Lingering jaundice in newborns treatment. Jaundice in newborns: when should it go away? How long does jaundice last in newborns Komarovsky

At the moment of birth, the baby, getting into a new habitat, experiences severe stress. In a fragile child's body, minor malfunctions can occur, which leads to such a phenomenon as jaundice in newborns. What is it, and should parents panic?

Why does jaundice appear

Causes of jaundice in newborns

Most often, pathological jaundice suffers from children whose mothers had a hard time tolerating pregnancy, for example, they had a threat of miscarriage, had early or late toxicosis.

What, besides this, can still serve as the causes of the disease?

• Hemolytic disease, which caused the incompatibility of the blood of the baby and the mother for the Rh factor.
• Heredity.
• Infection of a child's liver with a virus in the womb.
• Underdevelopment of liver cells.
• Decreased thyroid function - hypothyroidism.
• Abnormalities in the bile ducts.
• Premature birth in women with diabetes, including those that occur only during pregnancy (gestational diabetes).
• The introduction of oxytocin into the body of a woman in labor.
• Administering antibiotics such as cefazolin or ampicillin to the child.

How does the disease manifest? Tests for jaundice

In infants, additional manifestations of jaundice may be added to the change in the skin. The baby's urine becomes dark in color, while the feces, on the contrary, become discolored. On the body of the crumbs, bruises can appear for no reason. The general well-being of the child worsens, while the liver and spleen increase.

If the skin of the crumbs does not acquire a normal shade 2-3 weeks after birth, you need to consult a doctor for laboratory tests.

Before starting treatment, an analysis is prescribed to determine the amount of bilirubin in the blood. In full-term babies, the critical indicator is 324 µmol / L, and in premature babies, only 150-200 µmol / L.

Since this value depends on several reasons, the doctor will prescribe treatment based on the general condition of the baby. In addition, an ultrasound of the abdominal cavity is performed in order to determine the condition of the internal organs, and samples are taken for hemolysis.

How to treat jaundice in a newborn

If a child has a physiological form of jaundice, then we are not talking about treatment, but only about helping the little man.

What needs to be done so that the child can quickly cope with the problem that has arisen?

• You should start breastfeeding as early as possible. to help improve metabolic processes in the baby's body.
• So that the crumbs do not have digestive problems , mom should stick to a diet.
• The kid needs to be outdoors more often. , and if possible - take sunbathing.

Methods for treating jaundice in newborns

If pathological jaundice is detected, the treatment of the baby should be started immediately.

A lamp against jaundice in a baby

This is a treatment based on the effect of ultraviolet rays on the skin of the baby. When light is irradiated under the skin of a child at a depth of 2-3 mm, chemical reactions occur that convert indirect fat-soluble bilirubin into its water-soluble form - lumirubin. It dissolves freely in the blood of a newborn and is excreted in the urine.

Phototherapy is carried out in a hospital under the supervision of a doctor and following certain rules ...

• The baby's eyes are covered with special glasses or a bandage.
• The time of the treatment session is strictly regulated; for this, the lamp is equipped with a timer.
• The procedure can cause flaking of the skin and dehydration of the body, therefore it is carried out under the constant supervision of a healthcare professional.

After the phototherapy sessions, the child's stool color and character may change. This is normal because excess bilirubin is excreted in the baby's feces.

Together with phototherapy, the doctor may prescribe infusion therapy. It will be required in order to restore the water balance. It can be a glucose solution, membrane stabilizers, electrolytes and drugs that improve microcirculation.

Medicines to help with treatment

• One of the drugs is Hofitol - a preparation containing an extract from the leaves of a field artichoke. It improves liver function, promotes rapid excretion of bile and a significant decrease in the level of bilirubin in the body of the baby. Ursofalk has a similar effect on the body. Small crumbs are prescribed a medicine in the form of a suspension.
• Enterosorbents are prescribed as auxiliary agents, such as Polyphepan, Smecta or Enterosgel ... The drugs limit the circulation of bilirubin between the liver and intestines.
• To stimulate metabolic processes and strengthen immunity, babies are prescribed Elkar - a remedy consisting of carnitine. The drug breaks down fatty acids, helping to generate additional energy in the baby's body.

When is blood transfusion necessary?

Blood transfusion is used for severe forms of pathological jaundice. If the indices of indirect bilirubin rapidly increase and significantly exceed the norm, then exchange transfusion is indispensable. Most often, the procedure is carried out when a Rh-conflict occurs.

Exchange transfusion involves replacing a small amount of the child's blood with donor blood. This helps to flush out the bilirubin from the baby's body.

Folk remedies for the treatment of jaundice

In no case should you risk the health of a newborn and self-medicate! Folk remedies can only be used as an adjunct to the treatment that the attending doctor will prescribe and only with his approval.

To improve the general condition of the newborn, you can resort to a strengthening agent, the role of which can be played by a weak rosehip decoction. As an absorbent, you can give the child activated charcoal by dissolving the amount of powder in water corresponding to its weight.

You should not give the baby any medicinal fees as a diuretic and choleretic agent. No one can say for sure how the child's body will react to them.

Why is jaundice dangerous - the consequences of the disease

If the physiological jaundice quickly passes without leaving a trace in the body of the little man, then the pathological form of the disease can cause serious consequences.

With nuclear jaundice the nervous system of the child is affected, which leads to serious neurological abnormalities. In addition, the child may experience hearing and vision impairment, and in the most severe cases, cerebral palsy may develop. In rare cases, the disease can lead to paralysis of the sick baby.

If the jaundice color of the baby's skin does not subside in due time, immediately consult a doctor. If the crumbs have jaundice manifested in a pathological form, it must be treated immediately.

Video about jaundice, Komarovsky:

In this article:

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

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

Classification

Jaundice in newborns is of two types: 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 delivery. They do not require treatment, but disappear on their own within 3-5 days. Sometimes symptoms go away after 2-3 weeks. The child definitely needs examination in order to prevent the transition of such a state to pathology.

With physiological yellowing of the skin, the increase in bilirubin is insignificant.

Most often, this type of jaundice appears due to the production of new hemoglobin, since the hemoglobin of the fetus differs from normal. After birth, the composition of the blood completely changes.

Physiological jaundice is of two types: neonatal and breast milk jaundice. The first is the most common. Is she dangerous? No. Breast milk jaundice also does not pose a threat to the health of the baby. It appears due to the fact that breast milk contains a large amount of estrogen. The body of the crumbs, instead of excreting bilirubin, gets rid of this hormone.

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

There are two types of this jaundice:

• Hemolytic ... It rarely occurs, in about 1% of babies. Symptoms appear immediately, the whites of the eyes and facial skin turn yellow. On palpation, you can find that the crumbs have an enlarged liver and spleen.
• Mechanical ... It appears in diseases of the liver and gallbladder, as well as in problems with the excretion of bile. Most often, this type occurs due to genetic disorders or trauma during childbirth. One of the obvious symptoms of pathology is a transparent baby stool.

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

• conjugation - is a consequence of poor liver function to remove bilirubin;
• nuclear - characterized by a sharp increase in the concentration of bilirubin in the first 24 hours after childbirth;
• hepatic (parenchymal) - appears with infectious liver damage;
• hemolytic - characterized by massive destruction of red blood cells;
• subhepatic (obstructive) - appears with stagnation of bile in the liver.

Causes

Causes of pathological jaundice:

• , which arises due to the fact that the child has a positive blood type, and the mother has a negative one;
• intrauterine infection;
• different blood groups, especially if the newborn has a second or third, and the mother has the first;
• diabetes mellitus in the mother;
• antigen incompatibility;
• hormonal disorders in an infant;
• diseases of the circulatory system;
• hemorrhages in an infant, which are an additional source of bilirubin;
• the introduction of antibiotics to the baby or the use of drugs for the woman in labor during the labor process;
• diseases of the intestines, liver or gallbladder in a newborn;
• violation of the patency of the biliary tract.

The cause of physiological jaundice is an increase in the level of bilirubin due to the production of "new" hemoglobin and getting rid of the "old". The liver of the crumbs cannot cope with such a load, which is why jaundice appears.

It provokes yellowing of the skin in newborns, asphyxia and. Postpartum jaundice can result from trauma during labor.

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, the sky and the face turn yellow faster.

Signs of pathological jaundice:

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

With nuclear jaundice, the newborn refuses to eat, he is inactive. After a while, the child begins to throw his head back and screams monotonously.

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

The following signs can be used to distinguish physiological jaundice from pathological:

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

Symptoms of physiological jaundice never appear in the first day of life, the peak of all symptoms falls on days 3-4.

How long does the jaundice last?

When should neonatal jaundice go away? 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 babies who are breastfed, traces of physiological jaundice disappear faster.

Why doesn't jaundice go away for a month? This indicates a pathological condition. If symptoms persist for more than two weeks, it is worth taking the baby to a doctor. In rare cases, we can talk about jaundice of breast milk, then the jaundice remains for 2 months, and sometimes 3.

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

Diagnostics

The examination consists of a visual examination of the baby, as well as a series of tests.

Diagnostics include:

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

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

Bilirubin rate

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

Bilirubin is a yellow pigment that is involved in the exchange of hemoglobin. It is released from red blood cells when blood cells die. This substance must be excreted 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 indicators reach 35 μmol / l, then jaundice appears.

In premature infants, yellowing of the skin occurs at a bilirubin value of 85 μmol / L.

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

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

While the child is in the hospital, the bilirubin level should be measured 2-3 times over the entire period to make sure that its concentration does not increase.

Treatment

The newborn requires treatment for pathological jaundice. All therapeutic measures are carried out in a hospital setting, where the mother and child are placed. At home, newborns can be treated only with a slight increase in bilirubin.

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

In the treatment of 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:

• Reception of enterosorbents. These drugs speed up the elimination of bilirubin from the blood. Apply Smecta, Enterosgel, Polysorb.
• Administration of drugs to restore water balance after phototherapy. Apply glucose solution, soda, electrolytes.
• Choleretic and diuretics. They are used if bilirubin is approaching a critical level. Apply Hofitol, Essentiale Forte, magnesia solution for oral administration, rosehip decoction in the form of tea.
• Hepatoprotectors. They protect and repair liver cells. Ursofalk, Phosphogliv, Ursosan, Ukrliv will do.
• Homeopathic remedies. They improve bile secretion, remove toxins and normalize stool. Effective medicines - Hepel, Galstena.
• Preparations to improve metabolism. Elkar 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.

Blood transfusion belongs to the emergency measures in the treatment of jaundice, especially when it comes to the nuclear form of the disease.

With ICD in a child (urolithiasis), diuretics should be used with caution.

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

Phototherapy has a number of side effects. Drowsiness, peeling of the skin, upset stools may appear.

Phototherapy can be continued at home. Instead of a lamp for newborns from jaundice, direct sunlight is suitable. They contribute to the disappearance of symptoms. Sunbathing promotes the production of vitamin D, which accelerates the elimination of bilirubin from the blood.

Consequences and complications

Why is jaundice dangerous in newborns? Only a pathological form is a threat to health. A high level of bilirubin poisons the body of the baby, it affects the functioning of the brain and central nervous system, which leads to impaired development of the child. These are the most severe consequences of jaundice in newborns.

Other hazards:

• the likelihood of cirrhosis and liver cancer increases;
• reduced immunity;
• the liver does not work well.

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

Prophylaxis

A newborn can get true jaundice on the first day after childbirth, since the baby's body is no longer protected and is not yet adapted to the new living conditions. The best prevention of illness is breast milk. It is necessary to apply the newborn to the breast in the first minutes after birth, so that he receives the most valuable drops of colostrum.

Other preventive measures:

• dieting mom;
• walks in the fresh air with a child;
• sunbathing.

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

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

Useful video about jaundice in newborns

Jaundice, or the visual manifestation of hyperbilirubinemia, includes syndromes of various origins, the common feature of which is icteric staining of the skin and mucous membranes. In total, there are about 50 diseases that are accompanied by the appearance of yellowness of the skin. In adults, skin staining occurs when the bilirubin level rises above 34 μmol / L, in newborns - when the bilirubin level is from 70 to 120 μmol / L.

Neonatal jaundice caused by the accumulation of excess bilirubin in the blood is common and sometimes requires urgent treatment. Indirect bilirubin is a neurotoxic poison and under certain conditions (prematurity, hypoxia, hypoglycemia, prolonged exposure, etc.) causes a specific lesion of the subcortical nuclei and cerebral cortex - the so-called bilirubin encephalopathy. According to various sources, in the first week of life, jaundice occurs in 25-50% of full-term infants and in 70-90% of premature infants.

Bilirubin is the end product of heme catabolism and is formed mainly due to the breakdown of hemoglobin (about 75%) with the participation of heme oxygenase, biliverdin reductase, as well as non-enzymatic reducing substances in the cells of the reticuloendothelial system (RES). Other sources of bilirubin are myoglobin and heme-containing liver enzymes (about 25%).

The natural isomer of bilirubin - indirect free bilirubin - is highly soluble in lipids, but poorly soluble in water. In the blood, it easily enters into a chemical bond with albumin, forming a bilirubin-albumin complex, due to which only less than 1% of the resulting bilirubin enters the tissues. In theory, one albumin molecule can bind two bilirubin molecules. In combination with albumin, bilirubin enters the liver, where it enters the cytoplasm by active transport, binds to Y- and Z-proteins and is transported to the endoplasmic reticulum. There, under the influence of uridine diphosphate glucuronyl transferase (UDPGT), bilirubin molecules combine with glucuronic acid and monoglucuronid bilirubin (MGB) is formed. During the transport of MGB through the cytoplasmic membrane into the bile capillaries, a second bilirubin molecule attaches and diglucuronidbilirubin (DHB) is formed. Conjugated bilirubin is water-soluble, non-toxic and excreted in bile and urine. Further, bilirubin in the form of DHB is excreted into the bile capillaries and excreted together with bile into the intestinal lumen. In the intestine, under the influence of the intestinal microflora, further transformation of bilirubin molecules occurs, as a result of which stercobilin is formed, which is excreted in the feces.

Almost all stages of bilirubin metabolism in newborns are characterized by a number of features: a relatively large amount of hemoglobin per unit of body weight, moderate hemolysis of erythrocytes even under normal conditions, even in a healthy full-term newborn baby, the content of Y- and Z-proteins, as well as the activity of UDFGT, are sharply reduced in the first day of life and account for 5% of the activity of such systems in adults. An increase in the concentration of bilirubin leads to an increase in the activity of the liver enzyme systems within 3-4 days of life. The full formation of the liver enzyme systems occurs by 1.5-3.5 months of life. Morphofunctional immaturity, endocrine disorders (hypothyroidism, increased progesterone in human milk), disturbances in carbohydrate metabolism (hypoglycemia), the presence of concomitant infectious pathology significantly lengthen the formation of liver enzyme systems. The processes of removing bilirubin from the body are also imperfect, which is associated with increased intestinal reabsorption of bilirubin. The colonization of the intestine of a newborn with normal intestinal microflora sharply reduces the amount of bilirubin absorbed from the intestine and contributes to the normalization of the processes of its excretion from the body.

All jaundice is usually divided according to the level of the bilirubin metabolism block:

• on suprahepatic (hemolytic), associated with increased breakdown of erythrocytes, when the liver cells are not able to utilize large amounts of bilirubin that are formed like an avalanche;
• hepatic (parenchymal), associated with the presence of an inflammatory process that disrupts the function of liver cells;
• subhepatic (mechanical), associated with a violation of the outflow of bile.

In the practice of a neonatologist, the pathogenetic classification of neonatal jaundice is used (according to N.P. Shabalov, 1996), according to which the following are distinguished:

• Jaundice caused by increased production of bilirubin (hemolytic): hemolytic disease of newborns, polycythemic syndrome, swallowed blood syndrome, hemorrhages, drug hemolysis (overdose of vitamin K, oxytocin, the use of sulfonamides, etc.), hereditary forms of erythrocytic membrane and fermentopathies, hemoglobinopathies.
• Jaundice caused by decreased clearance of bilirubin by hepatocytes (conjugation): hereditary Gilbert, Crigler-Nayyard syndromes I and II, Arias, metabolic disorders (galactosemia, fructosemia, tyrosinosis, hypermethioninemia, etc.), impaired conjugation of bilirubin, with high pyloric obstruction, the use of certain medicines.
• Jaundice caused by impaired evacuation of conjugated bilirubin with bile through the biliary tract and intestines (mechanical): anomalies in the development of the biliary tract in combination with other malformations (Edwards, Alagill syndrome), familial cholestasis of Bayler, McElfresh, Rotor and Dubin-Johnson syndromes, cystic fibrosis, -1-antitrypsin insufficiency, bile thickening syndrome, compression of the biliary tract by a tumor, infiltrates, etc.
• Mixed genesis: sepsis, intrauterine infections.

The pathological nature of jaundice is always indicated by the following signs: the appearance of jaundice in the first day of life, the level of bilirubin is more than 220 μmol / L, the hourly increase in bilirubin is more than 5 μmol / L per hour (more than 85 μmol / L per day), its duration is more than 14 days, undulating course of the disease, the appearance of jaundice after the 14th day of life.

The most common reason conjugational hyperbilirubinemia in newborns, there is a discrepancy between the normal production of bilirubin and the imperfect system of its excretion from the body due to the immaturity of the liver enzyme systems. For conjugational jaundice, it is characterized by its appearance on the 3rd day of life, no enlargement of the liver and spleen, changes in the color of stool and urine, anemic symptom complex.

For transient neonatal hyperbilirubinemia the appearance of jaundice is characteristic at the age of more than 36 hours of life. The hourly increase in bilirubin should not exceed 3.4 μmol / L h (85.5 μmol per day). The highest intensity of icteric staining of the skin occurs on the 3-4th day, while the maximum level of bilirubin does not rise above 204 μmol / L. Transient hyperbilirubinemia is characterized by a progressive decrease in the level of bilirubin and the intensity of jaundice after 4 days and its extinction by 8-10 days. At the same time, the general condition of the child is not disturbed. No treatment required.

For jaundice of premature newborns an earlier onset (1-2 days of life) is characteristic, which creates difficulties in differentiating it from hemolytic disease of newborns. However, data from anamnesis (blood group of the mother and child, lack of sensitization) and laboratory tests (normal levels of hemoglobin, erythrocytes, absence of reticulocytosis) help to make a correct diagnosis. The duration of conjugational jaundice in premature infants is up to 3 weeks.

In 1963, I. M. Arias described “ jaundice from breast milk"(Pregnanic jaundice) in breastfed babies. The pathogenesis of this type of jaundice is not fully understood. However, it is believed that it is caused by low conjugation of bilirubin, which is a consequence of the inhibitory effect of pregnanediol, which is found in excess in the blood of some women in the postpartum period, as well as decreased excretion of bilirubin. The duration of jaundice is 3 to 6 weeks. The diagnostic test is the abolition of breastfeeding for 2-3 days, against which the jaundice begins to quickly resolve. When breastfeeding is resumed, the bilirubin level starts to rise again.

Gilbert's syndrome (constitutional hepatic dysfunction)- hereditary disease inherited in an autosomal dominant manner. The frequency in the population is 2-6%. The reason is a hereditary violation of the conjugation of indirect bilirubin due to a violation of the capture of the latter by the hepatic cell. In newborns, the disease resembles transient jaundice. No cases of kernicterus have been reported. The prognosis is favorable. The diagnosis is made on the basis of a family history of persistent hyperbilirubinemia in the absence of other pathological changes. The appointment of phenobarbital leads to a sharp decrease in jaundice, which also indicates the presence of this disease.

An inherited disorder of pigment metabolism in Crigler-Nayyar syndrome is due to the absence (type I) or very low activity (type II) of glucuronyl transferase in liver cells.

With Crigler-Nayyar syndrome Type I disease is inherited in an autosomal recessive manner. Intense jaundice is characteristic from the first days of life with an increase in the level of indirect bilirubin in blood serum 15-50 times higher than normal, a complete absence of a direct fraction of bilirubin. In the natural course of the disease, in most cases, staining of the brain nuclei occurs, and a lethal outcome can be noted. Phenobarbital is ineffective. The only treatment is phototherapy and liver transplantation.

In type II disease, which is inherited in an autosomal dominant manner, along with less intense jaundice and the level of indirect bilirubin 15-20 times higher than normal, the direct fraction of bilirubin is determined in the blood. A distinctive feature is a positive response to the appointment of phenobarbital. The prognostic Crigler-Nayyar syndrome of type II is more favorable. The development of bilirubin encephalopathy is extremely rare.

The first symptom of hereditary metabolic disorders, such as galactosemia, fructosemia, tyrosinemia and others, there may also be jaundice, which has a conjugational nature. First of all, the doctor should be alerted by the combination of lingering jaundice with symptoms such as vomiting, diarrhea, hepatomegaly, progressive malnutrition, severe neurological symptoms in the form of seizures, muscle hypotension, paresis, paralysis, ataxia, cataract development, delayed neuropsychic development. The diagnosis is confirmed by the presence of galactose in the urine, positive tests for sugar and other special methods of detecting metabolic disorders in each case.

Jaundice with hypothyroidism it is noted in newborns depending on the degree of insufficiency of the thyroid gland and is combined with other symptoms of the disease, such as large birth weight, pronounced edematous syndrome, low timbre of the newborn's voice, early and persistent constipation, etc. In the biochemical analysis of blood, along with indirect hyperbilirubinemia there is an increase in cholesterol. The screening test for hypothyroidism is positive, the level of thyroid-stimulating hormone is increased in the blood with a decrease in T4. Prolonged (from 3 to 12 weeks) jaundice in hypothyroidism is caused by a slowdown in all metabolic processes, including the maturation of the liver glucuronyltransferase systems. Timely diagnosis (within the first month of life) and the appointment of substitution therapy with thyroidin or L-thyroxine lead to the normalization of bilirubin metabolism.

Jaundice with polycythemia (diabetic fetopathy) due to a delay in the maturation of the liver enzyme systems against the background of hypoglycemia with increased hemolysis. Control and correction of hypoglycemia, the appointment of inducers of microsomal liver enzymes contribute to the normalization of bilirubin metabolism.

Jaundice with pyloric stenosis and high intestinal obstruction due to both a violation of the conjugating systems of the liver due to dehydration and hypoglycemia, and an increased reabsorption of bilirubin from the intestine. In this situation, only the elimination of pyloric stenosis and intestinal obstruction lead to the normalization of pigment metabolism.

The use of drugs (glucocorticoids, some types of antibiotics, etc.) can lead to a sharp disruption of the conjugation processes in the liver due to the competitive type of metabolism of the above drugs. In each specific case, an analysis of therapeutic measures is required, as well as knowledge of the metabolic characteristics of the drugs prescribed to the newborn.

All hemolytic jaundices are characterized by the presence of a symptom complex, including jaundice on a pale background (lemon jaundice), enlarged liver and spleen, increased serum levels of indirect bilirubin, normochromic anemia with reticulocytosis of varying severity. The severity of the child's condition is always due not only to bilirubin intoxication, but also to the severity of anemia.

Hemolytic disease of the newborn arises as a result of the incompatibility of the blood of the mother and the child for the Rh factor, its subtypes or blood groups. The disease proceeds in the form of edematous, icteric and anemic forms. The edematous form is the most severe and is manifested by congenital anasarca, severe anemia, hepatosplenomegaly. As a rule, such children are not viable. Icteric and anemic forms of the disease are more favorable, but can also pose a threat to the health of the child. In mild cases, the hemoglobin level in the umbilical cord blood is more than 140 g / l, the level of indirect bilirubin in the blood serum is less than 60 μmol / l. In this case, conservative therapy is sufficient. With hemolytic disease of newborns of moderate severity and severe course, a replacement blood transfusion operation may be required. In the clinical picture, jaundice is either congenital, or appears during the first day of life, has a pale yellow (lemon) tint, progresses steadily, against which neurological symptoms of bilirubin intoxication may appear. Hepatosplenomegaly is always noted. Discoloration of stool and urine is uncommon.

Damage to the structures of the central nervous system (CNS) occurs with an increase in the level of indirect bilirubin in the blood serum of full-term newborns above 342 μmol / L.

For premature babies, this level ranges from 220 to 270 μmol / L, for deeply premature babies - from 170 to 205 μmol / L. However, it must be remembered that the depth of CNS damage depends not only on the level of indirect bilirubin, but also on the time of its exposure in the brain tissues and concomitant pathology that aggravates the serious condition of the child.

Preventive measures to prevent the development of hemolytic disease of newborns, which should be carried out already in the antenatal clinic, consist in registering all women with Rh-negative and 0 (I) blood groups, clarifying the history data in terms of the presence of a sensitization factor, determining the level of Rh- antibodies and, if necessary, early delivery. All women with Rh-negative blood on the first day after childbirth are shown administration of anti-D-globulin.

With the development of hemolytic disease, the newborn is given a replacement blood transfusion, in the preoperative period, photo and infusion therapy is used.

Hereditary hemolytic anemias are very diverse. The most common of these is Minkowski-Shoffard microspherocytic hemolytic anemia. The defective gene is located in the 8th pair of chromosomes. The result of the mutation is the production of abnormal erythrocytes with a spherical shape and smaller (less than 7 nm) size, which undergo excessive destruction in the crypts of the spleen. The history is characterized by the presence in the family of relatives with a similar disease. The diagnosis is confirmed by the detection of microspherocytic erythrocytes, a shift of the Price-Jones curve to the left, a decrease in the osmotic resistance of erythrocytes, a change in the sphericity index and the average concentration of hemoglobin in erythrocytes. The disease proceeds in waves, hemolytic crises are accompanied by an increase in body temperature, decreased appetite and vomiting. Crises are provoked, as a rule, by acute viral diseases, hypothermia, the appointment of sulfonamides, etc. The main method of treatment is splenectomy.

During the neonatal period, another type of hereditary hemolytic anemia can be detected, characterized by a change in the shape of red blood cells - the so-called infantile pycnocytosis... The first signs of the disease appear in the first week of life and more often in premature babies. Erythrocytes in a stained blood smear have spiny processes. In addition to anemia, edema and thrombocytosis are also detected. The appointment of vitamin E at a dose of 10 mg / kg per day leads in most cases to clinical and laboratory remission.

When examining a blood smear in newborns, target erythrocytes can also be detected, which is characteristic of hemoglobinopathies(thalassemia, sickle cell anemia). Sickle cell anemia occurs more often in residents of Central Asia, Azerbaijan and Armenia and is manifested in the neonatal period only in homozygous carriers of s-hemoglobin.

Diagnosis hereditary enzymopenic anemias(deficiency of glucose-6-phosphate dehydrogenase, pyruvate kinase, hexogenase, 2,3-diphosphoglyceromutase, phosphohexoisomerase) is extremely rare in newborns, as it requires highly differentiated studies. In the clinical picture of newborns with this pathology, hemolytic anemia with reticulocytosis, enlargement of the liver and spleen are revealed. A family history is characteristic.

Large hematomas in the neonatal period can also cause severe indirect hyperbilirubinemia and anemia. The presence of large cephalohematomas, intraventricular hemorrhages, subcapsular hematomas of parenchymal organs, massive soft tissue hemorrhages in a child is accompanied by a characteristic clinical picture.

Obstructive jaundice is characterized by the accumulation of direct (bound) bilirubin in the blood, which is accompanied by jaundice with a greenish tint, an increase in the size of the liver, a change in stool color (discoloration) and urine (an increase in color intensity).

Syndrome of thickening of bile in newborns develops as a complication of hemolytic disease in newborns with extensive cephalohematomas, as well as those who have undergone asphyxia during childbirth. At the same time, an increase in the intensity of jaundice is noted from the end of the first week of life, accompanied by an increase in the size of the liver, sometimes significant, and partial discoloration of the stool. Treatment consists in the use of choleretics and cholekinetics.

In addition, bile thickening syndrome can be one of the earliest clinical manifestations of cystic fibrosis, especially if it is combined with meconium ileus or lesions of the bronchopulmonary system. In this case, the determination of the albumin content in meconium, an ultrasound examination (ultrasound) of the pancreas, and a sweat test contribute to the correct diagnosis.

The cause of obstructive jaundice in the neonatal period can be malformations of the biliary tract: intra- and extrahepatic atresia of the biliary tract, polycystic, twisting and kinking of the gallbladder, arteriohepatic dysplasia, Alagill's syndrome, syndromic decrease in the number of interlobular bile ducts.

With atresia of the biliary tract, the first sign of a malformation is jaundice, which is persistently growing, accompanied by itching of the skin, which makes children very restless and irritable. The size and density of the liver gradually increase, the nature of the stool changes: it becomes partially or completely discolored. The phenomena of cholestasis lead to malabsorption of fats and fat-soluble vitamins, hypotrophy and hypovitaminosis increase. At the age of 4-6 months, signs of portal hypertension and hemorrhagic syndrome appear. Without surgery, such patients die before the age of 1-2 years. A biochemical blood test reveals the presence of hypoproteinemia, hypoalbuminemia, an increase in direct bilirubin, alkaline phosphatase.

In the syndrome of tubular hypoplasia of the biliary tract (Aladgill's syndrome), inherited in an autosomal recessive manner, other malformations are also determined: hypoplasia or stenosis of the pulmonary artery, anomalies of the vertebral arches, kidneys. Stigmas of dysembryogenesis are characteristic: hypertelorism, protruding forehead, deep-set eyes, micrognathia.

Familial forms of cholestasis are known, manifested in the neonatal period. In McElfresh syndrome, discolored stools are present for a long period of time, up to several months. In the future, there are no deviations in the child's condition. In Beler's syndrome, on the contrary, after an episode of cholestasis in the first months of life, biliary cirrhosis of the liver develops.

Obstructive jaundice can be caused by compression of the bile ducts from the outside by a tumor, infiltrates and other formations of the abdominal cavity. Obstruction of the common bile duct is often noted in congenital cholelithiasis.

A group of hereditary defects in the excretion of bound bilirubin is distinguished. These include Dubin-Johnson syndrome, caused by a "breakdown" of the canalicular transport system. The syndrome is inherited in an autosomal recessive manner, accompanied by a moderate increase in the level of direct bilirubin, a slight increase in liver size, massive excretion of coproporphyrins in the urine. In liver biopsies, a brown-black pigment similar to melanin is deposited. Rotor syndrome is also inherited in an autosomal recessive manner, but this syndrome is based on a defect in the capture and accumulation of organic anions by liver cells. The clinical picture is similar to that of Dubin-Johnson syndrome. There is no pigment deposition in liver cells.

An ultrasound of the liver, radioisotope scanning, percutaneous liver biopsy, cholangiography, etc., help to make the correct diagnosis in cholestasis syndrome during the neonatal period.

Parenchymal jaundice is caused by an inflammatory lesion of the liver parenchyma. The cause of the lesion can be viruses, bacteria and protozoa: hepatitis B and C virus, cytomegalovirus, coxsackie, rubella, Epstein-Barr, herpes simplex virus, treponema pallidum, toxoplasma, etc. The septic process in a newborn can be accompanied by direct bacterial liver damage.

The clinical picture of parenchymal jaundice includes a number of general and strictly specific signs: children are often born premature or immature, with intrauterine growth retardation, low birth weight, have signs of damage to several organs and systems, as a result of which their condition at birth is regarded as extremely difficult. Jaundice is present at birth and has a grayish, "dirty" hue, against the background of severe microcirculation disorders, often with manifestations of cutaneous hemorrhagic syndrome. Hepatosplenomegaly is characteristic. In the study of biochemical analysis of blood serum, both direct and indirect fractions of bilirubin, increased activity (10-100 times) of liver transaminases, an increase in alkaline phosphatase, glutamate dehydrogenase are detected. The Eberlein method indicates serious disorders in the conjugation mechanisms of the hepatic cell - the overwhelming amount of direct bilirubin is represented by the monoglucuronidbilirubin fraction. A complete blood count often reveals anemia, reticulocytosis, thrombocytopenia, leukocytosis, or leukopenia. In the coagulogram - the deficiency of the plasma link of hemostasis, fibrinogen. To establish the causative agent of the infectious process, it is identified by polymerase chain reaction (PCR), the titers of specific immunoglobulin M and immunoglobulin G are determined. Treatment consists in the appointment of specific antibacterial, antiviral and immunocorrective therapy.

Summarizing the above, we note that diagnostic measures for neonatal jaundice should take into account a number of provisions.

• When collecting anamnesis, it is necessary to pay attention to the possible family nature of the disease: cases of lingering jaundice, anemia, splenectomy in parents or relatives matter.
• Anamnesis on the part of the mother must necessarily contain information about the blood group and Rh factor in her and the child's father, the presence of previous pregnancies and childbirth, operations, injuries, blood transfusions without taking into account the Rh factor. In a woman during pregnancy, impaired glucose tolerance, diabetes mellitus, and an infectious process can be detected. It is also necessary to find out whether the woman has taken drugs that affect bilirubin metabolism.
• Anamnesis of a newborn includes determination of gestational age, weight-growth indicators, Apgar scores at birth, clarification of the nature of feeding (artificial or natural), the time of appearance of icteric staining of the skin.
• A physical examination helps to determine the shade of jaundice, to establish an approximate level of bilirubin using an icterometer. The presence of cephalohematomas or extensive ecchymosis, hemorrhagic manifestations, edema syndrome, hepatosplenomegaly is determined. Attention should be paid to the nature of the color of urine and stool. An important diagnostic point is the correct interpretation of the neurological status of the child.
• Laboratory methods include a clinical blood test with the determination of hematocrit, a peripheral blood smear (necessary to diagnose violations of the shape and size of erythrocytes), determination of the blood group and Rh factor in mother and child (allows to establish the cause of hemolytic disease of newborns).

In addition, conducting a direct and indirect Coombs test will suggest whether there is an incompatibility between the blood of the mother and the child for rare factors.

A biochemical blood test (determination of total bilirubin and its fractions, the level of liver transaminases, alkaline phosphatase, the concentration of total protein, albumin, glucose, urea and creatinine, cholesterol and triglycerides, C-reactive protein, thymol test, etc.) allows not only diagnose the type of jaundice, but also collect data on the state of other organs and systems, which are of great importance in prescribing radical methods of treatment (for example, it is very important to have an idea of ​​the initial function of the kidneys before performing a replacement blood transfusion, since one of the complications of this operation is acute renal failure).

The Eberlein method (determination of direct bilirubin fractions - mono- and diglucuronidbilirubin) is important in the differential diagnosis of mechanical and parenchymal jaundice.

It is also necessary to conduct tests to identify an infectious agent in the blood, the stage of the disease (PCR, enzyme-linked immunosorbent assay, determination of the amount and type of immunoglobulins, determination of the avidity and affinity of antibodies, Wasserman reaction, etc.).

Determination of the profile of thyroid hormones is carried out when hypothyroidism is suspected.

Osmotic resistance of erythrocytes, hemoglobin electrophoresis, screening tests for the determination of glucose-6-phosphate dehydrogenase are carried out in order to clarify the cause of hereditary hemolytic anemias.

A sweat test for suspected cystic fibrosis is performed in children over 1 month of age; in the early neonatal period, it is possible to practice the determination of the albumin content in meconium.

Analyzes also include determination of the content of a-1-antitrypsin in blood serum, ultrasound of the brain, internal organs of the abdominal cavity.

X-ray method, computed tomography are performed in case of suspicion of intestinal obstruction, intracranial hemorrhage, fibroesophagogastroduodenoscopy - if pyloric stenosis is suspected. Percutaneous liver biopsy is performed in controversial cases in order to verify the diagnosis.

Before starting treatment, it is necessary to determine the method of feeding the newborn: breastfeeding is not allowed in hemolytic disease of newborns, galactosemia, tyrosinemia.

Treatment of hyperbilirubinemia

Consider the main methods of treating hyperbilirubinemia.

• Phototherapy at the present stage is the most effective method of treating indirect hyperbilirubinemia. The essence of the action of phototherapy is the photoisomerization of indirect bilirubin, that is, its transformation into a water-soluble form. Currently, there are several types of blue light lamps, with a wavelength of 410-460 nm, allowing you to choose the necessary treatment regimen (continuous, intermittent). Modern fiber-optic devices Biliblanket are devoid of almost all side effects, are compact, do not disrupt the normal routine of the child and his communication with the mother. Phototherapy is started when there is a threat of bilirubin growth to a toxic level. Lamps are placed at a distance of 20-40 cm from the level of the child's skin, the radiation power should be at least 5-9 nW / cm 2 / nm. Phototherapy is performed continuously and can only be interrupted during breastfeeding and mother visits. The eyes and external genitals of the child are closed with an opaque cloth. If phototherapy is used in a newborn with direct hyperbilirubinemia, a discoloration of the skin can be observed - the "bronze child" syndrome. Complications of phototherapy include skin burns, lactose intolerance, hemolysis, dehydration, hyperthermia, and sunburn. When carrying out phototherapy, measures are required to maintain a constant water balance in the newborn.
• Infusion therapy is used to prevent water imbalance during phototherapy using lamps with undifferentiated light; while the physiological need for fluid increases by 0.5-1.0 ml / kg / h. The basis of infusion therapy is glucose solutions, to which membrane stabilizers are added (in order to reduce the processes of peroxidation), electrolytes, soda (if necessary, correct them), cardiotrophics and drugs that improve microcirculation. To accelerate the excretion of bilirubin from the body, the forced diuresis technique is sometimes used. It is possible to introduce albumin solutions into the infusion therapy regimen at a dose of 1 g / kg per day.
• The feasibility of using inducers of microsomal liver enzymes (phenobarbital, zixorin, benzonal) is explained by the ability of the latter to increase the ligandin content in liver cells and the activity of glucuronyl transferase. These inductors are used in violation of conjugation processes. Phenobarbital is used at a dose of 5 mg / kg per day, the course of treatment should not exceed 4-6 days. A possible scheme for the use of phenobarbital, in which high loading doses are used - 20-30 mg / kg on the first day, then 5 mg / kg on the next, however, high doses of phenobarbital have a strong sedative effect and can cause respiratory distress, apnea in a newborn.
• Enterosorbents (smecta, polyphepan, enterosgel, cholestyramine, agar-agar, etc.) are included in therapy in order to interrupt the hepatic-intestinal circulation of bilirubin. However, they do not significantly affect serum bilirubin levels. Nevertheless, given the absence of the toxic effect of these drugs, they can be used in the treatment of hyperbilirubinemia, but only as an auxiliary method.
• Synthetic metalloporphyrins have previously been widely used in the treatment of indirect hyperbilirubinemia. Their mechanism of action is based on competitive inhibition of heme oxygenase, leading to a decrease in bilirubin production. Currently, these drugs are not used in the treatment of neonatal jaundice, since the phototoxic effect of tin-protoporphyrin IX was noted.
• Replacement blood transfusion is carried out with the ineffectiveness of conservative methods of therapy, a progressive increase in the level of bilirubin, in the presence of absolute indications, that is, when there is a threat of nuclear jaundice. Replacement blood transfusion is performed in the volume of two volumes of circulating blood, which allows replacing up to 85% of circulating erythrocytes and reducing the level of bilirubin by 2 times. The indications for this procedure are currently: edematous-anemic form of hemolytic disease of newborns, when transfusion is performed in the first 2 hours of life; the level of indirect bilirubin of the umbilical cord blood is higher than 60 μmol / l; the hemoglobin level of the umbilical cord blood is below 140 g / l; hourly increase in bilirubin above 6 μmol / l; hourly increase in bilirubin above 8.5 μmol / l with a drop in hemoglobin below 130 g / l; the presence of progressive anemia; the excess of bilirubin in the next day is above 340 μmol / l.
• Of choleretics and cholekinetics - with the phenomena of cholestasis (with the exception of atresia of the extrahepatic bile ducts and impaired synthesis of bile acids due to fermentopathy), magnesium sulfate, allochol can be used, however, at present, the preference is given to the drug ursodeoxycholic acid - ursofalk, which is produced in the form of a suspension, differs in ease dosage for newborns, is characterized by a rapid and distinct therapeutic effect. The initial therapeutic dose is 15-20 mg / kg per day. In case of insufficient effectiveness, the dose can be increased to 30-40 mg / kg per day. For long-term treatment, a maintenance dose of 10 mg / kg per day is used.
• Correction of fat-soluble vitamins is carried out with hypoplasia and atresia of the biliary tract and long-standing phenomena of cholestasis in the preoperative period. Vitamin D 3 - 30,000 IU intramuscularly once a month or 5,000-8,000 IU inside daily. Vitamin A - 25,000-50,000 IU intramuscularly once a month or 5,000-20,000 IU inside once a day. Vitamin E - 10 mg / kg intramuscularly; 25 IU / kg per day by mouth 1 time in 2 weeks. Vitamin K - 1 mg / kg once every 1-2 weeks.
• Correction of microelements: calcium - 50 mg / kg per day orally, phosphorus - 25 mg / kg per day orally, zinc sulfate - 1 mg / kg orally per day.
• An increase in protein and caloric load in such children is necessary to ensure normal growth and development, in addition, medium-chain triglycerides should be present in the diet. The need for such newborns for proteins is 2.5-3 g / kg, fats - 8 g / kg, carbohydrates - 15-20 g / kg, calories - 150 kcal / kg (60% - carbohydrates, 40% - fats).
• In Alagill's syndrome, non-syndromic form of intrahepatic bile duct hypoplasia, perinatal sclerosing cholangitis, there are no methods of etiopathogenetic treatment. The formation of liver cirrhosis during these processes is an indication for liver transplantation.
• Extrahepatic causes of the development of cholestasis syndrome are an indication for removing the cause of cholestasis or performing an operation according to Kasai, followed by prevention of the development of infectious processes and sclerotic changes in the bile ducts. Anti-inflammatory therapy includes the appointment of high doses of intravenous prednisolone during the first week after surgery (10> 2 mg / kg per day), then 2 mg / kg / day by mouth for 1-3 months.
• With hyperbilirubinemia caused by metabolic disorders, conservative methods of treatment are most often resorted to. For galactosemia, a diet free of galactose and lactose is used. In the first year of life, medicinal mixtures are used: NAN lactose-free, Nutramigen, Preregimil and other lactose-free mixtures. With tyrosinemia, a diet that does not contain tyrosine, methionine and phenylalanyl is prescribed (lofenolac, XP Analog, XP Analog LCP, Afenilak, Phenyl-Free, Tetrafen 40, etc.). In recent years, an inhibitor of the enzyme 4-hydroxyphenylpyruvate dioxygenase, nitisinone, is also used, which is prescribed at the rate of 1 mg / kg / day, orally. With fructosemia, it is necessary to exclude from the diet foods containing fructose, sucrose and maltose. Prescribed drugs that compensate for the lack of bile acids - cholic and deoxycholic at the rate of 10 mg / kg / day.
• With enzyme replacement therapy, Creon 10,000 is most often used, the dose of the drug is selected according to the insufficiency of the pancreas function, pancreatin - 1000 U of lipase / kg / day.

Literature

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2. Diseases of the fetus and newborn, congenital metabolic disorders / ed. R.E.Berman, V.K.Vogan. M .: Medicine, 1991.527 p.
3. Degtyarev DN, Ivanova AV, Sigova Yu. A. Crigler-Nayyar syndrome // Russian Bulletin of Perinatology and Pediatrics. 1998. No. 4. S. 44-48.
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L. A. Anastasevich, Candidate of Medical Sciences
L. V. Simonova, Candidate of Medical Sciences
Russian State Medical University, Moscow

Jaundice is not a disease, but a symptom of a disease in newborns. Approximately 60% of full-term and 80% of premature babies turn yellow in the first days of life. Newborns can get jaundice in the first 24 hours after birth, and if he has health problems, then the period of symptoms is delayed for another three days.

In the future, lingering jaundice gives rise to the development of other serious diseases in the newborn, such as

• toxoplasmosis,
• rubella,
• herpes simplex.

Doctors carefully pay attention to the baby's navel, check the throat, do pharyngeal swabs, advise to do a urine test, check the level of platelets, they can even use a spinal tap, chest x-ray.

List of risks of developing jaundice:

• A newborn has a low birth weight, for example: Premature birth can cause jaundice.
• Breastfeeding is an 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 phototherapy.
• It is easiest to get sick on the first day after birth.
• Babies whose mothers have diabetes.
• Boys get sick more often than girls, as well as children from East Asia.
• People living at high altitudes.

Causes of jaundice in newborns

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

If left untreated, jaundice will lead to severe symptoms. In a healthy body, a substance (bilirubin) is produced in small quantities. Then it is "processed" in the liver, and through the hepatic and bile ducts it is excreted through the intestines. So, disruptions in the exchange of bilirubin can be at all stages.

With a rhesus conflict between mother and newborn, jaundice may occur. The mother has Rh minus, and the child's plus is a group conflict.

Types of jaundice disease

• Suprahepatic
• Hepatic,
• Subhepatic.

Suprahepatic jaundice in a newborn

In a newborn, erythrocytes in the blood are destroyed, as a result of which bilirubin accumulates. This picture is observed in hemolytic anemias, malaria, etc.

Hepatic jaundice in a baby

It is characterized by a violation of the metabolism of bilirubin directly in the liver of newborns. It is caused by some infectious diseases (mononucleosis, viral hepatitis), toxic liver damage (including drugs), cirrhosis and oncological processes.

Subhepatic jaundice in an infant

Physiological jaundice in newborns

It is associated with increased interruptions of erythrocytes and immature liver functions of the newborn. The jaundice develops within 2 or 3 days and begins to disappear by the end of the first week. You can be completely cured by the 10th day of illness.

What should be the norm of bilirubin in newborns?

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

Early neonatal jaundice in newborns

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

Causes of neonatal jaundice in a newborn

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

• Increased hemolysis due to hematoma.
• Maternal autoimmune hemolytic anemia: eg, lupus erythematosus.
• Crigler-Najar syndrome or Dubin-Johnson syndrome.
• Gilbert's syndrome.
• Neonatal jaundice appears on the face of a newborn. Over time, it progresses and spreads throughout the baby's body

Prolonged jaundice is considered if the newborn's disease does not go away for more than 14 days in term babies, and 21 days in premature babies.

The main causes of lingering jaundice are:

• An infection in a newborn - such as a urinary tract infection.
• Hypothyroidism, hypopituitarism.
• Galactosemia.
• A breastfed baby is doing well and the illness usually goes away by the sixth week, but sometimes drags on for an additional four months.
• Gastrointestinal (GI): biliary atresia, common bile duct cyst, neonatal hepatitis.

How to treat lingering jaundice

• Pay attention to the state of urine - pale or brown with a film means that the newborn baby has problems.
• Measure the rate of bilirubin.
• Complete FBC.
• You should also do a blood test for both the mother and the 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 the prophylactic anti-D immunoglobulin agent during pregnancy.
• Conduct a urine test.
• Make sure your doctor performs metabolic screening (including for congenital hypothyroidism).

Conjugation jaundice

Causes

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

Signs of jaundice

In most cases, going to a parent's physical examination pushes the yellowish color of the newborn's skin. A more serious form of jaundice may also include a symptom of unexplained sleepiness.

As a rule, measuring the norm of bilirubin in the blood is the only way to determine the jaundice. The newborn is tested on the second or third day without fail. After the first test, even if the results are negative, parents should always be on the alert and visit the doctor as soon as the first signs of jaundice are suspected.

Jaundice is more common in breastfed newborns than in those who eat 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 a newborn require immediate attention to avoid the effects 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 due to an increased level of bilirubin in the blood of the newborn. If the parents notice that the child's urine has become very pale or brown, has a pungent, unpleasant odor, especially often this can 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 the newborn and place under strong light, preferably natural. To determine jaundice for examination, doctors use the sclera, make smears and check the condition of the child's skin. Parents should not rely on visual inspection, as this will not determine the level of bilirubin in the baby's blood.

Jaundice and the norm of bilirubin

Use a transcutaneous bilirubinometer for newborns with gestational age of 5 weeks or more, or for babies within 24 hours of birth. If bilirubin meter readings show bilirubin levels above 250 μmol / L, additionally check the results by measuring the serum level.

Always use a serum measurement to determine bilirubin levels in newborns:

• In the first 24 hours of life.
• In infants less than 35 weeks of gestation.
• Always use infant serum measurement. This is one of the most versatile methods and is suitable for all ages.
• Do not use an icterometer.
• If there are no visible signs of jaundice, normal testing should not be started.

Jaundice treatment

The newborn needs to increase its fluid intake. The disease usually resolves naturally without medication, but IVs can be used in severe cases. If you are not breastfeeding, seek help from your pediatrician, nurse, or lactation specialist. Breast milk is ideal for feeding your baby.

Phototherapy

The indications and use of phototherapy for jaundice varies 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 onset of jaundice. It is in such cases that it will have the greatest effect on the newborn.

The earlier the baby 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 a lower bilirubin concentration in the blood and can affect metabolism and cause the risk of neurodevelopmental disorders.

Essential care includes maximizing skin exposure, protecting the newborn's eyes, maintaining proper thermoregulation and hydration.

Jaundice treatment with LEDs

Light sources in phototherapy effectively reduce neonatal serum bilirubin levels, which are similar to conventional light such as compact fluorescent lamp (CFL) or halogen.

The main complications of phototherapy are separation from the mother, dehydration (fluid intake must be increased), and loose stools. It is usually not performed in cases of hyperbilirubinemia, as this method cannot cure a newborn with very severe forms of jaundice.

Exchange transfusion of blood through arteries, umbilical cords or veins; signs of jaundice depend on the clinical condition (children with health problems are given 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 the use of exchange transfusions twice (a double estimate of the total blood volume removed and replaced) for treatment.

How to treat jaundice in newborns

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

Not placing a newborn in direct sunlight is an unsafe way to treat jaundice. This method will help reduce the level of bilirubin, 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, he will get burns.

During an exchange transfusion:

• Don't use phototherapy.
• It is best to do the entire transfusion in one go.
• Use albumin.
• Administer intravenous calcium regularly.

After exchange transfusion:

• It is possible and even necessary to continue the phototherapy sessions.
• Measure serum bilirubin levels within two hours of transfusion and compare the results based on the rates 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 the moment of complete recovery.

If the jaundice lasts more than 3 weeks, you should consult a doctor. Follow the advice of experts and remember that the level is over 290 μmol / L. indicates serious liver disease of the newborn.

The beautiful and long-awaited baby, who was born, suddenly turned yellow. On the third day after giving birth, just in time for the discharge, which the whole family was waiting for, the baby acquired an unusual orange blossom, once and for all crossed out the mother's dreams of a beautiful photo session with the newborn. Anxiety has replaced joyful thoughts - what kind of jaundice is this and how is it dangerous? These questions are answered by the well-known pediatrician, TV presenter and author of books and articles on children's health, respected by millions of mothers, Yevgeny Komarovsky.

What happened?

Jaundice in newborns is a fairly common occurrence; it is observed in 50-60% of full-term babies and 80% of premature babies. Treat it as a disease is not worth it. The skin of the child turns yellow for completely physiological reasons. The fetal hemoglobin in the baby's blood (which was natural for him during pregnancy) changes to normal human hemoglobin A. The baby adapts to the environment. Its enzyme system is immature, as is the liver. It is this organ that is responsible for the excretion of bilirubin, which is formed in all people during the breakdown of erythrocytes. These blood cells are constantly being renewed, hence the need to "utilize" aging cells.

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

The enzyme system is improving pretty quickly. As the liver, receiving the necessary enzymes, begins to work at full strength, bilirubin begins to leave the body, the skin brightens, first acquiring a peach hue, and then returning to its normal color. Usually this process is completely completed by 7-10 days of life, thus, after discharge in 4-5 days, less often in a week, the jaundice should completely disappear. Prolonged neonatal jaundice can be observed in premature babies, but doctors try to carry out their treatment and observation in a hospital environment.

Another type of harmless jaundice is breastfeeding jaundice. According to Komarovsky, there are special substances in breast milk that slow down the binding of bilirubin in the liver. This situation is normal, requiring no treatment, and even more so the abolition of breastfeeding and the transfer of the baby to nutrition with adapted formulas.

How to treat?

Since the process is natural, Evgeny Komarovsky advises mothers to calm down and not bother 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 way to somewhat speed up the process of normalizing a child's skin color is phototherapy. To do this, use a "blue" lamp, which illuminates the skin of the child. As a result, the pigment bilirubin, under the influence of rays, breaks down into substances that the body of a newborn is quite capable of excreting with urine and feces.

Komarovsky advises using ordinary "white" lamps at home, if there are no LED ones, since any bright light neutralizes the toxicity of bilirubin.

Another effective cure for jaundice is created by nature itself - mother's breast milk. It contains natural substances to enhance the immune defenses of the child. Therefore, the sooner the baby is attached to the breast, the more often he will be fed with breast milk, the faster and easier his body will cope with physiological jaundice. Feeding such children is a special story. As a rule, crumbs with increased bilirubin are characterized by increased drowsiness and may skip feeding. It is important to make sure that the baby eats on time, wakes him up if necessary, but in no case overfeeds.

Walking with such a baby will also have a healing effect. It needs to be taken outside more often so that the child has contact with indirect sunlight. If the weather and season permits, a child with jaundice should spend most of the day outdoors in total.

Pathological situations

Abnormal is a condition in which a child, after birth, begins a massive disintegration of erythrocytes, not only aging and in need of replacement, but also quite healthy. The level of bilirubin 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 group, Rh factor, are different from those of the mother. If an immunological conflict occurs, the mother's immunity develops 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 the toxic effect of bilirubin on the body and all its systems. In the case of a rapid and severe hemolytic disease, death can occur.

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

There are other reasons for the appearance of jaundice, 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 severe bleeding in a woman. With 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 its enzyme system are underdeveloped due to the fact that the fetus suffered during pregnancy against the background of mom's diabetes.
• Genetic (hereditary) liver malformations. These are some types of genetic syndromes in which structural genetic errors have arisen at the level of organ laying in the fetus.
• Intrauterine infections. Some infectious diseases that the mother suffered during pregnancy can cause pathologies in the development of the fetal liver.

Treatment of pathological jaundice

Pathological jaundice does not go away in 7-8 days, it usually has a protracted character. Each type of jaundice requires a mandatory additional examination to find the true cause, after which adequate treatment is prescribed - conservative or surgical.

Quite often, in the treatment of pathological types of jaundice, children are prescribed such a serious drug as Phenobarbital. Yevgeny Komarovsky says that there is nothing unusual in this, this drug really has the ability to activate enzymes that accelerate the binding of bilirubin in the liver. However, nowhere in the world is this medication used to treat young children, since the side effect that Phenobarbital has on the child's nervous system is so destructive that its other properties are no longer relevant. Modern medicine has established for certain that the use of "Phenobarbital" at an early age always leads to a decrease in intelligence, the ability to learn at an older age.

Doctor Komarovsky's advice

With physiological (normal) jaundice in a newborn, it must be given water to drink. Glucose is very useful for crumbs.

The presence of physiological jaundice of a newborn is not a contraindication to vaccination against hepatitis. To refuse vaccination just because the baby is yellow is not worth it, says Yevgeny Komarovsky. With pathological jaundice, the risk of getting hepatitis increases significantly, and therefore Komarovsky considers vaccination even more necessary and useful.

It is not the parents, but the doctors, who should decide whether a child's jaundice is normal or pathological. Komarovsky urges in all cases when the baby's skin has changed color to yellow of varying intensity, be sure to visit a doctor.

You can watch the following video for more information on the bile of newborns.

Jaundice is a pathological symptom that manifests itself in the form of staining of the skin and sclera of the eyes in a yellow color of varying intensity.

Jaundice in newborns is considered a borderline physiological condition and does not require therapy. But today, more and more often in children during the neonatal period, there are other types of jaundice (intrauterine infection, hemolytic disease and obstructive jaundice) or there is a protracted course of physiological jaundice. Therefore, parents need to know the causes of this pathological symptom and how to treat jaundice in newborns.

The most effective methods of therapy at home are light therapy, proper nutrition for a nursing mother, prescribing hepatoprotectors (Galsten), sorbents (activated carbon and Smecta), bathing in herbal decoctions, glucose solution and rosehip decoction in the form of a drink.

Causes of jaundice

Physiological or postpartum jaundice occurs in newborns in the first days after birth - this is a normal condition associated with several reasons:

1. Breakdown of fetal hemoglobin.
2. The accumulation of bilirubin in the blood serum. This substance also stains the skin and visible mucous membranes yellow.

Often the following reasons have a negative effect on the course of jaundice in a newborn:

• persistent hormonal imbalance in the mother (increased levels of estrogen in the blood are transmitted through breast milk and the crumbs' body needs additional efforts to remove excess hormones);
• improper nutrition of a nursing mother;
• severe immaturity of the liver and biliary system.

Usually, the duration of jaundice is from 2 weeks to a month with a gradual decrease in the intensity of the icteric color of the skin in children.

Bilirubin accumulates in blood serum and is disinfected in the liver, therefore, a prolonged course is associated with immaturity of liver cells, impaired outflow of bile or reabsorption of disinfection products in the intestine.

A high concentration of bilirubin in the child's blood causes intoxication and the most dangerous and serious complication of this pathology is nuclear jaundice. The toxic effect of this substance on the neurons of the brain and the nucleus of the trunk and causes the development of persistent neurological pathology in children during the neonatal period. Therefore, with a protracted course of postpartum jaundice and the absence of positive dynamics within 14 days, it is imperative to determine the level of bilirubin in the blood and monitor the dynamics of its decrease in the future.

Other types of neonatal jaundice in children are no less dangerous:

• hemolytic disease of newborns associated with intrauterine breakdown of hemoglobin;
• intrauterine infections (TORCH-) - the cause is damage to liver cells;
• anomalies of the digestive tract with impaired outflow of bile (obstructive jaundice).

Treatment of both lingering neonatal and other pathological types of neonatal jaundice should be started immediately, immediately after determining the cause and clarifying the diagnosis with determining the level and dynamics of bilirubin. In this case, medications and folk remedies for jaundice are used. Also, a nursing mother should eat right - a diet for jaundice provides for the exclusion from the diet of foods that can negatively affect the disinfecting function of the baby's liver or cause digestive disorders.

Symptoms of jaundice in a newborn

On the third day, many mothers notice a change in the color of the skin and sclera of the newborn's eyes: the baby becomes unusually dark or the skin becomes icteric - these are the main symptoms of jaundice.

The intensity of the staining depends on the level of bilirubin (from 35 to 250 μmol / L) - the higher the level, the more serious the consequences for the baby's health.

The localization of the icteric staining of the child's skin is also important - the lower the yellowness (legs, feet, hands) goes down - the higher the level of bilirubin and the more serious its effect on the body.

If the baby, along with jaundice, develops other symptoms: anxiety, regurgitation or vomiting, lethargy, discoloration of urine (it becomes dark) or feces (bright yellow or green) - one can assume the toxic effect of bilirubin on all organs and systems of the child. When these signs appear, urgent and intensive treatment of the crumbs in the hospital is necessary, as well as dynamic monitoring of the baby's condition.

The symptoms of kernicterus are:

• increasing weakness, lethargy and drowsiness of the newborn;
• regurgitation and vomiting;
• extinction of the sucking reflex;
• tics, muscle twitching and seizures.

The appearance of these alarming manifestations in children requires an immediate visit to a specialist and urgent hospitalization of the child - treatment at home in this case is not carried out.

Basic principles of therapy for jaundice in newborns

Most children with jaundice are treated at home. Important and determining factors in this matter are:

• the baby's health status and pathological symptoms;
• causes of jaundice;
• the level of bilirubin and the dynamics of its decrease;
• the presence of background diseases.

The complex of therapeutic measures for the treatment of jaundice in newborns includes:

1. Full breastfeeding, but at the same time a diet must be followed for jaundice.
2. Phototherapy and sunbathing.
3. Mandatory walks in the fresh air with a newborn.
4. Medicines for jaundice: the use of sorbents (activated carbon, Smecta, Enterosgel), the appointment of hepatoprotectors (Galstena, Hofitol).
5. Treatment with folk remedies at home: bathing children in decoctions of herbs (calendula, chamomile), decoction of wild rose in the form of a drink, taking a glucose solution, which improves liver function.

The use of folk remedies for the treatment of jaundice

Prolonged physiological jaundice in newborns (except for difficult and severe cases) is treated at home.

At home, both mother and baby are more comfortable, and the crumbs recover faster. But the entire period of therapy should be monitored by the attending physician, who prescribes the treatment, notes the symptoms of this physiological state and their change during therapy, and corrects therapy in children with jaundice.

All means, both medications and alternative methods of treatment, must be agreed with a specialist.

Benefits of breastfeeding for neonatal jaundice

Proteins in breast milk bind toxic breakdown products of bilirubin, immunoglobulins - activate the body's resistance.

Also, natural feeding has a laxative effect, which stimulates the work of all organs of the digestive system.

Contraindication to breastfeeding with jaundice in children is only an immunological conflict between mother and child (according to blood group and Rh factor), when there is a possibility that through milk the baby will receive antibodies that aggravate the breakdown of hemoglobin and the active release of bilirubin. In all other cases, breast milk is the best home remedy for jaundice.

But a nursing mother must definitely eat right: a correct diet for jaundice is the key to the speedy and intensive elimination of bilirubin from the body.

It is necessary to exclude from the diet any foods that can cause digestive disruptions in the baby.:

• spicy and fatty foods;
• smoked meats;
• marinades;
• long-term storage products containing preservatives and dyes;
• allergens (citrus fruits, chocolate, red and orange fruits and vegetables, whole milk);
• food with a tendency to gas production (baked goods, sweets, grapes, carbonated drinks, strong tea and coffee);
• foods that can provoke stool retention.

Walking in the fresh air is considered an additional effective factor in treatment at home - this activates all metabolic processes in the baby's body, including the detoxification function of the liver.

Phototherapy

Light therapy or treatment with ultraviolet rays is an important element of the complex therapy for jaundice. This technique is used in specialized departments using special lamps of white or blue light, but it is also possible at home - sunbathing or renting an ultraviolet lamp. When using lamps, special bandages and fiber blankets are applied to the baby's eyes and body, and the course of treatment in most cases is 96 hours.

Ultraviolet rays accelerate the breakdown of bilirubin in tissues and stimulate its excretion from the body.

The baby receives natural ultraviolet light in the form of sunbathing - 15 - 20 minutes 2-3 times a day every day. This technique not only activates the binding of toxic decomposition products of hemoglobin, but is also considered an effective way of hardening a baby.

The use of sorbents for the treatment of jaundice

Bilirubin in a bound form is excreted in the stool - with a pronounced process of decomposition of hemoglobin, a change in the color of feces appears.

• In order for bilirubin to be removed from the intestines, a natural sorbent is used - activated carbon and drugs - Enterosgel or Smecta. The use of enterosorbents at home is possible only as directed by the attending physician, sometimes these funds can cause constipation or, conversely, loosening of the stool.
• Activated or white charcoal for a baby is used in a dose of no more than 1/4 of a tablet 2-3 times a day, after dissolving in a teaspoon of boiled water.

After starting to use these drugs, you need to monitor the condition of the crumbs. It should also be borne in mind that after taking activated carbon, inclusions of a dark color appear in the baby's stool, or the feces may be colored dark.

Rosehip decoction for the treatment of lingering jaundice

For the early removal of toxic products from the child's body at home, you can brew a rosehip decoction in a thermos in the form of a drink. To prepare a healing agent, you need to take a few dry rosehip berries (2-3), previously chopped, and pour a glass of boiling water. Insist in a thermos for 5-6 hours. Give a rosehip decoction to the baby in between feedings for 1-2 teaspoons. This remedy is prescribed with caution to children prone to allergic reactions.

Bathing in decoctions of medicinal herbs

Baths with decoctions of herbs (calendula or chamomile) improve blood circulation in the skin, have a calming and anti-inflammatory effect and accelerate the elimination of bilirubin from tissues.

To prepare a decoction at home, you need to take 200 grams of calendula or chamomile flowers in four liters of water, brew for 10 minutes and leave for 3-4 hours. This tool is used for daily bathing of the crumbs.

All these methods of therapy are considered auxiliary and are used only for prolonged course of neonatal jaundice. Therefore, parents should closely monitor the symptoms of this condition and immediately consult a specialist if signs of jaundice worsen.

Often, newly-made mothers, examining their newborn treasure, even in the maternity hospital notice the unusual yellowness of its skin. The pediatrician also pays attention to this.Jaundice of a newborn makes a young mother worry. Should I sound the alarm? Where does the yellowness come from? Why do babies turn yellow? Should it be treated and how?

Even in the maternity hospital, the mother may notice the yellowness of the child's skin and begin to worry. In most cases, baby jaundice does not bode well - this is a common physiological symptom.

Types of jaundice in newborns

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

First of all, mothers should know that the jaundice of newborns is of 2 types: 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 is stained 2-3 days after birth. Such jaundice in a newborn does not go beyond the normal range and usually disappears without a trace after a few days. In some children, the jaundice color of the skin is barely noticeable, in others it is quite pronounced. The degree of manifestation of jaundice depends on the rate at which bilirubin is produced, as well as on the ability of the small organism to excrete it. This type of jaundice also includes the so-called "breastfeeding jaundice". The general well-being of the child in this case does not suffer, urine and feces retain their natural color, the liver and spleen do not increase.

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 is the main sign of a physiological phenomenon. This condition passes in children without medical intervention and does not have any harmful consequences for the baby's body. The yellowness should begin to diminish already 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 feces are colorless, the urine is dark, but the bilirubin level does not exceed 115 μmol / l - this is not physiological jaundice. Most likely, there is a congenital pathology of the biliary tract. This condition of the child requires a thorough examination to make the correct diagnosis.

Pathological jaundice: how to quickly recognize the danger?

This type of jaundice requires the 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, a gradual poisoning of the body occurs (for more details in the article:). It is worthwhile to be wary if your baby has the following symptoms from the first days:

• darkening of urine and stool to an unnatural color;
• jaundice appears already in the first day of life;
• the baby is lethargic, inactive, does not suck well;
• high levels of 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 the large fontanelle (more in the article:);
• convulsive twitching;
• the baby cries monotonously;
• rolling eyes;
• violation of breathing until it stops.

A few days later, the symptoms of jaundice decrease, but it's too early to rejoice: in the future, formidable signs of cerebral palsy, hearing impairment, and mental and physical developmental delays develop. Pathological jaundice should be immediately treated in a specialized hospital.

Remember: the main symptom of this pathology is the early period of its manifestation! Baby's skin turns bright yellow almost immediately after birth.

Fortunately, pathological jaundice is rare. Such jaundice is diagnosed only in 5 out of 100 newborns. Parents should carefully observe 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?

During intrauterine life, the baby's tissues were supplied with oxygen by red blood cells (erythrocytes), but after birth the baby breathes on its 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 stains the skin of the newborn yellow (we recommend reading :). Bilirubin is excreted in feces and urine.

The baby's body is just learning to function correctly and is not yet able 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 liver of a newborn is still immature, in the first days of his life it does not have time to process all the bilirubin that is formed, therefore the pigment partially enters the bloodstream. It stains mucous membranes and skin yellow. When the child's liver grows up a little, it will more thoroughly process the bilirubin that enters it. As a rule, the liver begins to work fully by the 5th-6th day of the baby's life. From this point on, physiological jaundice gradually fades away and there is no reason for concern.

In some children, the adjustment of liver function is faster, in others it is slower. What determines the rate of excretion of bilirubin? A child has every chance of being "yellow-skinned" for a couple of weeks if:

• Mom is too young and has the highest bilirubin levels;
• diabetes mellitus in mom;
• he was born in a pair with a brother or twin sister;
• he was born prematurely - the liver of a premature baby is even more immature than that of babies born on time;
• mom experienced a lack of iodine during pregnancy;
• the mother did not eat well, smoked or was sick while carrying the baby;
• took some medications.

The birth of twins in some cases can cause jaundice: the liver of children is rather 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 formidable phenomenon occurs for the following reasons:

1. Incompatibility of the blood of the mother and the fetus for the Rh factor (hemolytic disease of the newborn). Currently, it is extremely rare, since all women with negative rhesus receive special preventive treatment from the 28th week of pregnancy.
2. Congenital diseases or underdevelopment of the baby's liver.
3. Genetic or hereditary abnormalities.
4. Congenital abnormalities of the circulatory system or intestines of the newborn.
5. Inappropriate antibiotic therapy.
6. Severe pregnancy of the mother, toxicosis, threat of termination.
7. Mechanical violation of the outflow of bile: blockage of the bile ducts by a tumor, narrowing of the bile ducts or their underdevelopment.

The norm of bilirubin for a newborn

How much bilirubin is in the blood is determined by a biochemical analysis. If the bilirubin level is higher than 58 μmol / l, then a noticeable yellowness 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 higher than 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 the normal content of bilirubin in the baby's blood can be found in the table:

If the yellowness of the skin of a baby against the background of breastfeeding does not go away even in the third week after birth, then doctors speak of "jaundice of breast milk." It is believed that the presence of breast milk in a baby's body increases the bilirubin content in his liver. In this case, the flowering of the jaundice falls on the 11-23th day of life. This condition passes very slowly, in many such children, the yellowness finally disappears by the third month, only sometimes by the second. In such cases, a thorough examination of the child for more serious causes of jaundice is recommended.

There is an opinion that during breastfeeding the level of bilirubin rises. For this reason, breastfeeding stops when the baby shows signs of jaundice, but current research has confirmed that breastfeeding is an important measure in treating newborn jaundice. Most of the yellow pigment is excreted from the baby's body in the feces. Breast milk has a mild laxative effect, which promotes the elimination of bilirubin and prevents the development of jaundice.

Indeed, an icteric skin tone is often seen in breastfeeding babies. However, there is a high probability 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 in the mother.

A slight yellowness of the baby's skin during breastfeeding should not bother the parents, but you still need to consult a doctor

There is no evidence that breast milk jaundice is causing any harm to your baby. If a baby who is only breastfeeding has a mild icteric skin tone, then this is not a problem and should not bother the parents.

Jaundice treatment

Treatment of a pathological process that can cause serious consequences should be carried out 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:

1. The main and main medicine is maternal colostrum, which has a laxative effect and helps to remove bilirubin from the newborn's blood.
2. Phototherapy is often prescribed. After exposure to a special lamp, bilirubin is excreted from the child's body after 10-11 hours.
3. 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 put the baby's crib closer to the window.
4. If the child has pronounced jaundice, more intensive treatment is needed. Usually doctors prescribe activated charcoal or "Smecta" inside (for 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 overwhelming majority of cases passes spontaneously. Pediatrician Yevgeny Komarovsky believes that the main thing is to monitor the symptoms. Let's hear what Komarovsky has to say about this phenomenon in the next video.