, indirect. In normal conditions, no more than 25% of the direct bilirubin parameter is observed.

Bilirubin levels are determined in three ways:

1. The most accurate level of bilirubin in newborns is determined by a blood test taken from a vein on the baby’s head. The longer the period of jaundice, the more likely it is that such an analysis needs to be done;
2. Determination of bilirubin using bilitest (a device that determines the level of bile pigment);
3. Cramer's rule. It is based on the spread of yellow color: first on the face, then throughout the body.

Bilirubin in physiological and pathological jaundice

Let's consider preventive treatment for two types of jaundice: physiological and pathological.

Physiological jaundice

For mild, transient jaundice, no treatment is undertaken. In the case of physiological, bilirubin in the blood serum is observed at an acceptable level. It poses a threatening danger to the health of the newborn. But there is a possibility that if the baby is not properly provided with care and proper nutrition, it may develop into a pathological condition.

In addition to putting the baby to the breast, it is necessary, whenever possible, to connect a special ultraviolet lamp above the baby. This phototherapy will quickly get rid of the yellow pigment and, therefore, reduce the level of bilirubin. Under its action, bilirubin breaks down into non-toxic components, which are then easily excreted by the body.

Pathological jaundice

In some cases, pathological jaundice, which requires urgent hospitalization, occurs in:

• Incompatibility of blood between mother and fetus;
• For various complications during pregnancy;
• Conflict between the Rh factor of the child and mother;
• In premature babies.

With a very high bilirubin ratio in the blood, bilirubin encephalopathy can develop. It develops due to a high toxic effect on the nerve tissue of the brain.
Bilirubin encephalopathy can develop with a highly pronounced concentration of bilirubin in the blood serum. In the first days of the appearance of icteric coloring, it is necessary to put the newborn to the breast.

The colostrum produced by the mother can actively lead to the process of emptying without delays in the urinary and intestinal tract. Consequently, bilirubin will not be able to stay in the body for a long time.

The barrier between the circulatory and nervous systems provides protection from toxic effects. When bilirubin is higher than normal, this barrier becomes permeable, resulting in brain tissue becoming susceptible to toxins.
To avoid such a diagnosis, it is recommended to monitor the level of bilirubin in the blood every day.

Basic actions for increased bilirubin

From all of the above, several conclusions should be drawn:

• Do not self-medicate under any circumstances;
• If the level of bilirubin is 290 or higher, the child needs urgent medical attention;
• If you observe a yellow color of the skin for 3 weeks, while the feces are colorless, and the urine is dark in color, this is a sign of a congenital urinary tract disease.
• Up to seven days, jaundice in most cases goes away on its own and does not require special treatment, the main thing is to consult a pediatrician.

Prevention of increased bilirubin in newborns

A mother must take care of her baby even when he is in the womb. She should know what causes jaundice in newborns. Therefore, she should not mindlessly consume foods that are harmful to the liver, so as not to harm the child. It is advisable to eat a balanced diet high in iron and other nutrients to promote normal liver and intestinal function. And of course, during pregnancy it is better to forget about bad habits.

It is imperative to see a doctor during pregnancy so that he can monitor the level of antibodies in the mother’s blood, identify infectious diseases and treat them in a timely manner.

Natural childbirth without any painkillers often helps prevent jaundice in the baby.

It is important to breastfeed your baby immediately after he is born. The more often a mother feeds her baby her milk, the less likely she is to suffer from jaundice.

Sunlight is an excellent preventive measure against jaundice in an infant, since exposure to light removes bilirubin from the body more quickly. Sunbathing is beneficial for babies.
Under no circumstances should a newborn be constipated, as toxins will be absorbed into the intestines and poison it.

If you have been told by health care workers that your baby has an increased level of bilirubin in the blood, do not despair and do not refuse medical treatment. Still, trusting a doctor is better than resorting to self-medication, since it is unknown what the consequences may be. It would be especially unnecessary to adhere to the opinions of other mothers, since each child is individual and requires special attention and certain treatment.

One of the special physiological conditions in newborns is jaundice. It occurs as a result of an increase in the concentration of a special pigment - bilirubin in newborns. It is formed from destroyed fetal (infant) hemoglobin.

Fetal hemoglobin was necessary for the child during intrauterine development; it more actively binds oxygen and delivers it to the tissues. After birth, this type of hemoglobin is replaced by adult hemoglobin, and active destruction of fetal hemoglobin occurs. As a result of the breakdown of hemoglobin, bilirubin is formed, which must be excreted by the liver and kidneys. The level of bilirubin in a newborn's blood plasma increases when hemoglobin is destroyed, but should not exceed certain limits of the norm for bilirubin in newborns. Exceeding the amount of bilirubin above certain limits can lead to special toxic effects - it affects internal organs, the nervous system, which leads to the formation of a dangerous and irreversible condition - kernicterus.

The main indicators of bilirubin in newborns change from the moment of birth within certain limits. The formation of physiological jaundice in newborns depends on these changes. Bilirubin levels change on the first and subsequent days, and its amount increases to certain limits. When a baby develops jaundice, the doctor determines the actual amount of bilirubin from a blood test and compares it with what the bilirubin should be in a newborn baby. If the child’s values ​​differ sharply from the norm, this may indicate the development of pathological types of jaundice that require treatment.

Total bilirubin: normal in newborns

Normally, a newborn always has a small amount of bilirubin in the blood. At birth, the level of bilirubin is determined in the umbilical cord blood. The normal limits of bilirubin in newborns by day are shown in the table.

The data in the table of bilirubin norms in newborns are given for children who were born full-term and at term. The norm and limits of bilirubin in newborns born prematurely will be different. For a premature baby, bilirubin is more toxic due to the immaturity of the nervous system. But what will be the norm of bilirubin in premature newborns? For them, the upper limit of bilirubin level will be 170-171 µmol/l, while for full-term women the upper maximum limit will be 256 µmol/l. They reach their maximum value by the third or fourth day of life.

If jaundice is present in newborns, the child’s test results are compared with the bilirubin norm in the table. If the deviations are strong, additional examination of the child is needed to determine the causes of jaundice. Exceeding these indicators indicates that the jaundice developing in a child is not physiological.

Direct bilirubin in newborns: normal

Another issue is the ratio of bilirubin fractions - direct and indirect bilirubin. The question of how much direct and indirect bilirubin a newborn should have is important because one of the fractions is toxic, and there should be very little of it, and the second is bound to plasma proteins and is soluble in water, it is easily excreted by the kidneys and has no toxicity.

What is the normal level of direct bilirubin for a newborn? Direct bilirubin is bound to plasma proteins, it is highly soluble in water and is not toxic to tissues. There should be more of this bilirubin out of the total amount - at an early age, in the first two weeks it is up to 90% of the total amount. By the age of one month, its level decreases to 75% of the total amount of bilirubin. The level of normal direct bilirubin in a newborn by the age of one month should be up to 15.0-15.4 µmol/l.

Many young mothers, seeing their newborn baby for the first time, are very puzzled by the yellow color of its mucous membranes and skin. Neonatologists say that this phenomenon is transient. This is due to the fact that in some cases, the level of bilirubin in newborns can only be balanced over time. What do bilirubin values ​​indicate, what are the symptoms and consequences of its increase in infants?

Types of bilirubin

First, you need to understand the concepts in question. So, bilirubin is a bright green-brown bile pigment. It is produced due to the breakdown of red blood cells - hemoglobin - as they age. Hemoglobin consists of two components: heme - protein and globin - iron. The body “takes” these elements, and the breakdown products take on two forms.

One type of component - direct - binds to liver albumin and is excreted from the body in urine and feces. And the second - indirect - does not dissolve in water, but easily penetrates the liver and “supplies” the body with toxins. A special protein is responsible for converting indirect bilirubin into direct bilirubin. The ratio of direct and indirect components - bilirubin - is measured in a ratio of 1:4. Any deviations may be associated with problems in the liver.

Norm of bilirubin in infants

Babies are born with two types of red blood cells in their blood: their own and the fetal ones, which were needed for intrauterine development. Having been born, the child’s body gets rid of fetal red blood cells, so there are significantly more breakdown products in the blood than in an adult. On the third or fourth day after full-term birth, the baby should have 205 µmol/l. Bilirubin levels in premature babies can be within 171 µmol/l. The table of bilirubin norms in newborns looks like this:

Thus, by the second or third week of life, the bilirubin level in infants stabilizes and approaches those of an adult.

Jaundice in newborns

Increased bilirubin in newborns causes a yellowish tint to the mucous membranes and skin. These are external manifestations of infantile jaundice, which are observed in 65% of infants. As a rule, it does not require treatment and goes away on its own. However, you still need to know some of its features. There are several types of jaundice in newborns:

• physiological (caused by the breakdown of fetal red blood cells);
• pathological (being a symptom of certain diseases).

To determine the type and determine treatment tactics, you should donate blood for bilirubin.

Causes and manifestations of physiological jaundice in infants

The causes of physiological jaundice are:

• fetal hypoxia;
• asphyxia;
• infection that aggravates uterine development;
• a combination of the mother's 1st blood group and the 2nd (sometimes 3rd) blood group of the baby.

Manifestations of physiological jaundice usually look like this:

• yellow tint of the skin on the chest, neck, face;
• yellowness appears for the first time 36 hours of life;

At the same time, the child is active, and all indicators of the body’s functioning are normal. Jaundice goes away by the second or third week of life, and in premature babies - by a month.

Causes and manifestations of pathological jaundice in infants

The causes of pathological jaundice are:

• different Rh factors of mother and child;
• genetic disorders;
• diseases associated with the circulatory system;
• problems with the liver or biliary tract;
• hormonal imbalances;
• problems with the intestines (when bilirubin is not excreted, but is absorbed back into the blood).

As a rule, pathological jaundice manifests itself as follows:

• yellow color of the skin below the navel, as well as the palms and soles of the feet;
• lethargy or overexcitement;
• white stool, very dark urine.

If symptoms intensify and do not go away by the third or fourth week of life, you should consult a doctor and undergo the necessary tests.

Complications that pathological jaundice can cause

Due to increased bilirubin levels that do not decrease for a long time, certain complications may occur:

• kernicterus (the level of bilirubin is so high - over 290 µmol / l that it penetrates the brain and causes destabilization of gray matter cells);
• obstructive jaundice (associated with a delay in the outflow of bile due to a cyst of the bile duct or the development of the bile ducts).

Symptoms of complications are:

• lethargy;
• breast refusal;
• constant screaming;
• uncontrollable head shaking.

Tests that are prescribed for prolonged jaundice

If the symptoms of infantile jaundice do not go away for a long time or there are suspicions of complications, diagnostics is necessary:

• blood test (to determine bilirubin levels);
• determination of the proportion of bilirubin types;
• study of liver function (in particular, albumin production);
• Ultrasound of the abdominal cavity (to rule out problems with the intestines);
• consultation with an endocrinologist and surgeon if necessary.

Treatment and prevention of infantile jaundice

Modern methods of treating jaundice make it possible to normalize bilirubin levels and eliminate possible complications. The following have a positive therapeutic effect:

• phototherapy with infusion therapy (ultraviolet rays that cause active production of albumin to transport indirect bilirubin to the liver. Combined with the introduction of solutions of membrane stabilizers to prevent dehydration);
• drugs that enhance the production of liver enzymes (phenobarbital, zixorine and others);
• blood transfusion in case of kernicterus;
• enterosorbents as auxiliaries to eliminate the threat of bilirubin cycling between the intestines and liver;
• vitamins, which are water-soluble fats (A, E, K);
• diet (lactose-free formulas, avoidance of breastfeeding).

The latter treatment method is used if the baby's bilirubin levels increase due to breast milk. Then the hormonal composition of milk and fatty acids prevents the synthesis of the indirect type of bilirubin into direct bilirubin. In order not to give up breastfeeding completely, you can heat and cool the expressed milk - it will not contain fatty acids.

The choice of a specific treatment method depends on individual bilirubin levels, as well as the presence or absence of concomitant diseases.

In order for a newborn to adapt to new living conditions as quickly as possible (including to stabilize its bilirubin level), there is nothing better and more effective than breast milk. Of course, it will serve a good purpose in this case only if there are no contraindications for breastfeeding. The more often the baby eats, the faster excess bilirubin will be excreted through urine and feces.

The bilirubin level in newborns usually stabilizes by the first month of life. Therefore, if the baby has a yellowish tint to his skin, there is no reason to be concerned, much less panic: most often this is a purely physiological phenomenon. Still, it is better to take a general blood test to see the amount of bilirubin, correlate it with the child’s age and choose adequate treatment tactics if necessary.

The topic of today's article, bilirubin in newborns, is extremely relevant, since an increase in its level is becoming more common.

“Your baby has elevated bilirubin.” Today, 70% of mothers of newborns hear this phrase from the doctor in the maternity hospital. Of course, in this way the joyful event of the birth of a long-awaited baby is noticeably darkened. And for many this sounds like a death sentence.

Of course, finding out that your baby has neonatal jaundice is an unpleasant event. And an increase in bilirubin in a child means precisely this diagnosis.

But there is no need to panic. We'll fix everything. Parents only need to figure out what depends on them in this condition and what needs to be done (or NOT done) for a speedy recovery of the baby.

Firstly, under no circumstances should an increase in bilirubin in a newborn be ignored or interfere with the examination and treatment of the baby. A pathological increase in bilirubin is dangerous for the child’s nervous system. In this case, it is easier to prevent than to treat the consequences of the disease.

What is bilirubin?

Bilirubin is an olive-yellow pigment that is a byproduct of the breakdown of red blood cells (erythrocytes). Red blood cells are found in the blood and are responsible for normal gas exchange in the body.

Red blood cells contain the protein hemoglobin, which brings oxygen necessary for life to each cell of the body, and on the way back, it picks up and removes carbon dioxide formed in the cells.

It is normal for red blood cells to disintegrate. Nothing lasts forever. So are red blood cells. Once they have served their time, they must be disposed of. New ones are formed in their place.

The blood of the fetus contains the so-called fetal hemoglobin, which ensures the transport of oxygen to the organs and tissues of the unborn child in the womb, while his lungs are not yet functioning. After the baby is born and the lungs begin to work, fetal hemoglobin begins to be replaced by regular hemoglobin A.

Hemoglobin itself outside the red blood cell is toxic. To neutralize it, the body initiates a series of transformations, as a result of which, at one stage, bilirubin is formed as a by-product.

Reasons for increased bilirubin

There is direct and indirect bilirubin.

First, the breakdown of hemoglobin produces indirect hemoglobin. It cannot dissolve in water, so it is not excreted from the body. As a result of connection with the blood protein albumin, indirect hemoglobin enters the liver through the bloodstream. There it is transformed into direct bilirubin, which is easily excreted from the body in urine.

Since the liver enzymatic system in a newborn is not yet complete, it cannot quickly cope with a large volume of unclaimed fetal hemoglobin. And for some time, indirect hemoglobin cannot be eliminated from the baby’s body. That is why the normal level of bilirubin in the blood of a newborn is much higher than that of a child at one month of age.

If liver function does not improve for a long time, bilirubin manages to turn the skin and mucous membranes yellow. And this condition is considered physiological jaundice of newborns.

Necessary examination for a child with jaundice

Even in the delivery room, the baby's bilirubin level in the umbilical cord blood is measured. Then, in full-term infants, bilirubin is monitored again after two days. For premature babies, the level of pigment in the blood is measured again 24 hours after birth. Thereafter, it is monitored every 12-24 hours.

For premature babies or babies with thin, fragile blood vessels, blood is often drawn from the parietotemporal vein, which is located on the baby’s head. This is very scary for parents. But there is no need to worry, since this is a large vein. The skin in this place is thin, the procedure is safe and less painful for the child than in other places. And the staff in children's departments is always recruited with experience.

Thanks to modern technologies, it has become possible to measure bilirubin levels using a bloodless method (bili test). That is, using a special device that is applied to the child’s forehead, the amount of this yellow pigment is determined by the color of the skin. More often this method is used in children who do not have clear signs of jaundice.

The advantages of the bili test method are that it is non-invasive (without damaging the skin), which means that the study is painless and safe, and the result becomes known instantly. Disadvantage - only total bilirubin is determined, without dividing into direct and indirect, which is very important in the diagnosis of pathological jaundice.

Throughout the entire period of treatment for jaundice in the hospital, bilirubin levels are regularly monitored until it normalizes. At the outpatient stage, a control measurement is carried out during a clinical observation of one month.

The norm of bilirubin for a newborn

After the baby is born, bilirubin numbers constantly change depending on age. For full-term and premature babies, the norms differ.

For clarity, I will give the figures for the normal content of bilirubin in the blood for full-term and premature babies in the form of a table.

Child's age	Norm of bilirubin for full-term babies, µmol/l	Norm of bilirubin for premature babies, µmol/l
24 hours	up to 85	up to 97
36 hours	up to 150	up to 120
48 hours	up to 180	up to 150
3-5 days	up to 256	up to 171
6–7 days	up to 145	up to 145
8–9 days	up to 110	up to 97
10–11 days	up to 80	up to 50
12–13 days	up to 45	up to 35
More than 14 days	up to 20.5	before 18

Signs of physiological jaundice

She appears by the third or fourth day of the baby's life. It resolves on its own by the end of the third week.

The skin is moderately yellowish, while bilirubin reaches the upper limit of normal, not exceeding 256 µmol/l. This condition has absolutely no effect on the baby’s general well-being (no loss of appetite, no lethargy or excessive drowsiness, the baby sucks well).

The reasons for its occurrence are different:

• maternal pathology during pregnancy and the associated use of various medications;
• multiple pregnancy;
• maternal alcohol or tobacco abuse during pregnancy;
• prematurity;
• hypoxia (lack of oxygen) of the fetus during pregnancy or childbirth.

Physiological jaundice is not yet a pathology. Such children need to monitor the level of bilirubin, including for timely diagnosis of the transition of physiological to pathological jaundice.

Jaundice from breast milk. Fact or fiction?

Sometimes jaundice in a baby does not appear until a week after birth. More often, such “delayed” jaundice is typical for babies with good weight gain.

The mothers of these babies usually produce a lot of milk, and due to the characteristics of the body, their milk contains an increased amount of estrogens (female sex hormones). And they, in turn, prevent the natural removal of excess bilirubin from the baby’s body.

If the newborn's bilirubin does not decrease, the mother should express milk and warm it to a temperature of 60-70°C. The baby should be given milk when it is cooled to 36-37°C. When heated, the structure of the hormone is destroyed, but the composition of the milk does not fundamentally change. This way it is possible to cope with the negative effect of the mother’s female sex hormones on the baby’s body, while maintaining the possibility of breastfeeding.

Knowing the features and capabilities of our maternity hospitals, I understand that in most cases they will not bother with expressing and warming up milk. It is immediately recommended to transfer the child to artificial feeding. It is not right. I am against such measures.

As an ardent supporter of breastfeeding, I want to explain that the mother’s hormonal changes will end in a couple of weeks, and not everyone will be able to preserve breast milk until this time. Especially if the mother was told that her milk is not suitable for the baby. So the baby will be left without the most useful product that preserves and increases his health.

Signs of pathological jaundice

Unlike physiological, pathological jaundice is a dangerous condition for the baby. It is diagnosed when the level of bilirubin in the blood is higher than normal.

The causes of the development of pathological jaundice in newborns can be:

• infectious liver lesions (viral hepatitis);
• hormonal disorders;
• Rh conflict or incompatibility of blood groups of mother and child;
• intestinal obstruction in a child;
• genetic diseases in which red blood cells are destroyed;
• mechanical jaundice (impaired flow of bile);
• cephalohematomas in a baby;
• liver dysfunction (enzymopathies).

Signs of pathological jaundice:

• appears almost immediately after birth (1st day);
• increased bilirubin, approaching critical levels or above normal;
• the skin is intensely colored yellow, including the feet and palms;
• in case of violation of the liver, dark urine and colorless feces appear;
• there is a confirmed fact of immunoconflict between mother and newborn child;
• jaundice is prolonged or has an undulating course.

The final diagnosis can only be made by a doctor, analyzing the pregnant woman’s medical history, clinical picture and examination results.

What is the danger of pathological jaundice?

The fact is that a newborn baby has an incomplete blood-brain barrier, which should trap all toxic and dangerous substances and prevent them from penetrating the brain. In this regard, excess bilirubin also passes through this barrier and enters the baby’s brain and nervous system through the bloodstream.

The toxic effect of bilirubin (usually at levels greater than 300 µmol/l) on the nervous system is manifested by so-called bilirubin encephalopathy (kernicterus).

Already on the first day after birth, the following manifestations can be observed in a child with bilirubin encephalopathy:

• increase in the size of the liver and spleen;
• a decrease in the sucking reflex up to its absence and, as a consequence, a lack of body weight;
• decreased blood pressure (hypotension);
• excessive physical activity or, conversely, lethargy and drowsiness;
• convulsive muscle contraction.

This form of jaundice must be treated without delay and immediately. This condition is very dangerous, including for all centers of the brain. If the child is not helped in time, then by six months the child will lag behind in physical and mental development. There will be a decrease in hearing. Often these children develop paralysis.

Therapeutic measures for jaundice

Of course, treatment of newborn children is carried out in a hospital setting and is prescribed exclusively by a doctor. The prescribed treatment will depend on the cause of the increase in bilirubin. The following information is provided for informational purposes.

1. Phototherapy is one of the main and most effective methods of treating jaundice in a newborn baby. The baby is placed under special lamps. Under the influence of their light, bilirubin is transformed into lumirubin - non-toxic soluble bilirubin, which is freely excreted from the body in urine and feces within 12 hours.

Protect the baby's eyes with a special bandage or tie a cap, since lamp light is harmful to vision. Possible side effects of this procedure: dry and flaky skin, loose stools, excessive drowsiness. All these effects disappear after phototherapy is stopped.

Light treatment results in a 30–35 µmol/L drop in bilirubin levels within 4–6 hours of therapy. Light therapy can be prescribed for 48 hours in a row with breaks for feeding, or carried out in several approaches at intervals of 3 hours. When bilirubin decreases to 220 µmol/l or lower, the procedure is usually stopped.

1. Intravenous administration (infusion) of detoxifying agents or glucose to facilitate the elimination of bilirubin. This is an emergency measure.
2. Drugs that improve the rheological properties of bile (fluidity), which promotes better outflow through the biliary tract. Relevant for problems associated with the passage of bile through the biliary tract.
3. Putting your baby to the breast frequently and as early as possible allows you to achieve a laxative effect from colostrum, so that the original stool, which contains a lot of bilirubin, leaves the baby’s intestines faster.

In most cases, it is possible to reduce the level of bilirubin in the blood quickly. It is important not to waste time. Even pathological jaundice in infants can be treated in an average of 4-5 days.

Believe me, the child’s health is more important than any inconvenience associated with hospital treatment.

Health to you and your children!

Practicing pediatrician and twice-mother Elena Borisova-Tsarenok told you about bilirubin in a newborn.