Causes of jaundice in newborn premature babies. Jaundice of newborns

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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 could it be fraught with? this disease 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 and is formed during the destruction of hemoglobin. Gradually accumulating in the skin, this pigment helps it acquire a yellowish tint.

With conjugation jaundice general state newborns do 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 not determined by external manifestations, and by level direct bilirubin in 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 necessary tests, which 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, upon penetration into the brain, affects its cell nuclei. Lack of effective timely treatment leads to such catastrophic consequences, such as delayed physical and mental development, cerebral palsy (CP), deafness, decreased vision up to blindness. In addition, it is possible to disrupt the activity of the entire nervous system and the occurrence of a serious neurological defect.

• Hemolytic. This type occurs when mother and newborn are incompatible by blood type and/or Rh factor. Hemolytic jaundice 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.

Concerning pathological jaundice in newborns, the main reason for 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, the newborn baby has a high level of bilirubin in the blood. Also to distinctive features pathological jaundice include:

• Refusal of the newborn to feed, suppression of the sucking reflex, lethargy, excessive drowsiness and lethargy of the baby. Point at pathological character Newborn jaundice can also have such obvious symptoms as a monotonous cry of a baby and muscle hypertonicity - a violation of the muscle tone of the body, expressed in muscle strain.
• An orange-yellow tint of the skin and visible mucous membranes on the child’s body that does not change 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 signs pathological disease were not detected in time, much more may appear severe symptoms– convulsions, bradycardia, shrill scream, 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 very large percentage 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 exact reasons diseases, as well as prescriptions for maximum effective methods treatment and prevention.

How dangerous is jaundice and when does it go away?

Conjugation jaundice, which resolves without any complications two to three weeks after the baby is born, does not entail any serious consequences that would affect the vital functions of the newborn’s body. If, while in the maternity hospital, doctors determine that the baby has jaundice, but he is not capricious and does not refuse breastfeeding, then there is no reason to worry.

As for pathological jaundice, in particular nuclear and hemolytic, these diseases threaten significantly greater danger. The fact is that both of these types of jaundice do not allow bilirubin to be excreted from the body, thereby facilitating its penetration into the blood and further effects on all vital functions. important organs. Because of this, all newborns who have suffered pathological jaundice visit a neurologist, orthopedist and ophthalmologist monthly 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 treatment of jaundice in newborns - phototherapy. This therapy involves irradiating the baby ultraviolet rays, the effect of which makes toxic bilirubin a harmless substance soluble 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 to prevent the formation of burns, overheating or dehydration of the newborn.

Treatment at home

Often, jaundice in newborns can appear after mother and baby are discharged from the hospital. In such cases, young parents can independently carry out everything necessary procedures for treating an infant. 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 attending doctor and young parents. Sometimes phototherapy alone is not enough and you have to resort to medical supplies. To the most effective medicines include hepel, ursofalk, ursosan, hofitol, activated carbon.

Hepel

Compound this drug contains the following components plant origin:

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

Hepel represents homeopathic remedy, which 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 mucous membrane oral cavity 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. List of indications for use this tool 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 inexpensive remedy which promotes excretion from the body pathogenic flora and practically does not cause side effects. Required dose 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 became the subject of numerous discussions not only on the pages of magazines, dedicated to the topic health of newborns, 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:

The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on individual characteristics specific patient.

Jaundice appears in newborns due to natural process increasing the level of normal bilirubin, liver disease, conflict of Rh factor and blood group, or even breastfeeding. According to statistics, jaundice occurs in approximately 60% of full-term and 80% of premature babies. Newborns turn yellow in the first 2-3 days after birth, and if they have health problems, the symptoms are delayed. Typically, physiological jaundice should go away within 10 days after onset. Jaundice can be identified by the color of the baby's skin, eyes and mucous membranes.

Symptoms, causes and signs, treatment and diagnosis of jaundice

Consequences of prolonged jaundice:

• toxoplasmosis,
• rubella,
• herpes simplex.

Doctors carefully pay attention to the baby’s navel, check the throat, do pharyngeal swabs, advise doing a urine test, checking platelet levels, and may even apply spinal tap, chest x-ray.

List of risks for developing jaundice:

• In a newborn low weight at birth, for example: premature birth may cause jaundice.
• Breast-feeding- excellent prevention of this disease.
• If parents have already had newborns with jaundice, it is likely that you will not avoid it this time. Doctors, in such cases, recommend undergoing phototherapy.
• It is easiest to get sick in the first days after birth.
• Infants whose mothers have diabetes.
• Boys get sick more often than girls, as do children from East Asia.
• People living at high altitudes.

Causes

The main cause of jaundice is an increase in the level of bilirubin in the blood (a product of natural hemoglobin metabolism) of the newborn.

Without treatment, jaundice will lead to severe forms symptoms. IN healthy body substance (bilirubin) is produced in small quantities. It is then “processed” in the liver and excreted through the intestines through the hepatic and bile ducts. So, failures in bilirubin metabolism can occur at all stages.

If there is a Rh conflict between mother and newborn, jaundice may occur. The mother has Rh minus, and the child has Rh plus - this is a group conflict.

Types of jaundice disease

• suprahepatic,
• Hepatic,
• Subhepatic.

Prehepatic jaundice

In a newborn, red blood cells are destroyed in the blood, resulting in the accumulation of bilirubin. This picture is observed in hemolytic anemia, malaria, etc.

Hepatic jaundice in a baby

It is characterized by a violation of bilirubin metabolism directly in the liver of newborns. Caused by certain infectious diseases (mononucleosis,), toxic damage liver (including medicines), and oncological processes.

Subhepatic jaundice in an infant

Physiological jaundice in newborns

Associated with increased red blood cell shortages and immature liver function in the newborn. Jaundice develops over 2 or 3 days and begins to disappear by the end of the first week. You can recover completely by the 10th day of illness.

What should be the norm of bilirubin in newborns?

The normal bilirubin level in newborns with jaundice usually does not rise above 200 µmol/l and the health status remains satisfactory. However, it can be much higher if the baby is born prematurely or if there is increased breakdown of red blood cells - for example, extensive bruising, kephalocheamatoma.

Early neonatal jaundice

Neonatal jaundice most often develops within 24 hours after the baby is born. If it develops on the first day after birth, medical workers will notice it, but if the mother has already noticed discomfort at home, then she should immediately consult a doctor. If your newborn has a yellowish skin color, you should not wait until the symptoms go away on their own.

Causes of neonatal jaundice

Hemolytic: for example, disease (Rh factor), ABO incompatibility, glucose-6-phosphate dehydrogenase, spherocytosis. Infection: congenital (eg, toxoplasmosis, rubella, cytomegalovirus (CMV), virus herpes simplex, syphilis) or postpartum infection.

• Increased hemolysis due to hematoma.
• Maternal autoimmune hemolytic anemia: for example, lupus erythematosus.
• Crigler-Najjar syndrome or Dubin-Johnson syndrome.
• Gilbert's syndrome.
• Neonatal jaundice appears on the face of a newborn. Progresses over time and spreads throughout the baby's body

Protracted jaundice is considered if the disease in a newborn does not go away for longer than 14 days in full-term infants, and 21 days in premature infants.

The main causes of lingering jaundice are:

• Infection in the newborn, such as a urinary tract infection.
• Hypothyroidism, hypopituitarism.
• Galactosemia.
• A breastfed baby feels fine, and the illness usually resolves by the sixth week, but sometimes lingers for an additional four months.
• Gastrointestinal (GI): biliary atresia, common bile duct cyst, neonatal hepatitis.

How to treat prolonged jaundice

• Pay attention to the condition of the urine - pale or brown with a film means that the newborn baby has problems.
• Measure your bilirubin level.
• Complete FBC.
• Blood tests should also be done for both mother and baby, as well as a direct antiglobulin test (DAT, or Coombs test). Interpret the result taking into account the strength of the reaction, and also pay attention to prophylactic anti-D immunoglobulin drugs during pregnancy.
• Do a urine test.
• Make sure your doctor does a metabolic screening (including for congenital hypothyroidism).

Conjugation jaundice

Causes

• Infection.
• Parenteral nutrition.
• Cystic fibrosis.
• Metabolic: alpha-1-antitrypsin, galactosemia, amino and organomedicines.
• GI: biliary atresia, biliary cyst, neonatal hepatitis.
• Endocrine: hypothyroidism, hypopituitarism.

Signs of jaundice

In most cases, parents are encouraged to go for a medical examination by the yellowish color of the newborn’s skin. A more severe form of jaundice may also include the symptom of unexplained drowsiness.

Typically, measuring the normal level of bilirubin in the blood is the only way identify jaundice. The newborn is tested on the second or third day of mandatory. After the first test, even if the results are negative, parents should always be on alert and visit a doctor as soon as the first signs of jaundice are suspected.

Jaundice occurs more often in breastfed newborns than in those who are fed special formulas, but in most cases with improper feeding. You should feed your baby 8 to 12 times throughout the day.

Neurological signs of jaundice

Changes in muscle tone, cramps and crying in the newborn require immediate attention to avoid the consequences of jaundice.

Hepatosplenomegaly, petechiae, and microcephaly are associated with hemolytic anemia, sepsis, and congenital infections.

Hepatitis (eg, congenital rubella, CMV, toxoplasmosis) and biliary atresia appear in association with increased level bilirubin in the blood of newborns. If parents notice that the child's urine has become very pale or brown, has a sharp, bad smell, this can especially often happen in the third weeks of the baby’s life, you should go to the hospital.

How to identify jaundice in a newborn baby?

Undress your newborn and place him in bright light, preferably natural light. To determine jaundice during examination, doctors use sclera, make smears and check the condition of the child’s skin. Parents should not rely on visual examination, as this will not determine the level of bilirubin in the baby's blood.

Jaundice and normal bilirubin

Use the transcutaneous bilirubinometer for newborns with a gestational age of 5 weeks or more, or for babies within 24 hours of birth. If bilirubinometer measurements indicate that the bilirubin level is greater than 250 µmol/L, further check the results by measuring the serum level.

Always use serum measurement to determine bilirubin levels in newborns:

• In the first 24 hours of life.
• Infants are less than 35 weeks of gestation.
• Always use the serum substance measurement for infants. This is one of the most universal methods and is suitable for all age categories.
• Do not use an icterometer.
• If not visible signs jaundice, you should not start testing for normality.

Treatment of jaundice

The newborn needs to increase fluid intake. The disease usually goes away naturally without drugs, but in severe cases, droppers can also be used. If you are not breastfeeding, seek help from pediatrician, nurse, or lactation specialist. Breast milk is the ideal option for feeding a baby.

Phototherapy

The indications and use of phototherapy for jaundice vary according to the level of hemoglobin in the newborn's blood, its rate of spread, and the date of birth.

Phototherapy should be started immediately, preferably within the first 24 hours after the development of jaundice. It is in such cases that it will have the greatest effect on the newborn.

How ahead of schedule the child is born, the higher the level of bilirubin in the blood should be. Prophylactic phototherapy to prevent jaundice in preterm or low birth weight infants helps maintain lower bilirubin concentrations in the blood and may have an effect on metabolism and put them at risk for neurological abnormalities.

Essential care includes ensuring maximum impact on the skin, providing eye protection for the newborn, maintaining thermoregulation at the proper level, as well as hydration.

Treatment of jaundice with LEDs

The light source in phototherapy is effective in reducing serum bilirubin levels in newborns, which is similar to conventional light, like compact Fluorescent Lamp(CFL) or halogen.

The main complications of phototherapy are separation from the mother, dehydration (fluid intake should be increased) and loose stool. Usually not performed in cases of hyperbilirubinemia because this method cannot cure a newborn with very severe forms of jaundice.

Exchange blood transfusion through arteries, umbilical cord or veins; signs of jaundice depend on clinical condition(babies with health problems receive transfusions earlier), the rate of increase in bilirubin and the gestational age of the newborn. The National Institute for Health and Social Excellence (NICE) recommends using exchange transfusion blood twice (a double estimate of the total blood volume is removed and replaced) for treatment.

How to treat jaundice

In many cases, jaundice does not require drug treatment. A naked newborn should be placed under a special light, which will reduce the level of bilirubin in the blood. Depending on the amount of bilirubin, the procedure takes place in the hospital or at home. The disease is treated with early stages when the child’s brain is not yet damaged.

You should not place your newborn in direct sunlight - this is not safe way treatment of jaundice. This method will help reduce bilirubin levels, but will only work if the baby is naked. The method is unsafe for treatment at home, since the little one will freeze. The baby should not be left in direct sunlight, as he will get burns.

During an exchange transfusion:

• You should not use phototherapy.
• It is best to do the entire transfusion at one time.
• Use albumin.
• Administer intravenous calcium regularly.

After exchange transfusion:

• It is possible and even necessary to continue phototherapy sessions.
• Measure your serum bilirubin level within two hours of the transfusion and compare results based on the values ​​in the table.

What mom needs to know about jaundice in the first 24 hours

Jaundice occurs in newborns due to serious health problems, such as infection, hemolytic disease or metabolic disorders. Any baby with jaundice in the first day of life should remain in the hospital until complete recovery.

If jaundice persists for more than 3 weeks, you should consult a doctor. Follow expert advice and remember that the level is more than 290 µmol/l. indicates serious liver disease in the newborn.

A beautiful and long-awaited baby who was born suddenly turned yellow. On the third day after giving birth, just in time for the discharge that the whole family was waiting for, the baby acquired an unusual orange color, once and for all ending the mother’s dreams of a beautiful photo shoot with the newborn. Joyful thoughts were replaced by anxiety - what kind of jaundice is this and why is it dangerous? These questions are answered by a famous pediatrician, TV presenter and author of books and articles about children's health, respected by millions of mothers, Evgeniy Komarovsky.

What's happened?

Jaundice in newborns is a fairly common phenomenon; it is observed in 50-60% of full-term and 80% of premature babies. You shouldn't treat it like a disease. The baby's skin turns yellow physiological reasons. Fetal hemoglobin in the baby's blood (which was natural for him during pregnancy) changes to normal human hemoglobin A. The baby adapts to environment. Its enzyme system is immature, like its liver. It is this organ that is responsible for the excretion of bilirubin, which is formed in all people during the breakdown of red blood cells. These blood cells are constantly renewed, hence the need to “recycle” aging cells.

The baby has postpartum period when hemoglobin is replaced with normal one, red blood cells that age also disintegrate, but the poorly functioning liver cannot yet remove bilirubin. This bile pigment, which remains in the body, causes the skin to turn yellow. This metamorphosis usually occurs with a newborn on the third day after birth.

The enzyme system is improving quite quickly. As the liver begins to work at full capacity, receiving the necessary enzymes, bilirubin begins to leave the body, the skin brightens, first acquiring a peach tint, and then returning to its normal color. Usually this process is completely completed by the 7-10th day of life, so after discharge in 4-5 days, less often in a week, the jaundice should completely go away. Prolonged neonatal jaundice can be observed in premature babies, but doctors try to treat and monitor them in a hospital setting.

Another type of harmless jaundice is jaundice natural feeding. According to Komarovsky, breast milk contains special substances that slow down the binding of bilirubin in the liver. This situation is normal and does not require treatment, much less the abolition of breastfeeding and the transfer of the baby to feeding with adapted formulas.

How to treat?

Since the process is natural, Evgeniy Komarovsky advises mothers to calm down and not bother themselves with questions about the treatment of neonatal jaundice. Modern medicine does not use special medications for these purposes. It is believed that the most effective method Somewhat speed up the process of normalizing the child's skin color - phototherapy. To do this, use a “blue” lamp, which illuminates the child’s skin. As a result, the pigment bilirubin, under the influence of rays, breaks down into substances that the newborn’s body is quite capable of excreting with urine and feces.

Komarovsky advises using regular “white” lamps at home if there are no LED lamps, since any bright light neutralizes the toxicity of bilirubin.

Another effective cure for jaundice was created by nature itself - mom’s breast milk. It contains natural substances to enhance immune defense child. Therefore, the sooner the baby is put to the breast, the more often he is fed breast milk, the faster and easier his body will cope with physiological jaundice. Feeding such children is a special story. As a rule, babies with increased bilirubin are more sleepy and may skip feedings. It is important to ensure that the baby eats on time, wake him up if necessary, but in no case overfeed him.

Therapeutic effect They will also enjoy walks with such a baby. It needs to be taken outside more often so that the child has contact with indirect sunlight. If the weather and season permit, a child with jaundice should spend most of the day outdoors.

Pathological situations

A condition in which a child, after birth, begins a massive breakdown of red blood cells, which are not only outdated and in need of replacement, but also completely healthy, is considered abnormal. The bilirubin level in this case is very high, and we are no longer talking about functional jaundice. Doctors talk about hemolytic disease of the newborn (HDN). This pathology can develop in children whose blood type and Rh factor are different from their mother’s. If an immunological conflict occurs, the mother's immunity produces specific antibodies against the fetal blood cells.

Such jaundice develops already in the first hours after the baby is born. As a result, severe anemia is observed in the newborn, his liver, central nervous system, and brain suffer. Doctors closely monitor bilirubin levels. When certain critical levels of this pigment in the blood are reached, a replacement blood transfusion is prescribed. Sometimes several such procedures are required to reduce toxic effects bilirubin on the body and all its systems. In the case of rapid and severe hemolytic disease, death can occur.

Another pathological jaundice characteristic of children is associated with biliary atresia. This congenital pathology, in which these pathways are not formed or formed incorrectly due to some genetic error. This disease is very rare and is susceptible to it, according to official medical statistics, one of 15 thousand children born into the world. This condition is eliminated surgically, the operation is very complex and high-tech, but it gives the child a chance for a further normal life.

There are other reasons for the appearance of jaundice that is abnormal for a newborn:

• Overdose of vitamin K. The drug "Vikasol" (a synthetic analogue of vitamin K) is used during childbirth to prevent or eliminate heavy bleeding in a woman. If there is an error in dosing or an urgent need for a large amount of the drug for a woman, an overdose may occur in the baby.
• Diabetic fetopathy. A condition in which the baby's liver and enzyme system are not sufficiently developed due to the fact that the fetus suffered during pregnancy due to diabetes mellitus moms.
• Genetic (hereditary) liver malformations. These are some types genetic syndromes, in which structural genetic errors arose at the level of organ formation in the fetus.
• Intrauterine infections. Some infectious diseases that the mother suffered during pregnancy can cause pathologies in the development of the fetal liver.

The baby was born. And three days later, a happy mother, who has just recovered from the “euphoria,” suddenly notices that something is wrong with her child. He is somehow different from everyone else: his skin and the whites of his eyes have acquired a yellowish tint. What to do? Doctors say that this is not dangerous, because jaundice in newborns is a very common phenomenon. And then, without explaining anything, they prescribe the “minipussy” some medications, carry out procedures, and answer all your questions so vaguely that the anxiety increases more and more. Common situation?

Moms, don't panic! If your baby turns yellow, it’s okay!

And it happens that a newborn turns yellow already at home. At the same time, my mother’s condition is even worse: she has no one to ask for advice, and she doesn’t know what to do. A bunch of assumptions (not at all optimistic) pop into my head before the pediatrician arrives. Making the mother aware is the first step to her peace of mind, and therefore to the child’s peace of mind. After all, he reads all the information from you and behaves restlessly if something worries you.

Why does the baby turn yellow and why is it dangerous?

Coloring of the skin after birth (on the 2-3rd day) is normal. That is why infantile jaundice is called physiological. It’s just that for some this process goes almost unnoticed, and for some it is a whole problem. It all depends on the rate of bilirubin formation and the body’s ability to neutralize it and remove it.

Premature babies are most prone to yellow discoloration of the skin.

Bilirubin is a breakdown product of blood cells. It is yellow in color and is present in every person, participating in metabolic processes. If some kind of malfunction occurs, the level of pigment increases, and the skin and sclera become colored. And since bilirubin is a toxic substance, exceeding its critical levels in the blood can lead to serious consequences: intoxication of the body, damage to the nervous system and brain, disability (retardation in mental development, deafness) and even death. That is why prolonged jaundice is dangerous and must be treated as soon as possible.

However Increased bilirubin in the body of newborns is a natural phenomenon. It is caused by the change from fetal hemoglobin obtained through the placenta to hemoglobin obtained through inhalation of oxygen with air. As a result of this process, many “obsolete” blood cells that have lost their function are destroyed, releasing bilirubin, which the child’s liver does not have time to cope with due to its immaturity. These are the mechanisms physiological jaundice, which occurs 2-3 days after the baby is born and goes away on its own as soon as all the baby’s blood is renewed and its filtering organ is rebuilt (ripened).

After a few weeks, the baby's skin acquires a healthy pinkish tint.

The line between normality and pathology

We looked at why jaundice is dangerous. Surely you are wondering how to distinguish its pathological form from its natural form. For this, the following criteria exist:

• objective: blood test for bilirubin and comparison of indicators with the norm, as well as comparison of indicators over time;
• subjective: time of appearance of jaundice, child’s behavior.

Norm of bilirubin- a relative concept. It differs in adults and newborns, as well as in children born at term and premature infants. Fluctuations in the level of toxin are also a phenomenon associated with the rate of breakdown of red blood cells and the subsequent elimination of the products of this process. As you understand, this cannot happen the same way all the time.

To visually assess the level of bilirubin in the blood, the Cramer scale is used. According to it, the child’s skin is not colored evenly, but in areas depending on changes in biochemical blood parameters. First, the face and neck turn yellow, then the body, upper limbs, then the hands, lower limbs and feet. If you take a test from a child with jaundice of the arms and legs, it is likely that his bilirubin level will exceed the permissible values. According to Kramer, when the yellowness of the skin disappears, blood counts return to normal.

As soon as the yellowness of the child’s legs goes away, you can be sure that the crisis is over!

At laboratory evaluation toxin levels, measurements of the amount of direct, indirect and total bilirubin. Doctors agree that direct bilirubin should not exceed 1/4 of the total. After all, it is precisely this substance that is most dangerous for the body, since it has not yet been neutralized by internal chemical reactions and is not ready for breeding.

Yellowness of the skin is not yet a reason to panic. It is much more important to pay attention to when it appeared (for example, if the skin turns color a few hours after birth, then this is an incentive to examine the child for serious diseases) and to the behavior and well-being of the baby.

Even Dr. Komarovsky pointed out the need to consider the “disease” in its dynamics. If the baby's jaundice persists, but he is cheerful when he is awake, sleeps well, and actively sucks, then there is no need to worry.

If you are watching following symptoms(in addition to yellowness), to medical care you should resort immediately:

• high-pitched scream, the child is difficult to calm down;
• limbs are compressed, trembling (convulsions);
• eyes wide open, pupils enlarged;
• hypertonicity of the neck muscles (inability to tilt the baby’s head).

All these signs indicate serious intoxication of the baby’s body, the consequences of which we have already considered.

Why does bilirubin increase?

We found out why the skin of a newborn turns yellow. Now let's highlight the reasons why bilirubin levels increase.

1. Blood conflicts between mother and child (different Rhesus, different group). Children with Rh positive born to an Rh-negative mother.
2. Immaturity of the child's liver, imperfection of the bile ducts.
3. Intrauterine infections.
4. An increase in estrogen levels in breast milk (this hormone inhibits the enzymatic activity of the liver to neutralize toxic influence bilirubin) or simply improperly organized breastfeeding, in which the baby does not receive enough food.
5. Recent studies indicate that jaundice most often occurs in children whose mothers had abortions or underwent planned childbirth. It is these facts that are believed to have contributed to the increase in the number of newborns with symptoms of icteric skin in the last few decades.

Moms, breastfeeding is very important for the health of your little one! Take care of yourself!

Methods for treating pathological jaundice

“How to treat a baby if he has jaundice?” - a question that worries all mothers who are faced with its manifestations in their child. Indeed, since he is so small, how can you poison his delicate, clean body with drugs? Treatment is not aimed at eliminating the symptom (that is, yellowness), but at helping the body fight the disease that caused it. Medicinal and non-medicinal means are used.

Drug treatment

The child is prescribed drugs that help neutralize the toxin and accelerate its elimination (diuretics, choleretic and hepatoprotective). Of these, the most common are: Hofitol in liquid form, Ursofalk, Phenobarbital and Magnesia. However, if you read the instructions for these drugs, then in many of them you will not find even a mention of jaundice. But you will certainly pay attention to the sea of ​​​​contraindications from the nervous system, gastrointestinal tract and others. In addition, it will be very difficult for the immature liver and intestines to cope with such a drug load.

A child’s body cannot cope with such serious medications on its own!

Some doctors suggest giving the baby rosehip decoction. This calms my mother down, because it’s not like swallowing pills, after all. natural product. In this position there is something from Soviet times, when the child was given juices and decoctions almost after birth. Well, the body of a newborn is not adapted to digest anything other than mother's milk or its equivalent!

In severe cases of hemolytic disease accompanied by jaundice, the baby may require a blood transfusion. But this, fortunately, happens extremely rarely.

Treatment without drugs

In the world practice of treating jaundice in newborns, there has already been a revision and departure from medicinal methods. Instead, the mother is taught about breastfeeding (correct attachment to the breast), mother and child rooms are practiced (to attach the baby to the breast as early as possible, feed him on demand), special lamps are used to treat jaundice and conduct phototherapy.

In some of our maternity hospitals, they still practice breastfeeding only on the third day (especially if there is a blood conflict), feeding by the hour and using lamps only in extreme cases.

The idea to use a lamp to treat jaundice arose when it was noticed that influenced sunlight In children, the general condition improves and the color of the skin is normalized. So maybe you shouldn’t “irradiate” your child and just take him outside more often? But it is advisable to do this only in the summer. The weather should be warm, sunny, calm. The baby should only be wearing a diaper and socks. At the same time, in the morning hours he has an increased risk of hypothermia, and in the hot afternoon - of getting a burn.

Here it is - an effective and safe way that will help you quickly cope with all skin defects!

The lamp is free of such shortcomings. It does not depend on the time of year or day, you can stay under it for a long time (only with breaks for feeding), there is no possibility of hypothermia or overheating. Recovery under it occurs much faster due to the emission of light of a certain spectrum, under the influence of which dangerous bilirubin is transformed into a compound that is easily excreted in urine and feces.

Should you be scared if a newborn's fontanel is pulsating? How to calculate the average size of a child's crown? How soon should the fontanel heal? What functions does the fontanelle perform? He will tell you the answers to these and other questions.

Do you often travel by car? Then you just need the right one. To make a profitable purchase, you need to know the classification of seats, how to install them in the car, and also find out which brand’s products are the best.

If your baby turns yellow after birth, your doctor will decide on his treatment. If the physician prescribes medications after which the baby’s body will require recovery, this is a signal that the doctor is not qualified enough. Consider finding a new doctor!

In this article:

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

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

Classification

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

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

For physiological yellowing skin The increase in bilirubin is slight.

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

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

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

There are two types of this jaundice:

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

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

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

Causes

Causes of pathological jaundice:

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

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

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

Symptoms

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

Signs of pathological jaundice:

• staining the mucous membrane and skin yellow;
• change in indicators biochemical analysis blood, excess normal level bilirubin;
• drowsiness and lethargy.

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

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

By the following signs You can distinguish physiological jaundice from pathological:

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

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

How long does jaundice last?

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

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

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

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

Diagnostics

The examination consists of visual inspection baby, as well as conducting a number of tests.

Diagnostics include:

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

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

Norm of bilirubin

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

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

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

In premature infants, yellowing of the skin occurs when the bilirubin value is 85 µmol/l.

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

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

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

Treatment

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

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

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

The treatment is as follows:

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

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

In case of urolithiasis in a child (urolithiasis), diuretics should be used with caution.

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

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

You can continue phototherapy at home. Instead of a lamp for newborns against jaundice, direct ones are suitable Sun rays. They help the symptoms disappear. Sunbathing promote the production of vitamin D, which accelerates the removal of bilirubin from the blood.

Consequences and complications

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

Other dangers:

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

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

Prevention

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

Other preventive measures:

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

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

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

Useful video about jaundice in newborns