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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Diagnosis of neonatal jaundice ( differential diagnosis of jaundice in newborns)

Diagnostics neonatal jaundice primarily based on visual inspection. newborn, and then already on measuring the level of bilirubin in the blood. An important diagnostic value is the anamnesis of jaundice, that is, information about when it appeared and how it developed further.

The severity of jaundice in newborns can be determined by several criteria. Most often it is the level of bilirubin in the blood. This criterion is universal and helps to determine the threshold concentration of bilirubin, that is, the threat of kernicterus with brain damage. But sometimes a visual scale for assessing jaundice according to Kramer is also used.

The severity of neonatal jaundice according to the Cramer scale

Degree	Visible signs
*First degree*	Jaundice is observed only on the face and neck of the baby.
*Second degree*	Jaundice affects the face, neck, and upper torso ( to the navel).
*Third degree*	Not only the face and torso are painted yellow, but also the upper thighs ( to the knee).
*fourth degree*	Jaundice affects all parts of the child's body, with the exception of the palms and soles. There is a threat of bilirubin encephalopathy.
*fifth degree*	Total jaundice, in which the entire body of the baby is stained, including the palms and soles.

Bilirubin for neonatal jaundice

The concentration of bilirubin in the blood of a newborn child varies depending on the type of jaundice. So, with physiological jaundice, the level of bilirubin in the blood should not exceed 200 micromoles per liter.

Indicators of bilirubin in the blood of a newborn with physiological jaundice

Hours/days after birth

Indicators

First 24 hours after birth

119 micromoles per liter, the color of the skin is not changed.

48 hours after birth

The severity of jaundice by the amount of bilirubin in the blood

These figures are somewhat different in premature babies. This is explained by the immaturity of the basic functions of the liver and the body as a whole. So, it is important to remember that for premature babies, the critical level of bilirubin, at which there is a danger of nuclear jaundice, is lower than for full-term babies, and it is 250-270 micromoles per liter.

Examination for neonatal jaundice

Examination of a newborn baby with jaundice begins with a visual examination. As mentioned above, sometimes the severity of jaundice can be determined by the prevalence of icteric color. Normally, the face, neck and upper body are painted yellow. With prolonged jaundice, staining can fall below the navel and reach the knees. A dangerous sign is the yellow coloring of the palms and soles of the baby.

Next, the doctor proceeds to palpation of the liver and spleen. With hepatitis and some congenital anomalies of the liver, the liver enlarges, with hemolytic jaundice, the spleen enlarges. Outwardly, a child with physiological jaundice looks healthy - he is active, reacts to external stimuli, the sucking reflex is well expressed and he actively sucks at the breast. A child with nuclear jaundice is lethargic, poorly responsive to stimuli, refuses to eat.

Tests for neonatal jaundice

In addition to determining the level of bilirubin, other tests are carried out with pathological jaundice. As a rule, this is a general blood test and a general urine test, as well as liver tests.

Type of analysis	What does it show?
*General blood analysis*	anemia ( decrease in the number of red blood cells and hemoglobin) indicates intense destruction ( hemolysis) erythrocytes; decrease in the number of platelets; an increase in the number of young erythrocytes ( reticulocytes) - also speaks of the process of destruction of red blood cells. Indicates the hemolytic nature of jaundice.
*Blood chemistry*	increased amount of cholesterol; increase in all liver enzymes ( ALAT, ASAT, alkaline phosphatase) indicates stagnation of bile and that the cause of jaundice is a liver pathology; decreased protein levels hypoproteinemia) - also indicates problems with the liver.
*Coagulogram*	deficiency of fibrinogen and other coagulation factors - occurs due to a lack of vitamin K, which, in turn, is synthesized in the liver.
*Analysis of urine*	*The results depend on the type of jaundice:* with hemolytic jaundice- orange urine with hepatic and obstructive jaundice– urine becomes very dark, acquiring the color of beer.

Urine and feces for neonatal jaundice

A change in the color of urine and feces with jaundice is an important diagnostic criterion. This is explained by the fact that each type of jaundice is characterized by its own changes.

Characteristics of urine and feces in various types of jaundice

Treatment of jaundice in newborns

Treatment for neonatal jaundice depends on the type of jaundice. Physiological jaundice of newborns completely excludes treatment, since it is not a pathological condition. Premature jaundice in most cases requires only phototherapy. Blood transfusions, drips, and other invasive treatments are recommended in exceptional cases, such as when there is a risk of developing kernicterus.

Droppers for jaundice in newborns

Droppers are rarely prescribed for neonatal jaundice. They are recommended when the level of jaundice is close to critical. As a rule, droppers with glucose solution are prescribed. Glucose is the main building and nutritional material for the brain. Therefore, it is prescribed in order to eliminate the negative effect of bilirubin on the child's brain. Glucose solution is often combined with ascorbic acid ( vitamin C) . The volume of the injected solution is very individual and is calculated based on the body weight of the child.

Medicines for neonatal jaundice

With jaundice in newborns, drugs are used very rarely. As a rule, medicines from the group of sorbents, hepatoprotectors, as well as vitamins are prescribed.

Hepatoprotectors ( drugs that improve liver function) used in the treatment of jaundice

Drugs such as phenobarbital and pagluferal are prescribed only if jaundice is accompanied by convulsions ( sudden muscle contractions). The choice of one or another drug depends on the type of seizures and their etiology. Ursosan, like other drugs that help dissolve gallstones, are not prescribed to newborn children.

Electrophoresis for jaundice in newborns

Electrophoresis is not recommended or indicated for neonatal jaundice.

Blood transfusion for jaundice in newborns

Blood transfusion for neonatal jaundice is recommended when the disease is due to incompatibility in the Rh factor or blood type. And even then, blood transfusion is a last resort, and is resorted to when the concentration of bilirubin rises to 340 micromoles or more.
Blood transfusion ( scientifically, blood transfusion) is a procedure during which a whole infusion of blood or its components ( erythrocytes, platelets) into the vascular bed of the recipient. The recipient in this case is a newborn child.

Indications for blood transfusion in jaundice are:

the concentration of bilirubin is more than 340 - 400 micromoles per liter;
hourly increase in bilirubin more than 10 micromoles per liter;
anemia ( decrease in the number of red blood cells and hemoglobin) second - third degree;
signs of bilirubin encephalopathy ( nuclear jaundice) - the child becomes lethargic, refuses to eat.

For transfusion, “fresh” blood is used, that is, blood with a shelf life of no more than 3 days.

What sorbents are best for newborns with jaundice?

Sorbents are preparations that absorb toxins circulating in the body on their surface. In other words, these are medicines that cleanse the body of toxins and other harmful substances. Sorbents include drugs such as activated carbon, enterosgel, polysorb. Despite the apparent harmlessness, sorbents are recommended with caution for newborns. Newborn children suffering from jaundice can be prescribed enterosgel and polysorb.

Drops for jaundice in newborns

Drops - one of the forms of release of drugs. As already mentioned, medications are prescribed in exceptional cases for jaundice. Of the above drugs in the form of drops, Galsten is prescribed.

Treatment of jaundice in newborns at home

Treatment of jaundice in newborns is a series of activities that are carried out in order to speed up the process of excretion of a substance formed during the breakdown of hemoglobin ( bilirubin) and gives the skin a characteristic shade. At home, therapy can be carried out only in cases where the pathology is physiological in nature.

There are the following measures to treat jaundice in infants:

ensuring proper baby food;
correction of the diet of a nursing mother;
taking medications;
sunbathing.

Ensuring Proper Baby Nutrition
According to experts, some newborns may develop jaundice due to the fact that they do not receive breast milk in the required volume. The fact is that bilirubin, which is the cause of the characteristic shade of the skin and mucous membranes, is excreted from the child's body along with feces. Breast milk has a slight laxative effect and the baby's stool becomes more regular and plentiful. In addition, milk contains a large amount of substances necessary for the proper functioning of the liver, which also speeds up the process of removing bilirubin. Therefore, one of the main methods of combating jaundice in newborns is the full feeding of the child with mother's milk.

A woman should put her baby to her breast at least every 2 to 3 hours. It should be noted that jaundice can make babies more sleepy and lethargic, causing them to suck less actively at the breast, and as a result, not getting the required amount of nutrients. Also, the cause of poor sucking may be making mistakes in caring for a child or in organizing the process of breastfeeding. In order to provide a complete diet for a child in this state, the mother should consult a nutritionist.

In situations where breastfeeding is not possible, the choice of formula for feeding should be made carefully. It is important that such food does not provoke problems with the regularity of the stool, since in this case the course of jaundice is delayed. If the child is bottle-fed, the doctor may recommend giving him rosehip decoction to drink. This will restore the deficiency of vitamins and other nutrients.

Adjustment of the diet of a nursing mother
If a newborn with jaundice is breastfed, the mother must follow a special diet. This will reduce the load on the child's liver, which will contribute to a faster removal of bilirubin.

There are the following provisions of the diet of a nursing mother:

exclusion from the daily menu of fried foods;
refusal of spicy and excessively salty foods;
limited fat intake emphasis should be placed on vegetable fats);
controlled consumption of raw vegetables and fruits ( They are best boiled or baked.);
reduced consumption of refined products ( sugar, white wheat flour, instant cereals).

To ensure an adequate volume of breast milk, a nursing woman should include in the diet rich in dietary fiber ( fiber) products. A sufficient amount of fiber is found in vegetables and fruits, which, as mentioned above, should be subjected to heat treatment before consumption. Also, for the normal production of breast milk, you should eat cereals ( oatmeal, buckwheat), whole wheat bread. In addition to volume, a nursing woman should take care that the milk produced is of high quality. The quality indicators of breast milk increase foods high in protein ( squirrel).

There are the following protein products recommended for breastfeeding:

milk products ( cottage cheese, low-fat and mild cheese);
diet meat ( rabbit, turkey, chicken);
lean fish ( hake, cod, zander).

Taking medication
In cases where the course of jaundice differs in duration or is accompanied by intense staining of the skin, certain drugs may be prescribed to the newborn. Medicines are taken in order to improve the functioning of the intestines, liver and other organs that are directly or indirectly involved in the process of removing bilirubin.

There are the following groups of drugs that can be prescribed for infantile jaundice:

sorbents ( colon cleansers);
hepatoprotectors ( drugs that improve liver function);
homeopathic remedies ( drugs that have a complex beneficial effect);
appetite stimulants.

Sorbents
Sorbents act on the principle of a sponge, that is, when they enter the intestines, they “absorb” toxic substances, including bilirubin. The intake of such drugs allows you to accelerate the removal of bilirubin, which contributes to the speedy recovery of a small patient.

There are the following preparations with absorbent action:

Activated carbon;
enterosgel;
polysorb;

The optimal drug is selected based on the weight and general condition of the child, the intensity of the icteric shade and other factors. Therefore, only a doctor should prescribe a medicine and determine the scheme for its use.

Hepatoprotectors
One of the most commonly prescribed drugs for infantile jaundice from this group is ursofalk, which is made from an analogue of human bile. The medicine is available in the form of a suspension, which must be dissolved in breast milk or formula and given to the child at bedtime. Analogues of this remedy are drugs such as ursosan ( also in suspension) and ukrliv ( most commonly available in capsule form). The last two drugs are not recommended for children under a month old, that is, newborns.

Most often, these drugs do not cause side effects, but sometimes taking them can provoke an upset stool or an allergic reaction. In such cases, the drug is canceled.

Homeopathic preparations
Homeopathic medicines are made on the basis of natural herbal ingredients and are designed to normalize metabolism and improve the general condition of the child.

There are the following homeopathic remedies for infantile jaundice:

hofitol ( syrup based on extract of artichoke leaves);
hepel ( tablets based on celandine, cinchona and other herbal ingredients);
galstena ( drops containing milk thistle, dandelion).

Means for stimulating appetite
A common drug that is prescribed to improve children's appetite for jaundice is elcar. The product contains the substance L-carnitine, which improves metabolism. The medicine is available in the form of drops, which must be mixed with a glucose solution. It is necessary to give the child a drug to drink half an hour before he is fed.

sunbathing
Under the influence of sunlight, bilirubin is more rapidly destroyed and excreted from the body. Therefore, when treating physiological jaundice at home, the child should receive a sufficient amount of sunlight. If the weather is appropriate, it is recommended to walk with the child on the street more often, leaving the arms, legs, and face as open as possible. It is important to avoid direct exposure to the sun, as this can cause the child to get sunburned. If the weather outside does not allow for frequent walks, the newborn should be kept close to a source of natural light ( e.g. near a window).

Phototherapy for neonatal jaundice

Phototherapy is indicated for the physiological and pathological form of jaundice. The principle of treatment is that under the influence of light, bilirubin is destroyed, turning into a liquid form, which is excreted along with urine and feces. Light therapy requires special equipment and constant monitoring of the patient's condition. The best option is to carry out such treatment in a hospital setting, since the presence of medical personnel helps prevent possible complications. If for a number of reasons the child cannot be in the hospital for a long time, phototherapy can be carried out at home. To do this, you need to purchase the necessary equipment ( bought or rented) and consult your doctor about the rules for conducting phototherapy at home. An important condition for treatment is breastfeeding the child. With artificial feeding, in most cases, alternative methods of treatment are selected instead of phototherapy.

How is the procedure carried out?
Phototherapy in a medical institution is carried out using a special lamp that emits light, which is installed next to a transparent box ( couveuse). At home, a crib or changing table can be used instead of a couveuse. An undressed child is placed in a couveuse or a crib, protective bandages are put on the eyes and reproductive organs. The duration of the procedure is on average 2 hours. Then they pause for several hours, after which the session is repeated. In general, a child spends 12 to 16 hours a day under a lamp. With a high level of bilirubin, the sessions may be longer and the pauses shorter. During phototherapy, the child should be periodically turned over on his back, stomach, right and left side. You also need to take breaks for feeding. During treatment, the amount of fluid consumed by the child should be increased by 20 percent in order to avoid dehydration. Phototherapy is carried out for 3 to 5 days. If the level of bilirubin decreases before this period, treatment is stopped.

Contraindications and possible side effects of phototherapy
Light treatment is not carried out in cases where the child is diagnosed with serious disorders in the liver. Also, phototherapy is not prescribed for patients who have an obstructive ( mechanical) jaundice.

In some cases, phototherapy may be accompanied by side effects such as peeling and/or bronzed skin tone, increased drowsiness of the child, changes in the consistency and/or color of the stool. As a rule, after completion of therapy, these symptoms disappear on their own, without additional intervention. Sometimes phototherapy can trigger an allergic reaction in the form of hives. In such cases, treatment is canceled. Light exposure is also stopped if the child's feces darken, the skin turns very red due to burns or acquires a marbled hue.

Photo lamp ( phototherapy irradiator) to treat jaundice in newborns

Photo lamp ( also called phototherapy irradiator) is the equipment used to treat newborns with jaundice with light. Previously, such lamps were used only in a hospital, and for treatment it was necessary to go to the hospital. Today, photolamps can be purchased for private use, that is, at home. The cost of such a device is quite high, so the best option is to purchase a photo lamp for rent.

Phototherapy sessions at home should be carried out only after receiving a detailed consultation with a doctor. The doctor should conduct an examination of the patient to determine the presence of possible contraindications. Also, the doctor will establish the optimal scheme ( duration and number of sessions per day) carrying out phototherapy. In addition, the doctor will inform you about how to monitor the condition of a small patient during the use of a photo lamp.

What kind of photo lamps exist?
There are several types of irradiators for phototherapy. Appliances differ in several respects, among which the most important is the type of lamps used and the light they emit. To date, phototherapy devices can be equipped with LED, halogen or fluorescent lamps. Each type of lamp has its own characteristics. So, devices with fluorescent lamps have a higher power, halogen light sources have a more capacious service life. Devices with LED lamps, as a rule, are compact in size and consume less electrical energy. LED lamps are the best choice for phototherapy at home. The light emitted by the lamps can be blue, white and blue-white.

The second criterion by which photolamps differ is their design. Most devices consist of 3 parts.

There are the following structural elements of photolamps:

ceiling with lamps, the number of which depends on the model and type of the lamps themselves;
base, which is made in the form of a tripod or other stable structure;
a metal or plastic pipe that connects the ceiling and the base. The pipe is adjustable in height, which allows you to install the equipment at the optimal angle.

For professional use, equipment is larger in size compared to photo lamps that are designed for phototherapy at home.

Equipment parameters ( lamp power and other technical characteristics) may also differ. For professional use ( in medical institutions) devices with high power are used, for use at home there are less powerful, but more economical units. It should be clarified that the operational life of the lamps is not unlimited. Therefore, when renting equipment, you should check the lamp life, since if it is used up, phototherapy will not be useful.

Another criterion by which photolamps differ is their equipment and the availability of additional options. So, there are phototherapy irradiators, the design of which involves various timers to control temperature, session time and other factors. Some photo lamps are supplied complete with goggles for eye protection, a couveuse ( boxing) and other details that facilitate the operation of the equipment.

How to use the photo lamp?
If light therapy is carried out in a hospital, medical personnel are responsible for organizing the conditions for treatment. When treatment is carried out at home, you should follow the instructions that come with the equipment. It is also necessary to follow the recommendations of the doctor and a number of general rules for using the phototherapy unit.

There are the following general rules for using a photo lamp at home:

before starting the session, the surface of the lamps must be wiped with a dry cloth, since the presence of dust significantly reduces the effectiveness of the procedure;
the child should be undressed, and protective bandages should be applied to the eyes and groin area;
then the newborn should be placed in the incubator ( or a crib);
the photo lamp needs to be rolled up to the place where the child lies, and the ceiling can be raised to the required height;
then you should connect the unit to the power source and adjust the position of the ceiling with lamps at the required angle;
there is a ventilation hole on the body of the unit, and before starting a session, you should check if it is covered;
then you need to set the countdown timers and turn the toggle switch ( or press the button) to the "on" position.

Light nurse in the treatment of neonatal jaundice

"Svetonyanya" is a modern device for phototherapy, which is equipped with LED lamps that emit blue light. The equipment is more often used in inpatient departments, but can also be used to treat jaundice at home. The photo lamp of this brand belongs to the phototherapeutic irradiators of the latest generation. Thanks to a well-thought-out design and a large number of additional options, the equipment is characterized by long and safe operation.

Design features of the device
The design of the device includes 364 LEDs, which have a long service life. Despite the large number of lamps, the unit is lightweight and compact, which facilitates its operation, transportation and storage. "Svetonyanya" is equipped with two shades ( top and bottom), which ensures an even distribution of light. The design of the device allows you to disconnect the upper cover from the connecting post and install it, if necessary, immediately on the lid of the couveuse.

There are the following elements that are included in the package of the device "Svetonyanya":

plastic pitcher;
flannel envelope for a child with transparent inserts on the back and chest;
an electronic control unit that is mounted on a connecting pipe;
stand-alone sensor that controls lighting parameters.

The unit has a sound notification function, and at the end of the session, the device emits a signal. The cost of equipment depends on the configuration. So, the price of the new "Svetonyanya", equipped with only the top lamp, varies within 65,000 rubles. If the package also includes a lower lamp, the unit costs about 70,000 rubles. The cost of the device increases to 80,000 rubles if it is purchased together with the incubator.

Sun exposure for jaundice in newborns

Under the influence of sunlight, bilirubin is converted into a liquid form and excreted from the child's body. Therefore, doctors recommend sunbathing newborns who have jaundice. It should be clarified that the detrimental effect on bilirubin provides diffused light, and not direct sunlight, which can also cause skin burns. For this reason, during the procedures, the child's skin should be protected from direct exposure to the sun.

The principle of sunbathing is to provide the child with regular exposure to sunlight. In the warm season, a partially dressed or naked baby should be taken out to a balcony or other place where sunlight penetrates. During exposure to the sun, the child should be regularly turned from one side to the other. The duration of the procedure should vary from 10 to 15 minutes. On the day of such sessions, it is recommended to carry out from 3 to 4. Also, in the warm season, you should take walks in the fresh air, opening the hood of the stroller ( if he is) to allow light to enter.

In the cold season, sunbathing can be carried out indoors, near the window, since the action of light on bilirubin also spreads through the glass. At the same time, the glass barrier reduces the intensity of the light exposure, so the sessions should be longer. It is best to move the baby's crib to the window and leave it in it throughout the daylight hours.

Breastfeeding for neonatal jaundice

Breastfeeding is the main method of dealing with neonatal jaundice. Therefore, whenever possible, breastfeeding should not be stopped, even in cases where certain difficulties arise ( for example, a child undergoing phototherapy). Until recently, it was believed that in some cases breastfeeding promotes the growth of bilirubin, and many experts insisted on transferring the child to artificial nutrition. Recent research in this area refutes this version and confirms the fact that a newborn with jaundice should receive breast milk in sufficient quantities.

Feeding with jaundice of breast milk

Breastfeeding jaundice is a type of physiological jaundice in which a characteristic skin tone provokes mother's milk. The specific reason for such a reaction of the child's body has not been established to date. There are several theories for the development of breastfeeding jaundice. The most popular assumption among experts is the version that some fatty acids in human milk inhibit the excretion of bilirubin, and it accumulates in the child's body.

It used to be thought that breast milk jaundice was rare, occurring in only 1 to 2 percent of newborns. Newer observations show that the condition is diagnosed in one third of breastfed babies. This kind of jaundice can last up to three months of age and after that it disappears without a trace. It is not accompanied by complications, since with jaundice of mother's milk, a non-toxic form of bilirubin accumulates in the body.

Whether or not to breastfeed a baby with breastfeeding jaundice is a question that interests many mothers. If earlier the tactics of treatment consisted in transferring the child to artificial mixtures, today doctors recommend continuing to breastfeed.

In some cases, breastfeeding is stopped for a while ( from 24 to 72 hours). During this period, the amount of bilirubin in the child's body is significantly reduced, after which the child begins to breastfeed again. During the stop of breastfeeding, a small patient is transferred to artificial mixtures. A woman should express her breast milk so that there are no problems with its production.

How to feed a child with milk with jaundice?
First of all, it should be noted that breastfeeding should be started as early as possible. A significant amount of bilirubin is excreted in the first feces ( meconium), and colostrum ( milk produced after childbirth) has a laxative effect. Therefore, the baby should be attached to the breast as soon as possible after birth. Subsequently, the newborn is recommended to feed 8 - 10 times a day.

A breastfeeding mother must control whether the baby suckles the breast correctly, because otherwise the baby does not receive the required amount of nutrients. This recommendation is relevant for jaundice, because sometimes it provokes drowsiness or weakness in children, as a result of which they do not breastfeed properly. There are a number of signs by which a nursing woman can check the effectiveness of suckling.

There are the following signs of poor-quality sucking:

the child spits, is naughty while eating;
in addition to the sound of swallowing, the baby makes other sounds;
lips turned inward;
the child clicks his tongue;
after eating, the baby burps profusely.

To improve the feeding process, the mother needs to see a doctor who will recommend how to improve the baby's appetite. Also, the mother can help the newborn by following some rules when feeding. Before you start feeding the baby, if the breast is too tight, you need to pump. Then you should lightly squeeze the nipple with your fingers and put it in the baby's mouth. If the baby keeps his mouth closed, you can run the nipple along the lower lip, so his lips open slightly and it will be easier to insert the nipple into his mouth. After the baby takes the breast, you need to direct the nipple towards the sky. Light stimulation of the upper palate activates the natural swallowing reflex, and the baby will begin to suck.

It is possible to determine that a child eats well and with appetite by a number of signs. If the baby does not smack his lips during feeding, makes short pauses, during which you can hear that he is swallowing milk, then he eats well. With effective sucking, the child deeply grasps the nipple and rests his chin on the chest.

Should neonatal jaundice be treated?

The expediency of treating jaundice in newborns depends on what reason provoked the staining of the skin in yellow. A characteristic shade can be either a consequence of a simple physiological process or a sign of serious pathologies.

In the first case, with physiological jaundice, treatment comes down to organizing the correct diet for the child and mother ( if she is breastfeeding). It is also recommended to ensure regular contact of the child's skin with sunlight. Sometimes a newborn is shown phototherapy.

In the second case, with pathological jaundice, the newborn needs timely and adequate treatment. The nature of therapy depends on the cause of the disease, the characteristics and condition of the child. As a rule, children are prescribed drug treatment in combination with phototherapy. With a high concentration of toxic bilirubin, a blood transfusion may be indicated for a small patient. With obstructive jaundice, when the disease is caused by the pathology of the internal organs, the child is operated on.

The biggest danger in this disease in newborns is that the pathological form can be mistaken for physiological jaundice. The main difference between one type of jaundice from another, which parents are guided by, is the time during which the icteric shade persists. Physiological jaundice lasts only a few days, and pathological jaundice lasts much longer. This fact helps parents to consult a doctor in time. But there is a kind of physiological form ( breast milk jaundice), which continues for quite a long time. In this case, parents may mistake the symptoms of a dangerous disease for manifestations of breastfeeding jaundice. To exclude such a possibility, you should systematically take tests for bilirubin, as well as monitor the behavior of the newborn.

Newborn jaundice blanket

The Newborn Jaundice Blanket is a relatively new invention developed by 3 students. This device allows you to conduct phototherapy sessions at home, as it is lightweight, compact in size and easy to operate.

Phototherapy Blanket Features
Outwardly, this device looks like a mattress, to the outer surface of which a coverall is sewn like an envelope. From a technical point of view, this device is a 3-piece construction. The first element is a lamp that emits light. A coating of a special polymeric material is installed on top of the light source. An envelope is attached to the polymer, in which the child is placed during phototherapy. Since the light is supplied from below, sessions can be carried out without protective eye patches. The device also radiates heat, which helps to prevent hypothermia of the child. The mattress is installed in a crib, and built-in timers allow you to control the duration of the session. When using the phototherapy blanket, there is no need to pause for swaddling, as you can change diapers or diapers right on it.

The most common in this segment of equipment is the BiliBed system, which is manufactured by the Medela brand. Instead of an envelope, the kit includes a soft blanket that you can wrap your baby in if the room is cool. The lamps installed in this equipment must be changed after 1500 hours of use. The cost of renting the BiliBed system is approximately 1000 rubles per day.

Folk remedies for jaundice in newborns

Many mothers are interested in whether there are folk remedies to combat jaundice in newborns. On the Internet, you can find recipes for remedies based on various herbs that are recommended to treat a child. Some sources offer preparations based on vodka or alcohol, toxic plants and other components that should not be introduced into the diet of a newborn. Many body systems of a newborn baby are immature, and the use of such drugs can lead to negative consequences. Therefore, mothers should not attempt to treat their child with such drugs.

The only remedies that can be used for jaundice are decoctions made from wild rose or corn stigmas. You can drink such drinks to a child only after a medical consultation. Also, the physician will determine the system of use and dosage of these funds. The recommendations of the doctor are mandatory, since the uncontrolled use of such drugs can worsen the condition of the newborn.

Corn silk for jaundice

The use of corn stigmas for jaundice is based on the fact that they normalize the outflow of bile and increase the frequency of urination. As a result of the use of a decoction, the process of breakdown and removal of bilirubin is accelerated, and recovery occurs faster. Corn stigmas are indicated only for physiological jaundice, since in the presence of pathological processes, the decoction can aggravate the condition of the newborn. Corn stigmas reduce appetite, so do not give decoction to those children who do not eat well. It is also not recommended to use this remedy to treat jaundice in premature babies.

Rosehip for jaundice

Rosehip decoction helps to reduce the level of bilirubin, as due to the rich vitamin composition it improves the functioning of many internal organs. However, this remedy produces a pronounced diuretic effect, which can provoke a load on the kidneys. Therefore, doctors often advise drinking rosehip decoction to a nursing mother so that the child receives vitamins along with breast milk.

Mom's diet for jaundice in newborns

The organization of proper nutrition of a nursing mother is an important condition for the treatment of jaundice in a newborn. Mothers of children with both pathological and physiological jaundice should adhere to a special diet. A woman should eat foods that are easy to digest in order to reduce the burden on the liver and other digestive organs in a child. Also, a nursing mother needs to include in the diet products that contribute to the production of high-quality milk in sufficient volume.

There are the following diet rules for mom with jaundice in newborns:

The calorie content of the daily diet should be at least 3500 calories. The increased calorie content of the menu is due to the fact that the female body spends a lot of energy to produce milk. Calorie deficiency can reduce milk production, and malnutrition is a factor that exacerbates jaundice.
The intake of alcohol and the use of tobacco products during feeding not only slows down the recovery of the newborn, but also adversely affects the physical and mental development of the child.
A large amount of spices and / or spices in the food eaten changes the taste of milk, which may not be pleasant to the child. Also, a newborn may suck with less appetite or refuse milk altogether if a woman abuses foods that are high in salt.
Legumes and all types of cabbage provoke excessive gas formation and bloating in a child. This not only stops the withdrawal of bilirubin, but also adversely affects children's appetite.
Fast food products, as well as those that have an unnatural color, taste or aroma, contain a large amount of dyes, preservatives, flavorings. These substances increase the load on the child's liver, which prolongs the course of jaundice.

The menu of a woman who is breastfeeding a newborn with jaundice should contain fresh natural products. The diet should be varied and balanced so that the child receives all the necessary elements.

There are the following foods that are recommended for mothers of newborns with jaundice:

cereal dishes ( corn, oatmeal, buckwheat);
low fat meat chicken, turkey, rabbit);
baked or boiled vegetables ( pumpkin, zucchini, potatoes);
boiled fruits or compotes from them ( apples, white cherries, pears);
vegetable oil ( olive, sunflower);
dairy products ( cottage cheese, yogurt, slightly salted cheese).

Complications and consequences of neonatal jaundice

As has been noted more than once, the main danger of jaundice lies in the toxicity of bilirubin. Bilirubin is most toxic when it is in its free, unbound form. The highest concentration of such bilirubin is observed in hemolytic jaundice, that is, in jaundice caused by the breakdown of red blood cells.

Why is jaundice dangerous in newborns?

If a child is diagnosed with physiological jaundice, this condition rarely entails severe complications. Some children may become more moody, passive, sleepy. Also, in some cases, small patients lose their appetite. This condition complicates the therapy and care of the child, but does no harm, since physiological jaundice quickly passes.

Pathological jaundice can turn into serious negative consequences. Bilirubin, which accumulates in the internal organs and tissues over the course of the disease, is highly toxic and has a detrimental effect on the vital systems of the body.

The most dangerous complication of pathological jaundice is bilirubin encephalopathy. With a high concentration of toxic bilirubin, a large amount of this substance accumulates in the brain cells. As a result, metabolic processes are disturbed and brain cells do not receive proper nutrition. Gradually, damage to various parts of the brain develops, and the function of this organ begins to fade.
skin color acquires a greenish tint;

spots appear on the skin like bruises;

feces lose color, and urine becomes dark.

Is jaundice contagious in newborns?

Whether jaundice is contagious or not depends on the cause that caused the newborn's skin to turn yellow. With physiological jaundice, there is no likelihood of infection, since doctors do not classify this condition as a disease. In the case of pathological jaundice, the situation is different. The chance of contracting this disease depends on the factor that provoked it. Jaundice is transmitted if the cause of its occurrence is an infectious process, which can be either bacterial or viral.

There are the following causes of jaundice, which can be contracted from a newborn:

Botkin's disease hepatitis A);
other types of viral hepatitis;
Infectious mononucleosis ;
yellow fever ( type of viral infection);
leptospirosis ( type of bacterial infection).

Is it necessary to have jaundice in newborns?

Neonatal jaundice is common but not mandatory. Medical statistics indicate that yellow skin coloration occurs in 60 percent of children who were born at term. In preterm newborns, jaundice is diagnosed in 80 percent of cases. Among all cases of detected jaundice among newborns, approximately 65 percent are physiological jaundice.

Prevention of jaundice in newborns

Prevention of jaundice in newborns is the prevention of those conditions that caused its development. Thus, there are no specific measures to prevent jaundice. Instead, there are measures aimed at preventing intrauterine infections, prematurity, and reducing the risk of developing hemolytic disease of the newborn. It should be noted that all these measures are aimed at preventing those pathologies that cause pathological jaundice. Physiological jaundice, which appears on the 3rd day and lasts up to 10, does not require preventive measures.

Preventive measures for pathological jaundice in newborns include:

timely treatment of infections in the mother ( First of all, these are sexually transmitted infections.);
prevention of prematurity - timely hospitalization of pregnant women with the threat of premature birth;
prevention of hemolytic disease of the newborn.

Among the above measures, the prevention of hemolytic disease of the newborn deserves the most attention. This is a pathology that develops due to the incompatibility of the mother and fetus according to the Rh factor or blood type. It is accompanied by extensive destruction of the child's red blood cells, which leads to an increase in the concentration of toxic bilirubin and the development of anemia.

Measures to prevent hemolytic disease of the newborn include:

introduction to primiparous mothers of anti-Rh-globulin serum;
regular ultrasound monitoring ( ultrasound) for the condition of the fetus;
not to allow the pregnancy to last;
blood transfusion to a child at a bilirubin concentration of 400 micromoles per liter;
determination of the antibody titer in the child's blood.

Hepatitis vaccine for neonatal jaundice

In the mandatory vaccination calendar ( vaccines) for newborns, only one vaccination against hepatitis is recommended - this is a vaccination against hepatitis B. This vaccine is given in the first 24 hours after the birth of the child. Revaccination ( booster vaccinations) is carried out after 1, 3 and 6 months of life after the birth of a child. Physiological jaundice is not a contraindication for hepatitis vaccination. With pathological jaundice, the decision is made by the doctor based on the severity of the baby's condition.

Jaundice vaccine for newborns

There is no vaccination or vaccine for neonatal jaundice. The reason for this is the fact that neonatal jaundice can be of various etiologies. Therefore, it is impossible to simultaneously eliminate all the factors that contribute to its development. There are contraindications. Before use, you should consult with a specialist.

Newborn jaundice (neonatal jaundice). Causes, types, classification, symptoms and signs

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What is neonatal jaundice?

Newborn jaundice is a syndrome characterized by icteric discoloration of the skin newborns children. As a rule, when it comes to neonatal jaundice, its physiological form is understood. Physiological neonatal jaundice is a condition in which icteric staining is due to the conversion of fetal hemoglobin to normal hemoglobin. Thus, this phenomenon is not considered a pathology, but rather a transient one ( passing) state.

Physiological jaundice appears on the second - third day of life, is most pronounced on the fourth and disappears by the eighth day. If jaundice in a newborn child appears later or earlier than these terms, then we are talking about pathological jaundice of newborns.

Neonatal jaundice syndrome

It is customary to consider jaundice not as an independent pathology, but as a syndrome. A syndrome is a complex of symptoms that are characteristic of a particular disease. For example, anemic syndrome may be a manifestation of intestinal bleeding. This means that the decrease in the number of red blood cells does not occur by itself, but is a consequence of blood loss. If we talk about the syndrome of pathological jaundice, then it is a manifestation of the underlying disease, most often associated with the liver. So, jaundice is observed in hepatitis, congenital liver diseases.

Neonatal jaundice syndrome may occur with hemolytic disease of the newborn or infections. Thus, the term "syndrome" suggests that jaundice is only a manifestation of another, underlying disease.

If we talk about physiological jaundice, then it is customary to consider it not as a syndrome or an independent disease, but as a period of adaptation of the baby to new environmental conditions.

Causes of jaundice in newborns

The main cause of jaundice is an increased concentration of bilirubin in the blood of an infant. Bilirubin is a bile pigment that is formed from blood hemoglobin and other iron-containing proteins. Normally, the blood of both an adult and a newborn contains a certain amount of bilirubin. If the concentration of bilirubin rises, then the human skin acquires a yellowish tint. The higher the hemoglobin concentration, the more pronounced the icteric coloration of the skin.

The causes of jaundice, in the first place, depend on its type. So, there are several varieties of jaundice, each of which is characterized by its own causes.

Types of jaundice in newborns

Initially, neonatal jaundice is divided into two types - pathological and physiological. Physiological jaundice is the one that appears on the 2nd - 3rd day of the baby's life and completely disappears by the 8th - 10th day of life. This type of jaundice is characterized by a moderate increase in the concentration of bilirubin and the absence of other symptoms other than a change in skin color. Physiological jaundice does not require any special treatment and is no longer considered a pathology, but as a state of adaptation of a newborn child to new environmental conditions.

Pathological jaundice can appear both on the first day of a baby's life, and later. The difference between this type of jaundice is a higher concentration of bilirubin in the blood and a longer course. Pathological jaundice is manifested not only by yellowness of the skin, but also by other symptoms from the nervous system and the body as a whole.

Causes of physiological jaundice in newborns

In no case should physiological jaundice be considered as a pathological condition. This is just a state of adaptation of a newborn child to new environmental conditions. It is due to several factors.

Factors that cause physiological jaundice in newborns are as follows:

the transition of fetal hemoglobin to normal;
immaturity of the liver enzyme system in a newborn baby;
adaptation to new environmental conditions.

Fetal hemoglobin is the hemoglobin that is contained in the blood of the fetus during its intrauterine development. This hemoglobin has an increased affinity for oxygen. Thus, it ensures an adequate supply of oxygen to all organs and tissues. In the fetus, fetal hemoglobin accounts for about 85 percent, while the proportion of fetal hemoglobin in an adult is less than 1 percent. By the end of the third trimester, fetal hemoglobin gradually begins to be replaced by normal, "adult" hemoglobin. After the birth of a child, this process intensifies. However, due to the immaturity of the enzymatic systems, the decomposed fetal hemoglobin does not have time to quickly be eliminated from the body.

It must be understood that the process of disintegration of red blood cells and hemoglobin is characteristic not only for the newborn period. So, in an adult, the process of destruction of erythrocytes is continuously going on ( red blood cells live for about 120 days) with a further release of hemoglobin into the blood, from which bilirubin is formed. However, the liver manages to quickly utilize and remove it, as a result of which approximately the same concentration of bilirubin remains in the blood ( 17 micromoles per liter), and skin color remains unchanged. In newborn children, the liver does not have time to utilize all the bilirubin, as a result of which it lingers in the blood and its concentration increases.

An increased concentration of bilirubin gives the child's skin an icteric color. Soon the liver begins to function at full capacity and takes on the bilirubin load. At the same time, the concentration of bilirubin in the blood decreases, and the skin of the child takes on a natural color.

Causes of pathological jaundice in newborns

Pathological jaundice is jaundice that appears later or earlier than the established dates and that lasts more than 14 days. Also, pathological jaundice is characterized by a high level of bilirubin in the blood.

The criteria for pathological jaundice in newborns are:

the concentration of bilirubin is more than 220 micromoles per liter;
the level of bilirubin rises by 5 micromoles or more every hour;
daily increase in bilirubin more than 80 - 90 micromoles;
the appearance of jaundice in the first day after the birth of the baby;
the duration of jaundice exceeds two weeks.

There are a great many causes of pathological jaundice, and these causes can be due to both the pathology of the mother and the pathology of the baby.

The causes of pathological jaundice are:

hemolytic disease of the newborn;
an overdose of vitamin K;
diabetic fetopathy ( fetal damage due to maternal diabetes);
taking certain drugs;
hereditary pathologies of the liver.

Hemolytic disease of the newborn
Hemolytic disease of the newborn is a pathology that occurs when the blood type is incompatible for the Rh factor in the mother and child. The result of this is massive decay ( hemolysis) erythrocytes. As a result of this, the concentration of bilirubin in the blood of a newborn baby increases sharply ( hemoglobin is released from red blood cells, and bilirubin is formed from it). Bilirubin stains the skin and visible mucous membranes of the baby yellow.

Hemolytic disease of the newborn can present in several forms. The most common edematous ( the heaviest), anemic and icteric form of this disease. With hemolytic disease of the newborn, jaundice appears on the first or second day after the birth of the baby. Despite the fact that the icteric form of hemolytic disease is a mild variant of its manifestation, it can also pose a threat to the life of the baby.

Vitamin K overdose
Vitamin K ( the synthetic analogue of which is vikasol) is prescribed for the prevention and / or treatment of bleeding during childbirth. Vikasol is also prescribed for hereditary coagulopathy ( blood clotting disorders), hepatitis and other diseases. However, an overdose of this vitamin can lead to massive hemolysis ( destruction) erythrocytes. The consequence of this is an increase in the level of bilirubin and staining of the skin in yellow.

diabetic fetopathy
Diabetic fetopathy is a pathology that develops in newborns whose mothers suffer from diabetes. It should be noted that due to the recent increase in the incidence of diabetes mellitus ( only in Russia the incidence increased by 20 percent), this cause of neonatal jaundice is very relevant. With this pathology, there is a delay in the development of the enzyme system of the liver. This leads to the fact that the liver does not have time to cope and utilize all the bilirubin.

Taking certain medications
Certain medications taken by a pregnant woman such as antibiotics or glucocorticoids) can also cause neonatal jaundice. Most drugs cross the placental barrier, thus ending up inside the fetus. With the blood flow, they instantly penetrate the liver, where they inhibit enzymatic processes. If in a healthy child the liver does not have time to dispose of bilirubin within only a few days ( physiological jaundice lasts up to 14 days), then at birth in such children, the removal of bilirubin takes even longer. Jaundice lasts up to a month or more.

Hereditary pathologies of the liver
The greatest danger to the health of the baby are hereditary pathologies of the liver. They are characterized by various congenital "breakdowns" at the level of the liver enzyme system, which makes it impossible to utilize bilirubin. For example, in Gilbert's syndrome, due to a defect in the gene responsible for bilirubin metabolism, the intrahepatic transport of bilirubin and its binding to glucuronic acid are disrupted.

Hereditary liver pathologies that are accompanied by jaundice include:

Gilbert's syndrome- a chronic disease, which is characterized by periodic jaundice with a moderate increase in bilirubin in the blood. The prognosis of the disease is favorable.
Crigler-Najjar Syndrome- hereditary pathology of the liver, which is based on a deficiency or low activity of glucuronyl transferase. This is an enzyme that is involved in the metabolism of bilirubin in liver cells. When it is absent, the level of bilirubin rises 20 to 40 times higher than normal. With this syndrome, jaundice appears from the first day and is characterized by very high concentrations of bilirubin. The icteric discoloration of the skin is very intense. Crigler-Najjar syndrome is characterized by a malignant course, untimely medical care can lead to death.

Symptoms and signs of neonatal jaundice

The main visible sign of neonatal jaundice is icteric discoloration of the skin and visible mucous membranes ( sclera). The intensity of staining depends on the concentration of bilirubin in the blood of the baby. Color can vary from light lemon to bright orange. Sometimes the skin of a child can even acquire a greenish tint. Physiological neonatal jaundice does not affect the baby's hands and feet, and rarely stains the shins.

The main and integral laboratory sign of jaundice is a high concentration of bilirubin in the blood. In the first hours after birth, the concentration of bilirubin varies from 100 to 150 micromoles per liter. Jaundice is most pronounced on the 3rd - 4th day after birth, when the level of bilirubin rises to 180 - 200 micromoles per liter. Starting from the 6th day, the level of bilirubin begins to fall, and jaundice completely disappears by 8-10 days. Further development of the symptoms of jaundice in newborns depends on its form. So, if physiological jaundice is manifested only by staining of the skin, then its pathological form is manifested by a number of other signs.

Signs of pathological jaundice

As with physiological jaundice, the main visible sign of pathological is icteric coloration of the skin. However, in this case, icterus is visible on the palms and soles of the feet. In addition to yellowness of the skin, pathological jaundice is manifested by damage to the nervous system of the baby, a change in the color of urine and other symptoms.

Signs of pathological jaundice are:

damage to the nervous system;
change in the color of urine;
change in stool color most often discoloration);
lethargy of the baby or, conversely, loud restless crying;
enlargement of the liver and spleen;
restless sleep;
refusal to eat.

Bilirubin is, first of all, a toxic pigment that, at a certain concentration, penetrates the nervous system. Therefore, the main danger of jaundice is the toxic effect of bilirubin on the child's brain. Normally, there is a certain barrier between the nervous system and substances circulating in the blood. It's called the blood-brain barrier. Thanks to him, not all toxic substances immediately penetrate the brain. With physiological jaundice, due to the low concentration of bilirubin, the child's brain remains intact.

However, with pathological jaundice or with prematurity of the fetus, bilirubin penetrates the nervous system and affects the structures of the brain. The critical level of bilirubin in full-term children is considered to be a concentration of more than 340 micromoles per liter. With these indicators, damage to the nuclei of the brain occurs ( kernicterus). In premature babies, this figure is 220 - 250 micromoles per liter. This is explained by the fact that in premature babies, the nervous system is more vulnerable, and a much lower concentration of bilirubin can harm it.

Other symptoms of pathological jaundice is a change in the general condition of the baby. As a rule, babies become lethargic and lethargic, suck poorly, and sometimes refuse to eat at all.

When does jaundice in newborns go away?

Physiological jaundice in newborns completely disappears by 8-10 days. In premature babies, jaundice can last up to 3 weeks; in very premature babies, jaundice can persist for up to 4 to 5 weeks. Milky jaundice lasts from 3 to 6 weeks, but may go away sooner if the baby is weaned.

Diarrhea with neonatal jaundice

diarrhea ( frequent stool) is not characteristic of neonatal jaundice. Stool disorder may occur with jaundice in older children, such as infants ( children under one year old). As a rule, this symptom is a manifestation of impaired liver function. This means that diarrhea is characteristic of the liver ( synonymous with parenchymal) jaundice. Sometimes stool disorder can be observed in infantsif the cause of jaundice was an infection. In this case, there is not only damage to the liver, but also an upset of the gastrointestinal tract, which is accompanied by diarrhea. Also, diarrhea may simply be an accompanying symptom and have nothing to do with jaundice syndrome.

Classification of neonatal jaundice

Neonatal jaundice can be classified by underlying cause, duration, timing of onset, and many other factors. As a variant of physiological jaundice, it is customary to consider jaundice in premature babies. A separate variant of neonatal jaundice is milky jaundice, synonyms of which are "pregnane jaundice" or "jaundice from mother's milk".

The main types of jaundice are:

prolonged, prolonged or prolonged jaundice;
jaundice in premature babies;

transient jaundice;
nuclear jaundice;
hemorrhagic jaundice;
infectious jaundice;
pregnane jaundice or milky jaundice;
jaundice with incompatibility of blood group and Rh factor.

Protracted, prolonged or prolonged jaundice

Protracted jaundice is most often considered as a variant of pathological jaundice. As you know, physiological jaundice appears on the second - third day and completely disappears by the 10th day. In 5 to 10 percent of cases, this does not happen, and jaundice persists for 3 weeks or more. This type of jaundice is called protracted or prolonged.

The consequences of prolonged jaundice depend on the concentration of bilirubin and on the reasons that led to its development. An increase in the level of bilirubin of more than 270 - 300 micromoles with prolonged jaundice is considered a dangerous sign, since damage to the nervous system is noted at this concentration. Like any pathological jaundice in general, prolonged jaundice is not an independent disease, but rather a syndrome. This means that prolonged jaundice is a manifestation of some other pathology, for example, liver pathology. So, very often prolonged jaundice is the result of intrauterine infections. The main treatment for prolonged jaundice is phototherapy.

Jaundice in premature babies

Premature birth and, as a result, prematurity of the fetus is one of the most common causes of prematurity. The reason for this is the immaturity of the enzyme system of the liver, as well as the whole body of the baby. The severity of jaundice does not depend on the body weight of the newborn baby, but on the degree of prematurity, that is, on the degree of immaturity of the fetal organs. In premature babies ( with a difference of 2 - 3 weeks) the concentration of bilirubin in the blood is 90 - 105 micromoles per liter. In more severely preterm infants ( 4 weeks apart) the level of bilirubin can reach 170 - 200 micromoles per liter.

Transient jaundice

Transient or transient jaundice is considered a variant of physiological jaundice. Transient jaundice appears on the second day after the birth of a child ( usually after 30-36 hours) and dies out on the eighth day. With transient jaundice, the level of bilirubin should not exceed 200 micromoles per liter, and its hourly increase should be within 2-3 micromoles per liter. Like physiological jaundice, transient jaundice is most pronounced on the 3rd - 4th day after birth. After 4 days, jaundice begins to regress ( subside) and completely disappears by 8-10 days. Transient jaundice does not require treatment and is not accompanied by a deterioration in the health of the child.

Nuclear jaundice

Nuclear jaundice is jaundice that is accompanied by damage to the nuclei of the cerebral cortex. As already mentioned, bilirubin is lipophilic ( fat soluble) a substance that easily penetrates the nervous tissue. At moderate concentrations of bilirubin in the blood, the nervous system remains protected. When the concentration of bilirubin reaches a critical level of 300 micromoles per liter, the baby's cerebral cortex becomes susceptible to the toxic effects of bilirubin.

Indirect ( i.e. not yet bound to glucuronic acid) bilirubin is a poison with a predominantly neurotoxic effect. This means that it has a selective effect on the cells of the nervous tissue. Penetrating into the nervous system, bilirubin affects the nuclei of the cerebral cortex ( vital structures) with the development of further bilirubin encephalopathy. Nuclear jaundice is observed in the case of Crigler-Najjar syndrome. This type of jaundice is an emergency condition, with a frequent fatal outcome. That is why treatment should be aimed at preventing its development. When there is a threat of development of kernicterus, blood transfusion and other methods of treatment are recommended.

Hemorrhagic jaundice

There is no such term as "hemorrhagic jaundice". It would be more correct to say "jaundice with hemorrhagic syndrome." This is a type of jaundice that occurs with bleeding symptoms. As a rule, in the clinical picture of such jaundice, in addition to bleeding, there are signs such as an enlarged spleen and liver, dropsy ( scientifically ascites). The tendency to bleeding is due to a deficiency of vitamin K, which is involved in the synthesis of proteins involved in coagulation processes ( blood clotting). When vitamin K is in insufficient or completely absent in the body, the necessary proteins are synthesized in smaller quantities, which leads to impaired blood clotting.

Vitamin K is a fat-soluble vitamin that is synthesized in the liver cells. Therefore, a deficiency of this vitamin is observed in jaundice, the cause of which lies in the liver itself. These are the so-called hepatic ( or parenchymal) and mechanical jaundice. Jaundice with hemorrhagic syndrome is often observed with atresia ( underdevelopment) biliary tract. With this congenital pathology, icteric coloration of the skin appears already on the first day after birth. Jaundice progresses very quickly, the daily increase in bilirubin is very high. An integral symptom of such jaundice is pruritus. The general condition of the children is rapidly deteriorating. Because of the itching, they become restless, cry constantly, refuse to eat. All the symptoms that develop with biliary atresia are associated with the phenomenon of cholestasis ( bile stasis). Stagnation of bile causes enlargement of the liver and spleen ( hepatomegaly and splenomegaly), skin itching, staining of the skin and mucous membranes in a yellow-green color. Without surgical treatment, children die before the age of one year.

infectious jaundice

Infectious jaundice is a type of jaundice that has been provoked by an infectious pathology. The name "infectious" reflects not the nature of jaundice, but its cause. Classification of jaundice by etiological ( causal) factor is most often used by neonatologists ( physicians who care for newborns).

The types of jaundice according to the etiological factor include:

Jaundice, hemolytic origin- those that are caused by increased breakdown of red blood cells. These include jaundice in hemolytic disease of the newborn, jaundice due to an overdose of vitamin K.
Jaundice due to impaired intrahepatic transport of bilirubin or parenchymal jaundice. This is the jaundice, the cause of which is hidden inside the liver. Most often, parenchymal jaundice in newborns is caused by congenital diseases. For example, this is Gilbert's syndrome or Crigler-Najjar syndrome.
Jaundice, mechanical origin- those that are provoked by obstruction ( blockage) biliary tract.
Jaundice, mixed origin- These include jaundice due to intrauterine infections.

As can be seen from the list, infectious jaundice combines several mechanisms at the same time. Infectious jaundice in newborns may be due to intrauterine infections, while in older children, infectious jaundice is most often a manifestation of hepatitis A. Intrauterine infections that can cause jaundice in newborns include cytomegalovirus, toxoplasmosis, herpes.

Pregnanoic ( dairy) jaundice

Pregnane or milky jaundice ( also jaundice from mother's milk) was first described in the 1960s. Despite the fact that half a century has passed since then, the cause of this jaundice has not yet been precisely clarified. There is an assumption that an excess of bilirubin in the serum of a newborn child is a consequence of an increased concentration of pregnandiol in the blood of women after childbirth. This substance ( pregnandiol) inhibits the metabolism of bilirubin, as a result of which it circulates in the blood of a child for a longer time and stains his skin in an icteric color. The child receives pregnandiol from the mother's breast milk, where it penetrates from the blood.

Pregnane or milky jaundice lasts 3 to 6 weeks. It is very easy to diagnose it. It is recommended to wean the baby from the breast for a couple of days, against which the jaundice quickly disappears. If you start feeding again, jaundice reappears.

Jaundice in newborns with incompatibility of blood type and Rh factor

Jaundice in a newborn baby can also occur when the mother and fetus are incompatible with the Rh factor or antigens of the ABO system ( among the people by blood group). As a rule, the first option is most common, less often the second. This incompatibility leads to intense hemolysis ( destruction) erythrocytes of the fetus, which is why the disease is called hemolytic disease of the newborn. The frequency of this pathology varies from 3 to 5 percent, and its mortality rate is 3 percent.

As mentioned above, the most common form is jaundice with Rh incompatibility. Rh factor ( or antigen D) is a system of antigens ( proteins), which are located on the inner membrane of erythrocytes. There are two types of Rh factor - positive and negative. Hemolytic disease of the newborn develops when the mother is Rh negative and the fetus is Rh positive. This combination occurs in cases where two people with different Rh factors enter into marriage. In this case, the risk of having a child with a Rh-positive blood group is 75 percent, and with an Rh-negative blood group - 25. A conflict between mother and fetus will arise only when the Rh factors are different. In this case, antibodies are produced in the mother's blood against the baby's red blood cells ( specific proteins). In the future, these antibodies penetrate the placenta into the blood of the fetus and are fixed on its red blood cells. As a result, red blood cells are destroyed, which leads to the release of hemoglobin from it and the formation of bilirubin from it. The massive destruction of red blood cells causes a significant increase in the concentration of bilirubin in the blood of the baby.

In more rare cases, jaundice is due to blood type incompatibility. As you know, there are 4 blood groups in humans - I, II, III, IV. Each of these groups is inherited by certain genes, which are represented by antigens of the ABO system - I - OO, II AO, AA, III - BO, BB, IV - AB. These antigens are contained not only on erythrocytes, but also in all human tissues and organs. In rare cases, a conflict occurs between the antigens of the mother and the fetus, which is accompanied by the production of antibodies to the erythrocytes of the fetus. After the penetration of the mother's antibodies into the child's body, hemolysis develops - the destruction of red blood cells. Most often, this picture is observed when the mother is a representative of the first blood group, and the child is the second or third.

Classification of jaundice according to the mechanism of formation

According to the mechanism of formation, three main types of jaundice are distinguished - conjugative ( synonyms - hepatic or parenchymal) jaundice, hemolytic jaundice and
mechanical jaundice.

Hepatic ( conjugative, parenchymal) jaundice

Hepatic jaundice is a type of jaundice caused by liver disease. Synonyms of hepatic jaundice are the terms - conjugative and parenchymal. Conjugation is the process of combining bilirubin with glucuronic acid, after which bilirubin becomes less harmful. Thus, two types of bilirubin circulate in the human body - free and bound. Free bilirubin is the one that is in the blood, after which the red blood cells are destroyed. Free bilirubin is highly toxic and easily enters the nervous system. It is this type of bilirubin that enters the liver, where it binds to glucuronic acid, thus being rendered harmless. Bound or “neutralized” bilirubin from the liver then enters the gastrointestinal tract. With hepatic jaundice, it is the process of conjugation, that is, the binding of bilirubin, that is disrupted. The second synonym for hepatic jaundice is the term - parenchymal. The parenchyma is the liver tissue that is damaged in this case. This term most accurately reflects the causative factor of jaundice. He explains that the cause of the disease lies not above and not below the liver, but in it.

Parenchymal jaundice develops with hepatitis, cirrhosis, congenital liver pathologies, atresia ( underdevelopment) biliary tract.

Diagnosis of parenchymal jaundice
The color of the skin with parenchymal jaundice acquires a reddish tint ( saffron color). The liver and spleen are often enlarged, and moderate pruritus is present. Important diagnostic features are changes in the color of urine and feces. With parenchymal jaundice, the urine becomes dark in color, and the feces become discolored. In blood tests, all liver enzymes are increased, the concentration of bilirubin is increased.

Hemolytic jaundice

Hemolytic jaundice develops due to intense hemolysis of red blood cells. Hemolysis is the process of destruction of red blood cells, after which hemoglobin is released from them, from which bilirubin is formed. Normally, erythrocytes live for about 120 days, however, under some pathological conditions, their lifespan is significantly shortened. When red blood cells are destroyed, free, toxic bilirubin is released into the blood. The danger of hemolytic jaundice lies in the fact that free bilirubin is a fat-soluble substance that easily enters the nervous system. There, it irreversibly damages neurons, leading to the development of bilirubin encephalopathy ( brain damage).

Hemolytic jaundice occurs with hemolytic disease of the newborn, with an overdose of vitamin K, with the use of a number of medications. A distinctive feature of hemolytic jaundice is the lemon color of the skin. Liver enzymes are within normal limits, the color of the stool is not changed, the urine acquires a bright orange color. With hemolytic jaundice, the spleen is greatly enlarged, which is an important diagnostic criterion. The increase in the level of bilirubin occurs due to free bilirubin.

Mechanical jaundice

A synonym for obstructive jaundice is the term "subhepatic jaundice". It also reflects the etiology ( causes) jaundice, indicating that the cause is not in the liver itself, but under it. In this case, jaundice is a consequence of mechanical blockage of the biliary tract.

Normally, after bilirubin has bound to glucuronic acid, it enters the digestive system as part of bile. In the digestive system, bile is involved in the absorption of fats. With obstructive jaundice, bile containing bilirubin cannot pass further from the liver into the digestive system. The reason for this is the obstruction ( blockage) at the level of the bile ducts. It can be a gallstone, squeezing of the duct by a tumor or cyst. Since bile can no longer find an outlet, it begins to accumulate in the gallbladder. Having filled the bladder, bile begins to saturate its walls and slowly penetrates into the blood. Thus, the level of conjugated bilirubin in the blood begins to rise. Together with bilirubin, bile acids also enter the bloodstream, which greatly irritate the nerve endings. This causes unbearable skin itching, which is observed with obstructive jaundice.

Subhepatic jaundice is also distinguished by a greenish tint to the skin, completely discolored stools, and dark-colored urine.

There are contraindications. Before use, you should consult with a specialist.

Approximately 60% of newborn babies born at term and 80% of premature babies have a yellowish skin within 1-2 weeks after birth. Blame it on bilirubin. It is the high level of this pigment in the blood that gives the skin a yellow tint. For most children, this condition is not dangerous and does not require special intervention or serious medical treatment. But you should not let the situation take its course, because in some cases, high bilirubin can be toxic to a growing organism. We will talk about the dangers of jaundice in newborns in our article. Be sure to dwell on the causes of this condition, possible consequences and features of treatment.

Physiological and pathological jaundice

The condition in which the surface of the skin of the crumbs turns yellow is not considered a disease, but rather a physiological phenomenon. After birth, the baby's body begins to adapt to the new conditions of existence. As a result of the breakdown of red blood cells during the breakdown of fetal (fetal) hemoglobin, a bile pigment, bilirubin, is formed. The liver is responsible for its excretion, which in babies is immature, like the entire enzyme system. Accumulating, bilirubin becomes a toxin, which, spreading throughout the body, is capable of affecting brain cells. And this is only one of the reasons why jaundice is dangerous for newborns.

Staining of the skin in yellow usually occurs on the third day. But when the jaundice will pass in a newborn, it is impossible to predict exactly. It all depends on how quickly the liver will receive the necessary enzymes and begin to work at full capacity. This usually happens on the 7th day after discharge from the hospital or on the 10th day from the birth of the baby, if he was born full-term.

Physiological jaundice is natural in newborns. This condition should not cause concern to parents. The pathological jaundice carries a danger to the fragile body of the newborn. It occurs as a result of a massive breakdown of red blood cells, not only those that already need to be replaced, but also new ones.

Pathological jaundice occurs in the first hours after birth and is accompanied by severe anemia. The level of bilirubin at this point is very high. In this case, not only the liver suffers, but also the central nervous system and the brain. To prevent this condition, the baby needs constant monitoring of the level of bilirubin in the blood and timely treatment.

Most often, the child becomes yellow on the third day after birth. The main cause of physiological jaundice is associated with natural processes in the body, the result of which is the replacement of fetal hemoglobin with normal or live. This condition rarely requires special treatment, since it is considered normal for the body of a newborn. The growth of bilirubin in this case can cause starvation, hypothermia, accumulation of meconium. To quickly cope with a high level of bile pigment, it is recommended to apply the baby to the breast more often. The first milk - colostrum - acts as a laxative, which contributes to the speedy discharge of meconium. Bilirubin at the same time decreases much faster.

Pathological jaundice in newborns deserves closer attention. The causes, consequences and norms of such a state are completely different. It occurs in 65 children out of 1000. There can be several reasons for the development of pathological jaundice:

Rhesus conflict;
incompatibility of maternal and fetal blood groups;
infectious diseases of the liver;
liver failure;
low birth weight of the child;
premature birth;
artificial feeding;
diabetes mellitus in a woman;
hormonal disorders in the body;
mechanical damage to the liver or biliary tract;
hereditary metabolic disorders.

Most of the factors listed above lead to a violation of the outflow of bile from the body. This condition requires constant monitoring by specialists.

Symptoms and diagnosis of pathology

The main sign of jaundice in newborns is the characteristic shade of its skin and sclera of the eyes. To assess the state, the Cramer scale is used. Examination is carried out in natural daylight, as artificial light distorts the results. To determine the yellowness of the child's skin, it is necessary to completely undress. As a result of the examination, it is possible to determine the approximate level of bile pigment in the body:

Jaundice is limited to the head and neck - indirect bilirubin in the blood plasma is 100 mmol. This indicator is averaged and can be confirmed or refuted by a blood test.
Jaundice of the head, neck and upper body - 150 µmol/l.
Including the lower part of the body - 200 µmol / l.
Including arms and legs below the knees - 250 µmol/l.
Including hands, palms and feet - more than 250 µmol/l.

Depending on the level of bilirubin in the blood, we can say that

If the main symptom of a physiological condition is a yellow skin tone, then the pathological phenomenon is accompanied by the following additional signs:

occurs on the first day or a week after birth;
the disease has a complex and undulating course;
the increase in bilirubin exceeds 85 µmol/l per day;
discoloration of the stool;
coloring of urine in bright yellow color;
a change in the normal state of the body (excitation or lethargy).

The pathological condition does not go away on its own and requires medical intervention.

The norm of bilirubin with jaundice in newborns

In order to provide timely assistance to the baby if necessary, it is necessary to control the level of bile pigment, which stains the skin in a characteristic color. Normally, the bilirubin index in a baby is 8.5-20.5 mmol / l. This means that the child's liver works well during the period of destruction of fetal hemoglobin and the appearance of a living one. The maximum level of bilirubin reaches the third day after birth. At this time, the bile pigment is usually fixed at a value of 205 µmol/L. Starting from the fourth day, the intensity of the icteric shade gradually decreases, and after about 10 days the skin returns to normal.

How long jaundice in a newborn will last depends directly on bilirubin and the general condition of the body. If, by the third week of the baby's life, the value of the bile pigment index does not decrease and is 160 µmol / l and above, the doctor decides on hospitalization. If the child's condition is not disturbed, the yellowness of the skin is moderate and decreases, liver tests are normal, then treatment can be carried out at home.

Features of breast milk jaundice

Sometimes the staining of the skin of a child in a characteristic color is not associated with either physiology or pathological disorders in the body. In this case, we are talking about another type of jaundice that occurs during breastfeeding. Although in most cases breast milk is a valuable source of nutrients, sometimes the substances contained in it can be harmful.

Breastfeeding jaundice is caused by high levels of hormones and fatty acids in milk. All this suppresses the normal functioning of the liver, as a result of which bilirubin begins to accumulate in the tissues. This condition occurs approximately 7 days after birth. But when the jaundice in a newborn passes, it depends on how quickly the correct diagnosis is made and adequate treatment is prescribed.

To reduce the level of bilirubin in the blood, the child is transferred for 3-4 days to feeding with a formula or breast milk expressed and pasteurized in a water bath. In such a diet, estrogens and other hormones that affect liver enzymes are practically inactive. If after a specified time the level of bile pigment falls, then the child really has jaundice in breast milk. With the restoration of natural feeding, after a few days, the bilirubin in the child will increase again.

When does jaundice go away in babies?

This question interests all, without exception, young mothers who first encountered a similar phenomenon. It is safe to say that the newborn had jaundice when the level of bilirubin in the blood returned to normal. This usually occurs 10-14 days after birth, if the phenomenon is related to physiology. If after a month the child's condition has not improved, and the yellowness of the skin persists, you should immediately consult a doctor.

It may take up to three months to treat pathological jaundice, subject to the treatment prescribed by your doctor. The level of bilirubin is determined by donating venous blood in the laboratory.

Why is jaundice dangerous in newborns?

In most children, the skin becomes yellowish for physiological reasons, which should not cause concern to parents. After one to two weeks, the skin and sclera of the eyes will brighten. Jaundice caused by the presence of enzymes and fatty acids in breast milk can last for 2-3 months. However, all this time the baby is fully developing. Thus, physiological jaundice, like that associated with breastfeeding, cannot be dangerous for a newborn.

But the child may turn yellow for other reasons. For example, pathological jaundice is hundreds of times more dangerous for a newborn than physiological and breastfeeding. Firstly, with this disease, the child's condition only worsens every day. Secondly, recovery without the help of doctors is impossible, since the consequences can be the most unpredictable:

High levels of bilirubin are toxic to the baby. In turn, this can lead to disturbances in the functioning of the central nervous system and the brain.
When bilirubin enters the brain, kernicterus often develops. This condition is accompanied by muscle spasms and mental retardation. With often there is deafness.
With prolonged jaundice, loss of control over the musculoskeletal system and partial paralysis are possible.

The toxic effect of bilirubin on the nervous system has the most severe consequences.

Treatment of jaundice with light

If the yellowing of the skin is due to physiological causes, then therapy in this case is not required. In this case, we should not talk about treatment, but about how to help a small body cope with this condition faster. All recommendations are given by the doctor. You should not stuff your child with some dubious drugs on the advice of friends. A newborn baby during this period of his life must be provided with:

daily walks in the fresh air;
taking sun and air baths;
complete breastfeeding.

In addition to the above, the mother must follow a diet, excluding from her diet those foods that create an additional burden on the liver. In general, the best prevention of neonatal jaundice is breastfeeding on demand from the first minute of a baby's life.

In some cases, the doctor recommends treating neonatal jaundice under a lamp. This method of bringing the level of bilirubin in the blood back to normal is called phototherapy. In the process of treatment, the child is placed under a lamp, after covering his eyes with a bandage. Under the influence of light, the bile pigment in the blood is destroyed, and the resulting substances are easily excreted from the body along with urine and feces. It should be noted that phototherapy is appropriate when the level of bilirubin is above 100 µmol/l. Then liver enzymes can break it down and remove it on their own. And when the bilirubin index drops to 8.5-20.5 µmol / l, we can say that the jaundice in newborns has passed.

When the baby's skin turns yellow as a result of pathology, in addition to herbal medicine, medication is prescribed in a hospital setting. Depending on the causes that caused jaundice, even blood transfusion can be used (with Rhesus conflict).

Medical treatment

To bring the level of bilirubin in neonatal jaundice back to normal, one of the following drugs is prescribed:

"Hofitol". One of the safest and most effective remedies for neonatal jaundice. The drug is a plant-based solution intended for oral administration. Its main action is to protect the liver. In addition, the drug provides the normalization of metabolic processes, improved kidney function and a choleretic effect.
"Galsten". This is a homeopathic preparation of plant origin, which is prescribed for jaundice in order to eliminate intoxication. For children, it is prescribed in the form of drops.
"Ursofalk" from jaundice for newborns. Under the influence of this drug, liver cells begin to work more actively. They produce more enzymes that help remove bilirubin from the body. The dosage of the drug is determined by the doctor based on the level of bile pigment in the blood.

The opinion of Dr. Komarovsky about the problem

It is a physiological process. Dr. Komarovsky advises mothers to calm down and not focus on this condition. For the treatment of physiological jaundice in modern medicine, the use of special medications is not recommended, unless it is of a protracted nature. However, a blue light can be used to speed up the process of normalizing the baby's skin tone. With jaundice in a newborn, phototherapy allows you to break down bilirubin into substances that are easily excreted by the body with feces and urine.

At home, Evgeny Komarovsky, in the absence of a blue lamp, recommends using an ordinary white one. He explains this by the fact that its bright light also neutralizes the toxicity of bilirubin. Approximately the same effect has diffused sunlight.

As for pathological jaundice, Dr. Komarovsky warns that Phenobarbital may be prescribed for its treatment in our country. He categorically does not recommend mothers to use this remedy in relation to their children. This drug, despite its effectiveness in activating certain enzymes in the liver, is banned from use worldwide due to side effects. "Phenobarbital" has a destructive effect on the nervous system of the child, leads to a decrease in intelligence and ability to learn at school age. The doctor does not say exactly when jaundice in newborns should pass. He notes only the protracted nature of the disease.

Dr. Komarovsky advises to supplement the child with water for jaundice and not to refuse vaccination against hepatitis B, since in this case the risk of the disease increases significantly.

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

What happened?

Jaundice in newborns is a fairly common phenomenon, it is observed in 50-60% of full-term and 80% of premature babies. It should not be treated like a disease. The skin of the child turns yellow for quite physiological reasons. Fetal hemoglobin in the baby's blood (which was natural for him during pregnancy) changes to normal human hemoglobin A. The baby adapts to 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 red blood cells. These blood cells are constantly renewing, hence the need to “recycle” aging cells.

In a baby in the postpartum period, when hemoglobin is replaced with normal, erythrocytes that age also decay, 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 quite quickly. As the liver, receiving the necessary enzymes, begins to work in full force, bilirubin begins to leave the body, the skin brightens, first acquiring a peach hue, and then returning to normal color. Usually this process is completely completed by the 7-10th day of life, thus, after discharge after 4-5 days, less often - after a week, the jaundice should completely disappear. Protracted neonatal jaundice can be observed in premature babies, but doctors try to treat and monitor them in a hospital setting.

Another type of non-dangerous 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, not requiring treatment, and even more so the abolition of breastfeeding and the transfer of the baby to nutrition with adapted mixtures.

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 the color of a child's skin is light therapy. 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 the newborn is quite able to excrete with urine and feces.

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

Another effective cure for jaundice created by nature itself is mother's breast milk. It contains natural substances to increase the child's immune defenses. Therefore, the sooner the baby is put 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 these children is a special story. As a rule, crumbs with elevated bilirubin are characterized by increased drowsiness and may skip feeding. It is important to ensure that the baby eats on time, wake him up if necessary, but in no case overfeed.

Walks with such a baby will also have a therapeutic effect. It needs to be taken out more often so that the child has contact with indirect sunlight. Weather and season permitting, a child with jaundice should spend most of the day outdoors.

Pathological situations

Abnormal is a condition in which a child, after birth, begins a massive breakdown of red blood cells, not only obsolete 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 type, Rh factor is different from the mother's. If an immunological conflict occurs, the mother's immunity produces specific antibodies against the fetal blood cells.

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

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

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

Overdose of vitamin K. The drug "Vikasol" (a synthetic analogue of vitamin K) is used during childbirth to prevent or eliminate severe bleeding in a woman. If there is an error in dosing or an urgent need for a large amount of the drug for a woman, an overdose may occur in the baby.
diabetic fetopathy. A condition in which the baby's liver and its enzyme system are not sufficiently developed due to the fact that the fetus suffered during pregnancy against the background of the mother's diabetes.
Genetic (hereditary) malformations of the liver. These are some types of genetic syndromes in which structural genetic errors have occurred 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, children in the treatment of pathological types of jaundice are prescribed such a serious drug as Phenobarbital. Evgeny 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 this medication is 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 lose their relevance. 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.

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

The presence of physiological jaundice in a newborn is not a contraindication to hepatitis vaccination. Refusing to vaccinate 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 the vaccine even more necessary and useful.

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

You can see more about the chick of newborns in the next video.

Description
Norm of bilirubin
Doctor Komarovsky

Jaundice in newborns is a physiological or pathological condition that is caused by an increase in the level of bilirubin in the blood and is manifested by an icteric color of the skin and mucous membranes.

Source: web-mama.ru

According to statistics, in the first weeks of life, jaundice develops in about 60% of cases in full-term and in 80% of cases in premature babies. Most often (60-70%), physiological jaundice is diagnosed in newborns, which occurs when the level of bilirubin in the blood rises to 70-90 µmol/l in full-term babies and more than 80-120 µmol/l (depending on the weight of the child) in premature babies. In most cases, jaundice appears in the first three days of a child's life and does not require treatment.

In the case of timely adequate treatment of pathological jaundice, the prognosis is favorable, it worsens with the development of neurological complications.

Bilirubin is one of the main bile pigments in the human body. Normally, it is formed during the breakdown of proteins (cytochrome, hemoglobin and myoglobin) that contain heme. In the blood, bilirubin is contained in two fractions - free and bound. Approximately 96% of bilirubin in the blood is represented by insoluble indirect bilirubin, which forms complexes with albumin. The remaining 4% bind to polar molecules, in particular glucuronic acid. Indirect (unbound) bilirubin is formed mainly during the destruction of erythrocytes and the breakdown of hemoglobin, it does not dissolve in water, dissolves in lipids and is quite toxic due to the ability to easily penetrate cells and have an adverse effect on their vital activity. Indirect bilirubin binds to blood albumin and is transported to the liver. Direct (bound) bilirubin is a low-toxic fraction of total bilirubin, which is formed in the liver. Connecting with glucuronic acid, bilirubin becomes water-soluble. Most of the direct bilirubin enters the small intestine, glucuronic acid is split off from it, bilirubin is restored to urobilinogen. In the small intestine, part of the urobilinogen is reabsorbed and enters the liver through the portal vein. The rest of the urobilinogen enters the large intestine, is reduced to stercobilinogen, oxidized to stercobilin in the lower parts of the large intestine and excreted from the body with feces, giving it a characteristic brown color. A small amount of stercobilinogen is absorbed into the blood and then excreted in the urine.

The excretory function of the liver of a newborn child is significantly reduced due to anatomical immaturity and reaches the elimination (i.e., excreting, removing) ability of the adult liver by the end of the first month of life.

The consequences of jaundice in newborns, which developed against the background of a particular pathological process, include nuclear hyperbilirubinemia with toxic brain damage, deafness, cerebral palsy.

Features of the intestinal metabolism of bile pigments in newborns cause a partial return of indirect bilirubin to the blood and an increase or maintenance of an elevated level of bilirubin. 80-90% of bilirubin in newborns is represented by an indirect fraction. When the enzyme systems of the body begin to function in full, the color of the child's skin returns to normal.

Causes of jaundice in newborns and risk factors

The immediate cause of jaundice in newborns is an increase in the level of bilirubin in the blood.

Source: allyslide.com

Physiological jaundice may be due to the following reasons:

rapid destruction of fetal hemoglobin;
insufficient transfer of bilirubin through the membranes of hepatocytes;
immaturity of liver enzyme systems;
low elimination capacity of the liver.

The causes of pathological jaundice in newborns are:

severe course of diabetes in a pregnant woman;
asphyxia, birth trauma;
thyroid disease;
infectious lesions of the child's liver (viral hepatitis, herpes, toxoplasmosis, cytomegalovirus, listeriosis, etc.);
sickle cell anemia, thalassemia;
erythrocyte membraneopathy;
cystic fibrosis;
toxic-septic damage to the liver;
violation of the excretion of bilirubin (bile thickening syndrome, intrauterine cholelithiasis, intestinal obstruction, pyloric stenosis, compression of the bile ducts by a neoplasm or infiltrate from the outside);
the presence in breast milk of maternal estrogens that prevent the binding of bilirubin;
unsteady lactation and relative malnutrition of the child;
taking certain drugs (sulfonamides, salicylates, large doses of vitamin K).

Jaundice is usually determined by a neonatologist during the child's stay in the maternity hospital.

Risk factors are too long intervals between feeding infants, prematurity, induction of labor, delayed clamping of the umbilical cord.

Forms of the disease

Jaundice in newborns can be physiological (transient) and pathological. Pathological on the basis of etiology are divided into the following types:

conjugative- develop against the background of a violation of the processes of transformation of indirect bilirubin;
hemolytic- due to intense hemolysis of erythrocytes;
mechanical (obstructive)- occur when there are mechanical obstacles to the outflow of bile into the duodenum;
hepatic (parenchymal)- develop with lesions of the liver parenchyma with hepatitis of various etiologies, hereditary metabolic disorders, sepsis.

By origin, jaundice is hereditary or acquired.

Depending on laboratory criteria, jaundice in newborns may be with a predominance of direct (more than 15% of total) or indirect (more than 85% of total) bilirubin.

Degrees of jaundice in newborns:

Symptoms of jaundice in newborns

Physiological jaundice in newborns occurs on the second or third day after birth and reaches a maximum on the fourth or fifth day. The skin and mucous membranes of the newborn turn yellow (mild jaundice), urine and feces are of normal color, the liver and spleen are not enlarged. Yellowness of the skin does not extend below the level of the umbilical line and is noticeable only in bright natural light. The general well-being of the child usually does not worsen, however, in the case of a significant increase in the level of bilirubin in the blood, lethargy, lethargy, drowsiness, nausea and vomiting (regurgitation) may be observed. With the organization of proper feeding and care, the symptoms of jaundice in a newborn completely disappear by about two weeks of age.

Physiological jaundice in newborns passes without complications, however, in case of violation of adaptation mechanisms, physiological jaundice can be transformed into pathological.

Jaundice in premature newborns, as a rule, appears earlier (the first or second day), reaches its peak by the seventh day of life and disappears by three weeks of age. Due to the longer maturation of liver enzyme systems in premature newborns, there is a risk of developing nuclear jaundice, as well as bilirubin intoxication.

With hereditary conjugative jaundice in newborns, there is a slight increase in the level of indirect bilirubin, while anemia and splenomegaly are absent. The pathological process occurs in the first days of a child's life and is steadily increasing. There is a risk of developing nuclear jaundice with subsequent death.

Jaundice against the background of endocrine pathology manifests itself on the second or third day of a child's life and subsides by three to five months. In addition to icteric skin, lethargy, arterial hypotension, a decrease in heart rate, pastosity, and constipation are noted.

The severity of jaundice that developed in a newborn against the background of asphyxia and birth trauma depends on the level of bilirubin in the blood and the severity of the hypoxic-asphyxic syndrome.

Jaundice in children who are breastfed may occur in the first or second week of life and persist from one to one and a half months.

With the progression of hyperbilirubinemia in newborns, bilirubin penetrates the blood-brain barrier and is deposited in the basal nuclei of the brain (nuclear jaundice), leading to the development of bilirubin encephalopathy. At the same time, at the initial stage of the pathological process, the clinical picture is dominated by symptoms of bilirubin intoxication (monotone cry, apathy, drowsiness, regurgitation, vomiting). Then, stiffness of the muscles of the neck, bulging of the large fontanel, muscle spasms, convulsions, intermittent excitation, nystagmus, bradycardia, and extinction of reflexes are added to these symptoms.

According to statistics, in the first weeks of life, jaundice develops in about 60% of cases in full-term and in 80% of cases in premature babies.

At this stage, which can last from several days to several weeks, irreversible damage to the central nervous system occurs. Over the next two to three months, children show an imaginary improvement in their condition, but already in the third or fifth month of life, neurological complications may develop in such children.

Indicators of physiological and pathological jaundice:

Indicator	Physiological jaundice	Pathological jaundice
Child's well-being	No symptoms of illness, good appetite	The child is lethargic, sucks badly at the breast, spitting up. Congenital reflexes are reduced
Visualization of jaundice	For 2-3 days of life	Early: congenital or appears within the first 24 hours after birth Late: appears on the 2nd week of life and later
The degree of bilirubinemia for 3-5 days	Bilirubin< 204 мкмоль/л	Bilirubin > 221 µmol/l
The course of jaundice	Monotonous increase, then gradual final disappearance	Wave-like: it appears, then disappears and reappears
Duration of jaundice	The first two weeks of life	More than 2-3 weeks
Direct bilirubin at 2–3 weeks of age	< 5,1 мкмоль/л	> 15–25 µmol/l

Diagnostics

Jaundice is usually determined by a neonatologist during the child's stay in the maternity hospital.

A visual assessment of the degree of jaundice in newborns is carried out according to the Cramer scale, it has five degrees:

The concentration of bilirubin is approximately 80 µmol/l, yellowness of the skin of the face and neck.
Bilirubin about 150 µmol/l, jaundice extends to the navel.
Bilirubin reaches 200 µmol/l, yellowness of the skin up to the knees.
Bilirubin about 300 µmol/l, yellowness of the skin of the face, trunk, extremities (except for the palms and soles).
Bilirubin 400 µmol/l, total jaundice.

Laboratory diagnosis usually includes.

Treatment of jaundice in newborns

Physiological jaundice in newborns does not require treatment. Feeding is recommended 8-12 times a day without a night break, the daily volume of fluid intake should be increased by 10-20% compared to the physiological need of the child.

Jaundice in premature newborns, as a rule, appears earlier (the first or second day), reaches its peak by the seventh day of life and disappears by three weeks of age.

Treatment of pathological jaundice in newborns depends on the etiological factor and is primarily aimed at eliminating it. In order to accelerate the excretion of bilirubin, enterosorbents, choleretic drugs, B vitamins can be prescribed. The method of phototherapy is used in intermittent or continuous mode. In some cases, the treatment of jaundice in newborns includes infusion therapy, plasmapheresis, hemosorption, and exchange transfusion.

Possible complications and consequences of jaundice in newborns

Physiological jaundice in newborns passes without complications, however, in case of violation of adaptation mechanisms, physiological jaundice can be transformed into pathological.

The consequences of jaundice in newborns, which developed against the background of a particular pathological process, include nuclear hyperbilirubinemia with toxic brain damage, deafness, cerebral palsy, mental retardation.

Forecast

The prognosis for physiological jaundice in newborns is favorable

In the case of timely adequate treatment of pathological jaundice, the prognosis is also favorable, it worsens with the development of neurological complications.