Jaundice in newborns. Jaundice in newborns: when should it go away? Consequences of kernicterus 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, and 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 in 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 in newborns due to the appointment of chloramphenicol, salicylates, sulfonamides, quinine, large doses of vitamin K, etc.

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

Symptoms of newborn jaundice

Physiological jaundice of newborns

Transient jaundice is a borderline condition of the neonatal period. Immediately after the birth of a child, excess red blood cells, in which fetal hemoglobin is present, is destroyed with the formation of free bilirubin. Due to the temporary immaturity of the liver enzyme glucuronyltransferase and intestinal sterility, the binding of free bilirubin and its excretion from the body of the newborn with feces and urine is reduced. This leads to the accumulation of excess bilirubin in the subcutaneous fat and staining of the skin and mucous membranes in yellow.

Physiological jaundice of newborns develops 2-3 days after birth, reaches its maximum at 4-5 days. 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.

With transient jaundice of newborns, a mild degree of yellowness of the skin does not extend below the umbilical line and is detected only with sufficient natural light. With physiological jaundice, the health of the newborn is usually not disturbed, however, with significant hyperbilirubinemia, sluggish sucking, lethargy, drowsiness, and vomiting may be noted.

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 the child, organizing proper feeding and care, the manifestations of jaundice subside on their own by the age of 2 weeks.

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. The development of nuclear jaundice is typical, a fatal outcome is possible. Type II syndrome, as a rule, has a benign course: neonatal hyperbilirubinemia is 257-376 µmol/l; nuclear jaundice 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 of kernicterus, accompanied by stiff neck, spasticity of the body muscles, periodic agitation, bulging of the large fontanel, extinction of sucking and other reflexes, nystagmus, bradycardia, and 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 while the child is in the 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)

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

As part of the diagnosis of obstructive jaundice, newborns undergo ultrasound 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 jaundice in newborns

To prevent jaundice and reduce the degree of hyperbilirubinemia, all newborns require early (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 the physiological need of the child, and take enterosorbents. If oral hydration is not possible, infusion therapy is performed: glucose drip, 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 treatment for indirect hyperbilirubinemia is continuous or intermittent phototherapy, 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 indicate that there is no relationship between hepatitis B vaccination and neonatal jaundice. Critical hyperbilirubinemia can lead to the development of kernicterus and its complications.

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

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

Jaundice in newborns: why did my baby turn yellow?

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

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

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

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

Physiological jaundice in newborns is within normal limits

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

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

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

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

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

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

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

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

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

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

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

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

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

Jaundice in newborns - consequences for everyone

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

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

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

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

Treatment methods for jaundice in newborns

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

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

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

Today, this method of treating jaundice in newborns is also used, but only in extreme cases. And in less severe situations, over the last decades they have been practicing another effective method of combating increased bilirubin - a bright lamp!

Phototherapy for jaundice: let there be light!

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

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

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

Breastfeeding jaundice: mother gilded

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

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

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

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

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

Jaundice in newborns: Epilogue

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

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

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

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

What is this?

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

Types of jaundice

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

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

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

Causes

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

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

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

The causes of parenchymal jaundice in a newborn are:

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

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

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

Factors that increase the risk of jaundice in newborns include:

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

Symptoms

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

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

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

Treatment

In each specific case of jaundice in a newborn, the question of the appropriateness and tactics of treatment must be decided by the doctor. Physiological jaundice in most infants is not treated at all, as it goes away on its own.

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

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

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

Possible consequences

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

If measures are not taken to reduce bilirubin levels, the child’s liver will become enlarged, body temperature will rise, and

Jaundice is a common disease during which the baby's skin, as well as visible mucous membranes and the whites of the eyes, acquire a yellowish-dark tint. Why does jaundice occur in a newborn? What can this disease be fraught with and how to treat it? Later in the article we will consider all these issues in detail and give practical recommendations.

Physiological

Conjugative (physiological, neonatal) jaundice in a newborn is a very common phenomenon, from which, according to statistics, about 60-70% of infants suffer in the first days of their lives. This is due to the immaturity of the newborn’s body systems responsible for the metabolism of a substance such as bilirubin, a pigment that has a red-yellow color and is formed during the destruction of hemoglobin. Gradually accumulating in the skin, this pigment helps it acquire a yellowish tint.

With conjugation jaundice, the general condition of newborns does not undergo serious deterioration. The exception is jaundice, which is very pronounced. In such cases, newborns experience excessive drowsiness, lack of appetite, and vomiting. However, the severity of jaundice is determined not by external manifestations, but by the level of direct bilirubin in the blood.

Pathological

If jaundice in a newborn does not go away after three to four weeks, then most likely it has a pathological form. But you shouldn’t jump to conclusions and panic. You will learn a reliable diagnosis only after consulting a qualified pediatrician and carrying out all the necessary tests that will help not only establish the form of the disease, but also its type. Pathological jaundice occurs:

• Nuclear. This type of jaundice is accompanied by a high amount of indirect bilirubin in the blood, which, when entering the brain, affects its cell nuclei. The lack of effective timely treatment leads to such catastrophic consequences as delayed physical and mental development, cerebral palsy (CP), deafness, decreased vision and even blindness. In addition, the activity of the entire nervous system may be disrupted and a serious neurological defect may occur.

• Hemolytic. This type occurs when mother and newborn are incompatible by blood type and/or Rh factor. Hemolytic jaundice is accompanied by massive destruction of red blood cells (hemolysis). It often occurs if the mother has blood group I, and her child has blood group II (less often III). Doctors say that with each subsequent pregnancy, the risk of this type of complication increases, which makes abortion very dangerous, especially for women with a negative Rh factor.

Causes of jaundice in newborns

The occurrence of transient conjugation jaundice in most healthy newborns in the first days of life is associated with the following factors:

• The content of a special type of hemoglobin in the red blood cells of the fetus - fetal (hemoglobin F), the gradual destruction of these red blood cells after the birth of the child.
• Deficiency of a special protein in newborns, which ensures the transport of bilirubin through the cell membranes of the liver.
• Excessive accumulation of bilirubin, resulting from the defective functioning of the immature enzymatic systems of the newborn’s liver, which are involved in the conversion of indirect bilirubin into direct bilirubin.
• Low excretory capacity of the liver in newborns, which affects the rate of excretion of bilirubin from the body.

As for pathological jaundice in newborns, the main cause of its occurrence generally does not differ from those listed above. The occurrence of this disease is caused by excess bilirubin in the child’s blood, which happens when there are no enzymes in the baby’s body that supply this pigment to the liver. But in this case, the absence of such enzymes is not associated with a delay in the formation of liver systems, but with massive hemorrhages on the skin and head of the child, prematurity or very pronounced jaundice in previous children, if any.

Symptoms of jaundice in newborns

Conjugation jaundice in newborns usually occurs on the second to fourth days after birth. Its main symptom is that the baby acquires a yellow-orange skin color. As for the general condition of the child, the concentration of hemoglobin in his blood, as well as the color of urine and feces, these indicators remain normal. Physiological jaundice disappears on average in three to four weeks, but the extinction of the disease, i.e. The disappearance of a noticeable yellow tint to the skin should begin by the end of the first week of the child's life.

Unlike physiological, jaundice, which has a pathological form, is expressed already in the first 24 hours after the birth of a baby and lasts more than three weeks. During this period, in addition to the characteristic yellow color, a newborn child has a high level of bilirubin in the blood. Also, the distinctive signs of pathological jaundice include:

• Refusal of the newborn from nutrition, inhibition of the sucking reflex, lethargy, excessive drowsiness and lethargy of the infant. The pathological nature of the jaundice of a newborn can also be indicated by such obvious symptoms as the monotonous cry of an infant and muscle hypertonicity - a violation of the muscle tone of the body, expressed in muscle strain.
• An orange-yellow hue of the skin and visible mucous membranes on the child's body that has not changed for four or more weeks, discoloration of his feces, darkening of the urine. These symptoms can be noticed directly by the parents of the newborn, spending time with him outside the maternity hospital and hospital. However, if all the above-mentioned signs of a pathological disease were not detected in time, much more serious symptoms may appear - convulsions, bradycardia, high-pitched screams, stupor and even coma.

Norm of bilirubin in infants

Bilirubin is a substance formed during the breakdown of red blood cells. While in the mother's womb, the child's body contains a very large percentage of red blood cells that carry hemoglobin. But after birth, the newborn no longer needs such a volume of them, and therefore they are subject to destruction. The normal bilirubin level in infants is distributed as follows:

• A newly born baby – no more than 51-60 µmol/l.
• Child from 3 to 7 days - no higher than 205 µmol/l (in premature babies, the bilirubin level should not exceed 170 µmol/l).
• Children from 2 to 3 weeks – 8.5-20.5 µmol/l.

If in the first three weeks after birth the bilirubin level in a full-term baby exceeds 256 µmol/l, and in premature babies - 172 µmol/l, then the newborn is diagnosed with “Pathological jaundice”. Such children require examination in a hospital for differential diagnosis of the exact causes of the disease, as well as the prescription of the most effective methods of treatment and prevention.

How dangerous is jaundice and when does it go away?

Conjugational jaundice, which disappears without any complications two to three weeks after the birth of the child, does not entail any serious consequences that would affect the life of the newborn's body. If, while in the hospital, the doctors found that the baby has jaundice, but he is not naughty, does not refuse breastfeeding, then there is no reason to worry.

As for pathological jaundice, in particular nuclear and hemolytic, these diseases threaten a much greater danger. The fact is that both of these types of jaundice do not allow bilirubin to be excreted from the body, thereby contributing to its penetration into the blood and further effects on all vital organs. Because of this, all newborns who have suffered pathological jaundice visit a neurologist, orthopedist and oculist every month throughout the year. In addition, they are given a medical exemption from vaccinations for one year.

Phototherapy

One of the most common and effective ways to treat jaundice in newborns is phototherapy. This therapy consists in irradiating the baby with ultraviolet rays, the effect of which makes toxic bilirubin a harmless substance that dissolves in water. The phototherapy procedure in the hospital is carried out according to the following scheme:

• A protective bandage is put on the newborn's eyes.
• The baby is placed under special lamps.
• The doctor clearly regulates the duration of the procedure in order to prevent the formation of burns, overheating or dehydration of the newborn.

Treatment at home

Often, jaundice in newborns can occur after the mother and baby are discharged from the hospital. In such cases, young parents can independently carry out all the necessary procedures to treat the baby. Daylight can completely replace a medical ultraviolet lamp. However, direct sunlight should be avoided on the delicate skin of the newborn in order to avoid the formation of burns.

Pharmaceutical drugs for treatment

Often, jaundice in a newborn goes away on its own, but in some cases when complications arise, it requires increased attention from the treating doctor and young parents. Sometimes phototherapy alone is not enough and you have to resort to the use of medications. The most effective medicines include hepel, ursofalk, ursosan, hofitol, and activated carbon.

Hepel

The composition of this drug contains the following components of plant origin:

• Great celandine.
• Thistle.
• Nutmeg.
• Cinchona.
• Moss club-shaped.
• White hellebore.
• Bitter gourd.
• White phosphorus.

Hepel is a homeopathic remedy that is designed to improve the functioning of the gallbladder and liver. It is indicated for use to achieve the following goals:

• Intestinal dysbiosis.
• Removing toxins and poisons from the newborn’s body.
• Normalization of newborn stool.
• Activation of bile excretion.

As for the dosage of a drug such as hepel, when treating jaundice in infants, children should be given 1/4 of a tablet, first grinding it to a powder and diluting it with breast milk/formula. Due to the fact that the newborn is not yet able to take the medicine from a spoon, the mixed medicine is dripped onto the oral mucosa two to three times a day, an hour after meals or half an hour before meals.

Ursofalk

The active ingredient of this drug is ursodeoxycholic acid, which has a pronounced immunomodulatory, choleretic, cholelithiasis and hypocholesterolemic effect. According to the instructions for Ursofalk, the recommended dose for newborns is up to 40 mg per 1 kg of body weight per day. The list of indications for use of this product includes:

• Toxic damage to the liver and spleen of newborns.
• Hepatitis of various origins.
• Biliary dyskinesia.

Hofitol

Hofitol for newborns is a herbal medicine, the composition of which consists of an extract of field artichoke leaves. The dose required to take the drug is always calculated by the attending physician. Newborn babies are given 5-10 drops of hophytol three times a day on an empty stomach, which were previously diluted in 5 ml of water. Indications for the use of this medicinal drug include:

• Constipation caused by gallbladder diseases.
• Normalization of metabolic processes in the body of a newborn.

Activated carbon is an inexpensive product that helps remove pathogenic flora from the body and causes virtually no side effects. The required dose of coal is calculated taking into account the weight of the baby. Newborns weighing less than 3 kg should take no more than 1/4 tablet at a time. And children whose weight is 3-5 kg ​​are given 1/3 of the tablet.

The list of indications for the use of activated carbon includes:

• Atopic dermatitis and colic.
• Intestinal dysbiosis in a newborn, accompanied by bloating and diarrhea.
• Prolonged jaundice.

The comparative cost of the above drugs, which are prescribed by experienced pediatricians when jaundice occurs, is as follows:

• Hepel – 240-270 rub.
• Ursofalk - from 205 to 2200 rubles.
• Chofitol – 275-630 rub.
• Activated carbon – 6-10 rub.

Video: jaundice - Dr. Komarovsky

Jaundice in babies is a very common problem. It has become the subject of numerous discussions not only on the pages of magazines devoted to the topic of newborn health, but also on television. We bring to your attention one of the episodes of the program “Dr. Komarovsky’s School”, where the doctor talks in detail about jaundice and methods of its treatment:

Jaundice is a yellow discoloration of the skin, sclera and mucous membranes due to the deposition of bile pigments in them. Fat-soluble bilirubin, which is formed during the breakdown of red blood cells, accumulates in the skin.

The liver does not have time to neutralize decay products. Therefore, an excess amount of this pigment appears in the blood.

Bilirubin is:

• unconjugated or indirect. It is fat soluble;
• conjugated or direct. This bilirubin is water soluble.

Therefore, direct bilirubin is freely excreted in bile and urine, while indirect bilirubin is excreted as a result of a complex biochemical process in the liver.

Direct bilirubin does not have a neurotoxic effect. Its level is determined only for the purpose of diagnosis. Indirect bilirubin is neurotoxic.

This happens only at a very high level. In full-term children, one level is above 342 µmol/l, in premature infants another – from 220 µmol/l, in very premature infants the third – from 170 µmol/l.

The threshold level of neurotoxicity also depends on the duration of exposure and a number of other circumstances. Jaundice in newborns is quite common. 60% in full-term and 80% in premature.

Neonatal jaundice of newborns and its types

Physiological jaundice of newborns becomes noticeable on the second - third days, reaching a maximum on the second - fourth. Jaundice should go away when the baby is 5 to 7 days old.

If this is the case, then this is classic physiological jaundice associated with insufficiency of bilirubin conjugation in the liver. But it is considered so only after excluding other causes of postpartum jaundice.

Jaundice in a newborn can occur on the first day of birth and appear later. It depends on the reason.

When is neonatal jaundice considered severe?

1. They appear on the first day of life.
2. For viral and bacterial infections.
3. In the presence of hemorrhage.
4. In case of incompatibility of mother and child by Rh antigens and blood group.
5. In case of prematurity or immaturity of the newborn.
6. With insufficient nutrition.
7. If older children in the family have jaundice.

Jaundice in a child begins from the face. The higher, the lower the body is colored (yellow).

Jaundice has a bright yellow, even orange color due to indirect bilirubin and a greenish or olive color due to direct bilirubin. The difference is clearly visible with severe jaundice.

Pathological jaundice occurs:

• conjugation for liver enzyme deficiency;
• hemolytic when changing the normal structure of hemoglobin and red blood cells;
• hepatic for liver diseases;
• obstructive, or mechanical, jaundice when the normal outflow of bile is disrupted.

If jaundice worsens, symptoms of hemolysis, or infections occur, a laboratory blood test is required. Total bilirubin, direct and indirect, blood type and Rh factor are determined. A microscopy of a blood smear is performed to determine the percentage of reticulocytes and a Coombs test. To determine the level of bilirubin, non-invasive transcutaneous determination of bilirubin is used.

This is the determination of pigment using a reflectance photometer, which, based on the color of the skin, determines the level of bilirubin in the blood.

When can pathological jaundice be suspected in newborns?

• If infantile jaundice develops at birth, or on the first day, then it requires increased attention.

It is necessary to exclude the following conditions in the child: newborns, infections (syphilis, toxoplasmosis, rubella), hidden hemorrhages;

• on the fourth - seventh day, jaundice occurs more often with congenital infections;
• the causes of jaundice after the 1st week of life are infections, hypothyroidism, hepatitis, biliary atresia, cystic fibrosis;
• in case of persistent jaundice during the first month of life, it is necessary to exclude infections and hereditary genetic pathologies;
• Among the causes of hemolytic disease of newborns is bile thickening syndrome, bile stagnation, biliary atresia and other pathologies.

In clinically healthy children who are not at risk, it is sufficient to control bilirubin levels.

Jaundice in newborns can develop after the 1st week of life. This is connected with the beginning. Elevated bilirubin levels in infants can last up to 10 weeks during breastfeeding.

If breastfeeding is stopped for 1 - 2 days, the jaundice will go away and bilirubin levels in the blood will quickly decrease. When breastfeeding is resumed, hyberbilirubinemia usually does not return. The general condition of the child is usually normal.

Although such jaundice in infants is rarely accompanied by bilirubin, cases of its occurrence have been described. Why this happens is not yet clear to medicine.

Why is bilirubin encephalopathy, also known as kernicterus of newborns, dangerous?

The risk of bilirubin encephalopathy is higher in immature newborns. Bilirubin penetrates the neurons of the brain and has a toxic effect on them.

Clinically this manifests itself:

• weakening of sucking;
• hyperextension of the neck;
• lethargy;
• lethargy;
• convulsions.

As it progresses, reflexes disappear, breathing problems and a sharp, piercing cry appear. Severe damage to the nervous system leads to death.

Consequences of kernicterus in newborns

• the child is more likely to develop delayed motor development;
• after the first year of life - movement disorders, deafness;
• by the age of three - oligophrenia, hearing loss, strabismus, motor disorders;
• with obvious neurological symptoms, the prognosis is unfavorable, mortality reaches 75%.

Bilirubin encephalopathy is rare these days.

But there are always risk factors:

• discharge from the maternity hospital before the 3rd day without follow-up for two days;
• lack of alertness and underestimation of the severity of jaundice.

How to treat jaundice in newborns?

Treatment of jaundice in newborns aims to reduce bilirubin levels to levels that do not exceed the threshold of neurotoxicity (the ability to damage brain neurons).

There is no consensus at what level of bilirubin it is necessary to start phototherapy. But since 6-12 hours must pass for visible results, phototherapy should begin with a safe level of bilirubin.

In the process of phototherapy, indirect bilirubin is converted into direct, “non-dangerous”, and is easily removed from the body. Conventional phototherapy is carried out continuously.

The child is often turned to illuminate the skin as much as possible. Phototherapy is carried out until the bilirubin level decreases to the maximum safe level.

Skin color is not always indicative, since under the influence of light the yellowness of the skin decreases, and the bilirubin content in the blood remains high.

When carrying out phototherapy, protect the child's eyes.

Complications of phototherapy – skin rashes, diarrhea. After undergoing a course of phototherapy, “bronze child” syndrome may occur—discoloration of the skin in a gray-brown color.

No long-term effects of phototherapy have been recorded, but it is not recommended to prescribe phototherapy without indications. In vitro scientific studies have shown the possible pathological effects of the applied light radiation on DNA.

1. If phototherapy is ineffective, exchange blood transfusion is used. Treating jaundice in newborns in this way is a very unsafe procedure and carries a risk of serious side effects. But if necessary, repeated blood transfusions are possible.
2. Other treatment methods include a single intramuscular injection of the drug Tinmesoporphyrin on the first day of life, which reduces the need for phototherapy. This method is practically not used due to little knowledge.
3. Infusion therapy (intravenous administration of solutions) is used as necessary during phototherapy when the child loses a lot of fluid. Indirect bilirubin is not excreted by intravenous administration of any solutions.
4. Prescribing medications that reduce bile density makes sense for bile thickening syndrome.
5. The effectiveness of prescribing sorbents has not been proven.

Prevention of jaundice

It is carried out during the pregnancy stage.

1. Complete examination of a pregnant woman.
2. Prevention of risk factors in pregnant women.
3. Early breastfeeding.

It is also necessary to understand that even a seemingly harmless jaundice needs consultation with a neonatologist or pediatrician. It is possible to judge the safety of a child only after excluding pathological conditions when monitoring bilirubin levels.