Acceptable level of bilirubin in the blood of newborns. Norms of bilirubin in the blood of newborns and elimination of abnormalities. Reasons for the increased rate

Almost half have new babies born After some time, jaundice appears. Even though this is considered normal physiological process, the course of the disease should be closely monitored. Otherwise, you may miss the development of a pathology that can negatively affect the baby’s health. A neonatologist must analyze bilirubin in newborn babies to make sure that there is no threat to their life and health. Let's figure out what the bilirubin standards should be and what this indicator depends on.

What is bilirubin

In the mother’s womb, the baby’s lungs were not yet functioning, and the cells were supplied with oxygen using hemoglobin found in red blood cells. To increase binding to oxygen, the structure of the molecules of this protein in unborn children differs from the structure of ordinary hemoglobin. This protein is called fetal hemoglobin.

After the baby is born, the need for such hemoglobin disappears, and it begins to break down, forming free bilirubin. This type of bilirubin is an insoluble toxic fraction that freely penetrates cells and interferes with normal metabolism.

Since indirect bilirubin is not excreted in the urine, it ends up in the liver. As a result of the reaction with glucuronic acid, bilirubin is converted into direct bilirubin and becomes water-soluble, due to which it is excreted in the feces and urine of the child.

How are newborns tested? Today, the amount of bilirubin in newly born children is analyzed using special equipment. A device for measuring bilirubin levels in newborns allows you to determine the amount of direct, indirect and total bilirubin.

Carrying out analysis

Where is blood taken from babies? The first blood test to determine bilirubin levels in newborn babies is taken in the first moments after birth. The biomaterial will be taken directly from the umbilical cord, before the blood has clotted. It is worth noting that today there is no child who was not tested once at birth.

A repeat test for bilirubin in newborns is performed on the third day of life. The obtained bilirubin indicators make it possible to assess the course of the hemoglobin breakdown process and monitor liver function.

How to test for bilirubin in newborns? Blood for bilirubin is taken on an empty stomach, but it is enough if the baby does not eat for 3-4 hours before collecting the sample. Before the test, you can take a bottle of clean water and give her baby something to drink.

A blood test for bilirubin in newborns shows that maximum concentration direct fraction appears on the third day of life. After this, the level of bilirubin in newborns begins to fall, returning to normal over the next two weeks. If the child has hidden pathologies, malfunctions of the liver or intestinal tract- then the process of bilirubin metabolism in newborns is disrupted, and the toxic pigment begins to poison the body’s cells.

A table that shows the norm of bilirubin in the blood of newborns, broken down by day and month, makes it easy to identify deviations. Due to the fact that the measuring device shows the content of each fraction of bilirubin, the doctor can not only determine the type of jaundice, but also determine the reasons for its transition to a pathological form.

A non-invasive testing device will show how much pigment is in the child's blood. Such a device makes it possible to carry out a blood test only once, and further control is carried out using a screening method. In this way, children are selected who should undergo a repeat blood test. Your doctor should explain to you how to donate blood.

Norms

The level of bilirubin in the blood of a newborn changes daily during the first days of life. The norm and limit these days may differ significantly:

If at 2 months the baby’s bilirubin level is elevated and symptoms of jaundice persist, the mother should seek help from a doctor as soon as possible.

Deviations from the norm

Due to the fact that blood cell renewal occurs continuously, a certain amount of bilirubin is always present in human blood. In a baby that has barely been born, there is natural process replacing fetal hemoglobin with regular hemoglobin. The product of its breakdown is also bilirubin. Why is a high rate dangerous?

U one month old baby your anxiety should be too a large number of pigment that has toxic properties, because in this case it has a detrimental effect on internal organs and the baby’s vital functions.

An increase in the level of bilirubin in the blood of a newborn is due to the following reasons:

prematurity;
Rhesus conflict in a pregnant woman;
anomalies of intrauterine development;
acute forms of illness in the mother during pregnancy;
refusal of breastfeeding;
diabetes mellitus in the mother;
hormonal imbalances in the mother’s body during breastfeeding;
the presence of autoimmune diseases;
taking certain types medicines, including during childbirth.

If the level of bilirubin in newborns exceeds the permissible limit, then the doctor must monitor pigment levels to prevent the development of pathology.

Doctors distinguish between two types of jaundice:

physiological;
pathological.

While the first type of jaundice does not require treatment and usually goes away within 1-2 weeks, the second form can seriously harm the baby’s health.

Mothers do not even always need to know what the norm of bilirubin should be in babies at a certain period of life, since the signs of safe and pathological jaundice are quite easy to distinguish.

Physiological jaundice

If the amount of bilirubin in timely born babies increases above 120 µmol/l, and in premature babies over 85 µmol/l, the pigment penetrates the surface layers of the skin. This causes yellowing of the skin and sclera.

As long as the critical limit is not exceeded, doctors talk about physiological jaundice. The critical level is 256 µmol/l for full-term babies, and 172 µmol/l for premature babies.

With this type of jaundice:

the baby retains a good appetite and physical activity;
on the 2nd, and less often in the 3-5th days, yellowness of the skin appears;
yellowing spreads from the upper part of the body downward;
the color of urine and stool is normal;
After 2-3 days, the pigment level usually begins to decrease.

Typically, such jaundice lasts no longer than 2-3 weeks and the newborn’s bilirubin gradually decreases. Therefore, a 1-month-old baby should have normal indicators pigment. If after 1 month the indicators do not decrease, a pathological deviation occurs.

Additional tests are prescribed for such children.

The course of physiological jaundice must be monitored by a doctor, since it very often turns into a pathological form. It is unacceptable to independently treat a child for jaundice, much less give him medications without the consent of the doctor.

Pathological jaundice

If the baby’s liver cannot cope with the binding process indirect bilirubin or there are congenital developmental pathologies, jaundice becomes pathological. The danger of this condition lies in the possibility of serious intoxication of the baby’s body. It is manifested by the following symptoms:

the child is lethargic or overexcited, does not latch on well, does not eat much;
the skin begins to turn yellow first on the feet, palms, and lower abdomen;
the disease has a wavy nature;
feces become discolored, and urine, on the contrary, takes on a dark shade;
bilirubin in the blood increases rapidly, reaching a daily increase of up to 85 µmol/l.

Depending on the reasons for the appearance, there are the following types pathological jaundice:

hemolytic - appears with some genetic diseases or Rh conflict with mother;
conjugation - noted when the enzyme system is dysfunctional;
parenchymal - occurs when the liver is damaged by toxins, hepatitis, herpes;
mechanical - occurs when the outflow of bile is disrupted due to abnormalities of the efferent ducts or gallbladder.

Regular determination of pigment levels is very important. If too much of it enters the blood, the development of kernicterus will begin. It is fraught with paresis and paralysis, deafness, mental retardation, brain damage. A photometric device for assessing pigment levels allows testing to be carried out in a few seconds.

Treatment

Most effective methods decreases in pigment levels are:

phototherapy, since under the influence of light bilirubin turns into an indirect (non-toxic) form;
a diet for a nursing mother that eases the load on the liver;
early breastfeeding - the baby can be fed immediately after birth, and the more often you do this, the more faster intestines clear meconium - and recover normal level pigment;
at severe forms jaundice must be treated with medication.

Mothers should not be afraid of high concentrations of bilirubin in their infants, but they should monitor these indicators so as not to miss possible complications. If you follow your doctor's recommendations, jaundice usually goes away without a trace within a few weeks.

In contact with

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

Even in the maternity hospital, the mother may notice the yellowness of the baby’s skin and begin to worry. In most cases, infantile jaundice does not foretell anything terrible - this is common physiological symptom

Types of newborn jaundice

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

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

Signs of physiological jaundice

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

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

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

Pathological jaundice: how to quickly recognize the danger?

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

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

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

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

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

Remember: the main symptom of this pathology is early date its manifestations! Baby's skin becomes bright yellow almost immediately after birth.

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

Why does physiological jaundice occur?

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During intrauterine life, the baby's tissues were supplied with oxygen by red blood cells (erythrocytes), but after birth the baby breathes on his own and now red blood cells with hemoglobin are no longer needed. They are destroyed and in the process of their destruction bilirubin is produced, which turns the newborn’s skin yellow (we recommend reading:). Bilirubin is excreted in feces and urine.
The baby’s body is just learning to function correctly and does not yet know how to fully cope with all its responsibilities. Jaundice in a newborn is a natural phenomenon that occurs as a result of insufficient liver function. Since the newborn’s liver is still immature, in the first days of his life it does not have time to process all the bilirubin that is formed, so the pigment partially enters the blood. It stains the mucous membranes and skin yellow. When the child's liver grows a little, it will more thoroughly process the bilirubin that enters it. As a rule, the liver begins to function fully by the 5th-6th day of a baby’s life. From this moment on, physiological jaundice gradually fades away and there is no reason for concern.
In some children, liver function improves faster, in others slower. What determines the rate of bilirubin excretion? A child has every chance of being “yellow-skinned” for a couple of weeks if:
Mom is too young and she has the highest level of bilirubin;
diabetes Mom;
he was born in a pair with a twin brother or sister;
he was born prematurely - the liver of a premature baby is even more immature than that of babies born on time;
mother experienced iodine deficiency during pregnancy;
the mother ate poorly, smoked or was sick while she was carrying the baby;
took some medications.

The birth of twins in some cases can cause jaundice: the children’s liver is quite weak, since the resources of the mother’s body were spent on two fetuses at once
Where does pathological jaundice come from?
Most often, this terrible phenomenon happens for the following reasons:
Incompatibility of the blood of mother and fetus according to the Rh factor ( hemolytic disease newborns). Currently, it is extremely rare, since all women with negative Rh receive special preventive treatment already from the 28th week of pregnancy.
Congenital diseases or underdevelopment of the baby's liver.
Genetic or hereditary abnormalities.
Congenital pathologies of the circulatory system or intestines of a newborn.
Inappropriate antibiotic therapy.
Severe pregnancy of the mother, toxicosis, threat of miscarriage.
Mechanical disturbance of the outflow of bile: blockage of the bile ducts by a tumor, narrowing of the bile ducts or their underdevelopment.

Norm of bilirubin for a newborn
How much bilirubin is in the blood determines biochemical analysis. If the bilirubin level is above 58 µmol/l, then noticeable jaundice of the skin appears. With physiological jaundice it is never higher than 204 µmol/l.
If the level of bilirubin in the blood of a full-term baby in the first three weeks of life is above 255 µmol/l, and in a premature baby – 170 µmol/l, then this indicates a serious pathology and requires urgent examination and treatment. It must be prescribed by a doctor.
The upper limits of normal bilirubin content in a baby’s blood can be found in the table:
If the yellowness of a baby’s skin due to breastfeeding does not go away even in the third week after birth, then doctors talk about “breast milk jaundice.” It is believed that the presence of mother's milk in the baby's body increases the bilirubin content in his liver. In this case, the bloom of jaundice occurs on days 11–23 of life. This condition goes away very slowly; in many of these babies, the jaundice completely disappears by the third month, only sometimes by the second. In such cases it is recommended thorough examination child to identify more serious reasons jaundice.
There is an opinion that bilirubin levels increase during breastfeeding. For this reason breastfeeding stops when signs of jaundice are detected in the child, however modern research confirmed the fact that breastfeeding is an important measure in the treatment of neonatal jaundice. Most of yellow pigment is excreted from the baby’s body with feces. Breast milk has a mild laxative effect, which helps eliminate bilirubin and prevents the development of jaundice.
Indeed, a jaundiced skin tint often appears in breastfed infants. However, there is a high likelihood of developing breast milk jaundice in those babies who began to breastfeed late or too rarely and too little, due to a lack of milk from the mother.

A slight yellowing of the baby’s skin during breastfeeding should not bother parents, but you still need to consult a doctor
There is no evidence that breast milk jaundice causes any harm to the baby. If a baby who is only breastfed has a slight jaundiced skin tint, this is not scary and should not worry parents.
Treatment of jaundice
Treatment pathological process, which can cause serious consequences, must be performed in a hospital under strict medical supervision. Physiological yellowness in most cases can go away on its own without treatment. With a pronounced degree of physiological jaundice, you can help the child with the following measures:
The main and main medicine is maternal colostrum, which has a laxative effect and helps remove bilirubin from the newborn’s blood.
Phototherapy is often prescribed. After exposure to a special lamp, bilirubin is removed from child's body in 10-11 hours.
The sun's rays are also an excellent treatment. When walking with your child in warm weather, leave him naked for a while in the lacy shade of trees. At home, it is advisable to place the baby's crib closer to the window.
If the child has pronounced jaundice, more intensive treatment. Doctors usually prescribe activated carbon or Smecta internally (more details in the article:). Activated carbon absorbs bilirubin, and Smecta stops its circulation between the liver and intestines.

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

Bilirubin is a special yellow-green protein that is found in blood and bile and is formed as a result of the breakdown of red blood cells.

Checking bilirubin baby
normal Cardiologist In breast milk
Jaundice see a doctor Baby suffers from hiccups

High bilirubin in newborns is very common. main reason This phenomenon is that the liver of a newborn cannot function like that of an adult, and therefore cannot cope with the formed element as it should. That's why increased level This protein in a newly born baby does not surprise anyone.

Even if bilirubin is slightly elevated in the newborn’s tests, most often this is not a cause for concern; within two weeks from birth, the jaundice disappears. The doctor monitors the level of the disease using daily blood tests, and at home, the level of bilirubin in newborns and its deviations can be monitored using special tests.

There are 3 main reasons provoking the jump:

the presence of an accelerated rate of destruction of red blood cells;
the presence of violations of the process of processing the element by the liver;
presence of bile flow disorders;
hereditary glucuronyl transferase – enzyme deficiency.

In approximately 70% of children, protein levels noticeably increase in the first days of life, which immediately decreases. The number of these jumps can reach 3-4 times per day. At the same time, such changes have absolutely no effect on the child’s body. But there are situations when the norm of bilirubin in the blood of newborns cannot be achieved so easily. This is a consequence of some physiological or external factors.

You need to stick to normal levels

The secondary causes of increased protein include the following.

Term of the child - in premature children the level of this element is higher.
The course of pregnancy - whether there were any diseases or medications.
Intrauterine fetal hypoxia.
The presence of diabetes mellitus in the mother.
Presence of asphyxia during childbirth.

Diseases with increased bilirubin

If large deviations from the norm are observed, the so-called pathological jaundice, this may indicate a number of deviations.

Infectious liver disease.
Intestinal obstruction.
Mechanical jaundice.
Hormonal disorders.
Gilbert's syndrome is a constitutional liver dysfunction.
Incompatibility of mother and child by blood type.

You need to understand that only a specialist will be able to select the appropriate symptom for the situation, conduct further diagnostics, and determine whether treatment is necessary. increased bilirubin in newborns.

Table of norms for children

Today, there is a table of norms for protein content in a child’s blood developed by WHO. These data relate to indicators total protein. Direct and indirect have their own table, the indicators are different.

Total bilirubin in the blood was determined next norm, the table below shows these indicators.

As you can see, the rate of bilirubin in the blood of newborns and children at 1 month is very different. This suggests that this protein is capable of being excreted from the body in large quantities in a short period of time.

How dangerous is the disease?

The main danger posed by increased bilirubin in the blood of a newborn is the toxic effect on the child’s body. The protein cannot be completely blocked by typical blood albumin, so it goes directly into the nervous system.

This is dangerous for vital nerve centers Due to the undeveloped blood-brain barrier, high levels of bilirubin in the newborn's blood can enter the brain cells. There it accumulates in tissues and can cause very serious neurological damage. As a rule, bilirubin encephalopathy manifests itself during the first days of a baby’s life.

The main signs of the disease are:

decreased sucking reflex;
severe drowsiness.

The fact that bilirubin in a newborn is not normal and its limit has already been reached is indicated by such a sign as a significant decrease blood pressure, as well as motor restlessness, which may be accompanied by convulsions. Sometimes there is an enlargement of the liver and spleen.

If the baby’s treatment is started at the wrong time or is not carried out at all, then:

there is a risk of the baby losing hearing by 6 months;
mental development slows down;
on acute stage the disease develops paralysis.

High bilirubin in the blood of newborns is serious reason for concern and observation by a neurologist, but in no way a reason for panic - the protein level most often comes very quickly to the desired levels.

How to treat the disease?

Doctors from the maternity hospital begin treatment. According to blood tests, the indicators are compared with the table, determining whether bilirubin in children is normal or within its limits. Treatment begins immediately as soon as the distance from the norm is sufficiently large, fearing a further increase in the child’s protein concentration.

The most effective and harmless treatment method used by today's pediatricians is light therapy or phototherapy. The method is effective for physiological jaundice when a blood test indicates slight deviations from the norm.

The basics of phototherapy are that under the influence ultraviolet rays the indirect protein is almost immediately converted into lumirubin, which is no longer perceived by the body as a toxin, and is then removed from the body along with feces and urine in about 12 hours. This method has some unpleasant side effects – loose stool and severe peeling of the baby's skin. However, these signs do not last long.

Another effective way- treatment breast milk. Since the described protein is fat-soluble, and there is a lot of these fats in mother’s milk, it is this useful source capable of influencing its level and complete recovery child. Therefore, knowing what bilirubin should be in her newborn and comparing it with tests, the mother can immediately begin her own method of treatment.

Attention!

The information published on the website is for informational purposes only and is intended for informational purposes only. Site visitors should not use them as medical recommendations! The site editors do not recommend self-medication. Determining the diagnosis and choosing a treatment method remains the exclusive prerogative of your attending physician! Remember that only full diagnostics and therapy under the supervision of a doctor will help you completely get rid of the disease!

Most newborn children are faced with the problem of physiological jaundice with a 95% probability. This condition is characterized by the accumulation of soft tissues bilirubin pigment, the increase of which is associated with the breakdown of fetal hemoglobin.

With proper care of the child, this condition does not pose a threat to the health and life of the newborn baby. In order for young parents to have an idea of the norm and pathology, they are recommended to familiarize themselves with age indicators norms of bilirubin in the body of a newborn.

What is bilirubin

This substance is a pigment, the formation of which is associated with the destruction of protein components of the blood. Bilirubin is characterized by a yellow-brown color. IN everyday practice You can observe the accumulation of this substance in the skin, at the site of bruise formation. Bilirubin is removed from the body through feces and urine under the action of special liver enzymes.

The presence of this component is observed in the body of everyone healthy person. Excessive accumulation of the substance in the body leads to the development of general intoxication syndrome, and its penetration into the brain structures leads to the formation of so-called kernicterus.

Pigment classification

The result of the breakdown of fetal hemoglobin is the formation of large fractions of indirect pigment. Free faction pigment cannot be independently removed from tissues. In order to remove this substance, it is necessary to convert it into a direct fraction of bilirubin. Only liver enzymes can help in this matter.

The total fraction of bilirubin is also distinguished, which is the ratio of direct and indirect pigment. At the moment the child is born medical specialists Blood is taken from the umbilical cord to analyze the level of pigment. During the analysis, the concentration of direct, indirect, and total fractions is measured.

The level of indirect bilirubin in newborns should be at least 75%. The direct fraction occupies no more than 25%. If medical specialists note an increase in bilirubin in the first and subsequent tests, then we are talking about development.

IN medical practice There are 2 types of jaundice.

Physiological

This condition does not pose a threat to the health and life of the baby. The prevalence of physiological jaundice is more than 85%. The first symptoms of bilirubin accumulation appear on days 2-4 of the baby’s life. If medical recommendations are followed and the child is properly cared for, physiological jaundice disappears after 14 days.

The following factors can cause the development of this condition:

Chronic diseases in a woman during pregnancy (including diabetes mellitus);
Intrauterine oxygen starvation fetus;
Mechanical asphyxia of the fetus when entwined with the umbilical cord;
Prematurity or low birth weight.

In some children, signs of physiological jaundice become apparent 7 days after birth. This delay is observed in healthy babies gaining weight according to the age norm.

Pathological jaundice

Given pathological condition poses a risk to the health and life of a newborn baby. The following factors can provoke excessive accumulation of pigment:

Conflict on the Rh factor between the mother and the developing fetus;
Incompatibility of mother and child by blood type;
Intestinal obstruction in infants;
Genetically determined breakdown of red blood cells;
Infectious lesion of liver tissue in a newborn;
Premature onset labor activity in a pregnant woman;
Hormonal imbalance in the child’s body;
The use of medications to stimulate labor in a pregnant woman.

Important! If the yellowness of the skin is accompanied by intense staining of urine and discoloration feces child, then this indicates pathological changes in the biliary tract.

Age norms of pigment in newborns

In order for parents to be able to navigate their baby’s condition, doctors recommend familiarizing themselves with the indicators age norm concentration of this pigment in the blood.

Age	Normal values in µmol/l
Age	General	Straight	Indirect
First day of life	23,09	8,73	14,38
2nd day from birth	54,23	8,73	45,51
4 days	90,15	7,88	82,27
6 days	69,11	7,73	63,28
9 days	53,03	8,73	44,31
30 days	11,13	2,58	8,56

The danger of increased bilirubin

An increase in the concentration of pigment in the child’s body leads to its penetration into the structures of the brain. This substance has a toxic effect on nerve cells, causing central nervous system disorders. nervous system. For the purpose of prevention severe complications bilirubinemia, it is necessary to control the pigment fractions immediately after the birth of the baby. A dangerous complication jaundice is bilirubin encephalopathy leading to severe consequences for higher nervous activity.

The following signs indicate the development of this condition:

Brief convulsions;
Increased size of the spleen and liver;
Increased physical activity;
Suppression of the sucking reflex;
Reduced blood pressure;
Lethargy and increased drowsiness.

In the absence of proper treatment, by six months the child may develop hearing disorders, as well as other developmental problems.

Treatment

The fight against physiological jaundice in newborns always brings the expected result. For this purpose, children are prescribed infusion therapy and phototherapy. To reduce the concentration of pigment in the body, infants are placed under a special lamp. Under the influence of ultraviolet radiation, the indirect fraction of bilirubin is transformed into a safe substance that leaves the baby’s body along with its feces. Treatment with ultraviolet radiation often entails a number of adverse reactions.

During the treatment process, it is necessary to take care of the child’s safety. Before turning on the radiation source, a special bandage is put on the baby’s eyes, which is necessary to protect the retina from the damaging effects of ultraviolet rays.

In the treatment of physiological jaundice in newborns great importance is breastfed. The fact is that mother's milk is not only effective means to treat this condition, but also helps to avoid excessive accumulation of bilirubin in the child’s body. A young mother needs to put her baby to her breast as often as possible.

If pathological jaundice occurs, the baby is recommended to undergo infusion therapy aimed at cleansing the body of pigment. At severe course If bilirubinemia occurs, the newborn is given an exchange transfusion. Pathological bilirubinemia, which arises against the background of incompatibility of mother and child by blood type, can be treated by administering immunoglobulin. This substance prevents the accumulation of harmful antibodies in the baby's blood.

If immunoglobulins were administered in a timely manner, the child will not require a replacement blood transfusion.

At mild flow For this condition, the duration of treatment is 4 days. If the yellowness of the skin persists for a long period of time, the baby and mother are sent to specialized hospital to continue treatment.

After completing therapy, the baby must be regularly shown to a pediatric neurologist. This condition is necessary for timely detection of the consequences of bilirubin accumulation in the body. Treatment of delayed physiological jaundice involves stopping breastfeeding for 2 days.

Prevention

To prevent bilirubinemia in newborns, a young mother should pay attention to her diet while pregnant. A pregnant woman's diet should include dandelion leaves and alfalfa.

If the baby is breastfed, then breastfeeding occurs on demand. The feeling of hunger increases the concentration of bilirubin in the body.

In the process of correcting bilirubinemia, the baby is under the continuous supervision of medical specialists.

The whole family waits for the birth of a newborn for 9 long months. During the long 40 weeks of pregnancy, the baby was in sterile conditions under the protection of the mother’s body. It is not surprising that in the first months of birth the child’s body is in a state of constant stress. Such stress factors include newborn jaundice. Experienced parents know what this is normal condition the child’s body during the adaptation period, but there are mothers who are very worried about whether infantile jaundice is dangerous. But there are times when postpartum yellow tint baby's skin is considered dangerous and requires treatment from an experienced pediatrician.

Classification of species

Experts identify the following types of jaundice in a newborn:

Physiological. After a certain period of time it disappears without a trace. Such a child does not need treatment.
Pathological. Occurs as a manifestation of certain diseases. Requires constant medical monitoring and treatment.

Causes

Why do newborns develop physiological jaundice?

Yellowish skin color occurs after birth and appears on the 3rd day in approximately 65% of babies. In the womb, the fetus could not breathe on its own, so erythrocytes (red blood cells) brought oxygen to its cells. After birth, the child’s body is in full swing with work in all systems and organs. But we are interested in jaundice, so we will now understand its causes step by step.

The baby is born and the red blood cells with hemoglobin that supplied him with oxygen are destroyed as unnecessary.
As a result of destruction, free (indirect) bilirubin is produced, which has an insoluble composition and cannot be excreted in the child’s urine. This type of bilirubin is very toxic.
A special protein transports bilirubin to liver cells.
As a result of a series of biochemical reactions, bilirubin is converted into direct bilirubin.
The child's body is cleared of direct bilirubin through the kidneys and intestines.

Due to the immaturity of the bilirubin-conjugating system, the process that we discussed above (or rather not the entire process, but steps 3-5) can take several days or even several weeks.

What causes skin coloring yellowish color:

intrauterine fetal hypoxia;
asphyxia;
diabetes mellitus in mother;
the mother has 1 blood group, and the child has 2 or (slightly less often) 3 blood groups;
intrauterine infection;

Causes of pathological jaundice:

Incompatibility by blood group or Rh factor.
Diseases of the circulatory system.
Diseases of the liver parenchyma or biliary tract.
Hormonal disorders (in this case, treatment is carried out by an endocrinologist).
Intestinal diseases (When bilirubin from the intestines is absorbed back into the body. In this case, only surgeons can help.)
Genetically determined disorders.

Norms

If the bilirubin level in the first three weeks of a full-term baby exceeds 256 µmol/l, and in a premature baby - 172 µmol/l, then the newborn is diagnosed with pathological jaundice and an examination in a hospital is necessary to determine the cause and treatment.

It is worth noting that the test results indicate 3 indicators of bilirubin:

straight,
indirect,
general.

The ratio of direct and indirect bilirubin in a newborn baby is usually disturbed and differs from the norm: direct - 1/4, indirect - 3/4.

How long does jaundice last, why is it dangerous?

The bilirubin secretion system gradually improves and usually after 6-7 days, maximum 14-21 days, the yellow color of the skin disappears without a trace. Physiological jaundice is not dangerous and there will be no consequences after it. If the child is on breastfeeding, then the process of removing bilirubin is more intense.

Complications also sometimes occur. They are associated with the toxic effects of indirect bilirubin on the CNS (central nervous system) of the newborn.

Kernicterus

Not all substances contained in the blood are sent through circulatory system into the brain. There is a brain blood barrier that is responsible for keeping the brain safe from toxic substances. Thanks to this barrier With physiological jaundice, there is no damage to the nervous system and brain cells are not destroyed. But when bilirubin levels are very high, it can enter the brain and cause destruction nerve cells. This process is called kernicterus. It is clear that when this state the child urgently needs medical care. There are several stages of kernicterus:

The newborn is lethargic, does not take the breast, and does not show any activity.
The head tilts back and the child screams monotonously.

The exact numbers at which the baby’s condition will definitely deteriorate are not known. There are standards, deviations from which may indicate that the risk of damage to the nervous system is very high. If the baby is more than 3 days old and the bilirubin level is 380, this is very dangerous condition! Indicators above 250 µmol/l require treatment.

IMPORTANT! If the bilirubin level is above 290, the child needs urgent medical attention.

When jaundice does not go away for more than a month, but the bilirubin level is not higher than 117 µmol/l, this condition does not require hospitalization of the baby, but it should alert parents. Such lingering jaundice cannot be physiological and most likely has another cause, which the pediatrician must find out.

IMPORTANT! If the yellowish skin color remains for more than 3 weeks, the baby's urine is dark in color, and the stool is discolored, this is a sign congenital disease biliary tract.

Obstructive jaundice

This type occurs when there are disturbances in the functions of the outflow of bile. Causes:

bile duct cyst;
ring-shaped pancreas;
atresia (underdevelopment) of the bile ducts.

Analyzes

If jaundice persists for a long time, it is necessary to determine the cause of this condition. To do this, a number of analyzes are carried out:

general blood analysis;
level determination total bilirubin and its fractions in blood serum;
liver function indicators;
hemolysis tests (Coombs test);
Ultrasound of organs abdominal cavity;
consultation with a surgeon, endocrinologist or other specialist as necessary.

Treatment

Phototherapy (light therapy). On this moment the most the best remedy for the treatment of jaundice. Phototherapy is carried out continuously, the baby is given to the mother only for feeding. Possible complications which may cause this method: skin burn, lactose intolerance, dehydration, hemolysis, hyperthermia and sunburn.
Infusion therapy. Needed for recovery water balance with phototherapy. These are glucose solutions + membrane stabilizers, soda, electrolytes, cardiotrophics, preparations for microcirculation.
Inducers of microsomal liver enzymes (Phenobarbital, Zixorin, Benzonal). This therapy is used for disorders of the bilirubin-conjugating system. Phenobarbital course: 5 mg/kg per day, 4-6 days. Sometimes another regimen is used: 20-30 mg/kg on day 1, then 5 mg/kg for the next up to 6 days. But high doses have a strong sedative effect and respiratory impairment, so the first regimen is more often used.
Enterosorbents (Smecta, Polyphepan, Enterosgel, etc.) are needed to interrupt the circulation of bilirubin between the intestines and liver. This is a helper method like self-treatment does not apply.
Replacement blood transfusion. It is carried out when there is a threat of kernicterus.
For symptoms of cholestasis, the drug Ursofalk is used. It is available in the form of a suspension and is not contraindicated in newborns. The initial dose is 15-20 mg per kg of child weight per day. The dose can be increased to 40 mg per kg. If treatment is long-term, the dose is reduced to 10 mg/kg.
Replenishment is also sometimes necessary fat-soluble vitamins(D 3, A, E, K), microelements (calcium, phosphorus, zinc sulfate).
In Alagille syndrome, a nonsyndromic form of intrahepatic hypoplasia bile ducts There is no treatment for perinatal sclerosing cholangitis. If cirrhosis of the liver develops, a transplant of this organ is necessary.
At metabolic disorders use conservative methods treatment. If a child has galactosemia, then you need to use mixtures that do not contain galactose and lactose (for example, NAN lactose-free, Pregistimil, Nutramigen). If a baby has tyrosinemia, then he needs a diet that does not contain tyrosine, methionine and phenylalanyl (lofenolac, Aphenilac, HR Analogue, HR Analog LCP, etc.)