Jaundice in newborns: symptoms and treatment. Infant jaundice: symptoms, treatment methods, consequences for newborns. Physiological jaundice of newborns

Doctors quite often diagnose jaundice in children in the first months after birth. The signs of this disease are easy to notice with the naked eye. The skin of babies becomes dark with a yellow tint. The whites of the eyes become unnaturally yellow. Such changes cause concern among parents. Below we will try to figure out how dangerous such a disease is and whether you need to panic. Perhaps the culprit is normal physiological processes in the body, which can provoke pronounced symptoms.

Why does jaundice appear?

In fact, it is necessary to look for the cause of the disease in bilirubin. The child, while still in the womb, has a specific blood composition, enriched with a unique set of hemoglobin substances. This hemoglobin is responsible for the transport of oxygen within the circulatory system of the child's body. After birth, the baby can already breathe independently through the lungs. Accordingly, changes occur in the composition of the blood. As a result, “new” hemoglobin, called bilirubin, appears in place of fetal hemoglobin. This substance has no function, so the body tries to get rid of the excess blood component.

As a rule, babies experience this process quite painfully, since the removal of bilirubin takes time and can affect the functioning of some organs. When bilirubin enters the liver, it interacts with other enzymes. Then it dissolves in urine, which is excreted from the body. When the liver does not have time to remove all decay products in a timely manner, and the level of bilirubin found in the blood increases to a critical limit, the first symptoms of jaundice appear.

In some cases, the course of jaundice is pathogenic and is caused by insufficient bile drainage due to:

Blood type discrepancies;
The occurrence of Rh conflict;
Liver diseases;
Metabolic and hormonal disorders;
Diseases transmitted at the genetic level;
Rupture of the bile ducts or liver walls.

Acceptable level of bilirubin content

According to official medical sources, the norm of bilirubin in the baby’s blood should be in the range of 8.5-20.5 µmol/l, which is determined after a molecular blood test. The results of the analysis give reason to believe in which cases this indicator exceeds the permissible norm. If the bilirubin level reaches more than 35 µmol/l, we can confidently say that the child has jaundice.

Specialists dealing with diseases of newborns make a distinction between physiological and pathological jaundice.

This type of disease in children in the early stages of life occurs only occasionally, but carries with it a hidden threat. Cases of pathological jaundice are accompanied by a certain list of additional symptoms that parents do not always notice.

Hemolytic disease

According to statistics, about 1% of children suffer from hemolytic disease, which is mostly caused by an incompatible Rh conflict between the child and mother or a difference in blood groups. This type of jaundice is easy to recognize compared to other modifications of the disease. As soon as the baby is born, his skin acquires a yellowish tint. Upon examination, it becomes obvious that the spleen and liver are inflamed and swollen. Treatment is prescribed immediately. In severe cases, the disease progresses to the stage of kernicterus, when the level of bilirubin is so critical that the child’s brain begins to fail.

Obstructive jaundice

Another type of pathological disease. The causes of the development of the disease include: disruption of the gallbladder and patency of the bile ducts, liver damage.

In some cases, obstructive jaundice is dealt with when faced with genetic disorders or when the baby was injured during childbirth. It is possible to notice the first signs of pathology only after 2-3 weeks. The baby's skin appears yellow-green. The stool becomes discolored, the spleen enlarges, and the liver walls feel dense to the touch. To make sure the diagnosis is correct, doctors conduct a set of additional tests and prescribe an ultrasound. Correct treatment is generally determined by the type of disease.

In addition to the main types of jaundice, there are other types of disease in which prolonged postpartum jaundice takes on pathological forms.

For example, the condition of conjugation jaundice has something in common with difficult liver function, when enzymes stop binding bilirubin and do not have time to remove the substance from the body.

The cause of kernicterus is a sharp increase in the level of bilirubin in the child’s blood during the development of postpartum jaundice. As a result, bilirubin components enter the nervous system and cause poisoning.

If the liver is exposed to a viral infection for a long time, this gives rise to the development of hepatic jaundice.

Today, even official medicine recognizes the fact that physiological jaundice should be considered a normal reaction of the body of an infant. However, no one cancels monitoring the baby’s condition during this period.

Breast milk jaundice

The baby's body is rarely exposed to the above-mentioned disease. It occurs when there is a high estrogen content in breast milk. After milk is digested, the liver first tries to remove estrogen and then bilirubin from the blood. Because of this, the duration of the illness can last for several months. However, this type of jaundice has virtually no effect on the baby’s well-being. The child does not experience developmental problems and sleeps well. Over time, the symptoms stop and the disease recedes. When a newborn is exposed to breast milk jaundice, doctors recommend that mothers still not give up breastfeeding. Of course, the yellowness of a child’s skin will go away faster, but do not forget about the value of children’s immunity, which is strengthened by natural nutrition.

Neonatal jaundice

Neonatal jaundice is considered one of the most common forms of physiological jaundice. Many children face this disease. No complex therapeutic measures are carried out. Soon the overloaded liver is restored and works as before. During this period, it is important for the baby to simply pay special attention.

All types of jaundice have characteristic symptoms, for example, darkening of the skin and mucous membranes. The whites of the eyes turn yellow and look almost lemony at the height of the disease.

If after two weeks the baby's skin is still an unnatural shade, then there is reason to become concerned and visit a doctor. To find out the type of jaundice and the level of bilirubin, you need to take a blood test. Only after this is appropriate treatment prescribed. Since the bilirubin indicator is closely related to a number of factors, it is not possible to guarantee the interpretation of the results obtained. Doctors make a conclusion about the course of the disease and outline the overall picture. The signal about the development of pathology always comes down to an abnormal change in skin color.

The onset of symptoms differs in time and other characteristics:

Metamorphoses with the skin occur in the first days of a baby’s life;
After 3-4 days the yellowness becomes more intense;
The yellow color of the skin may not disappear for 30 days;
The onset of symptoms sometimes occurs intermittently;
In addition to yellowness, a green tint is possible.

In addition to the above signs of the disease, the following is observed:

Discoloration of stool;
Darkening of urine;
The appearance of bluish edema;
Inflammation of the liver and spleen;
General deterioration in health.

When a child's body is sick with nuclear jaundice, babies look drowsy and show a weak sucking reflex.

Any pathological variations of the disease require surgical treatment. The mother and child should spend some time under the supervision of doctors, undergo tests and undergo a course of therapy. For example, if the child’s and mother’s Rh factors or blood groups are incompatible, transfusion is an effective treatment. Sometimes more than half of the child’s blood needs to be transfused for a full recovery. In difficult cases, the procedure must be repeated more than once. The described method allows you to cope with the violation of the state of bilirubin in the blood, but at the same time the entire body is weakened. Additionally, a course of antibiotics and regular visits to physical therapy are prescribed.

It is often possible to stop the development of obstructive jaundice only through surgery. The decision on the need for surgical intervention is made by a medical commission after a thorough examination. Mother and child will have to spend the rehabilitation period in the hospital.

More common cases of physiological jaundice require no treatment, just the support that the baby needs. The child’s body tolerates the disease more easily when the mother begins breastfeeding very soon after birth, sticks to a diet, and walks with the baby in the sun. Fresh air and breast milk are essential factors for strengthening the immune system. It is much easier to provide access to fresh air in the summer than in the winter. Even short-term sunbathing will be beneficial for the baby. Doctors recommend walking with a stroller in light shade, since such diffuse lighting will not harm children's delicate skin. Thanks to daily walks in the fresh air, bilirubin is eliminated from the body faster, jaundice disappears, and the child’s well-being improves.

Mother's milk is considered the most effective therapeutic and preventive agent for combating neonatal jaundice. This is why it is so important to put babies to the breast immediately after birth. Colostrum has a specific taste and has a strong laxative effect, which accelerates the excretion of bilirubin simultaneously with stool.

As an additional procedure in the hospital, the baby is irradiated under a special lamp. During a phototherapy session, the baby's eyes are bandaged and only then placed under a lamp. The general course should be about four days.

Phototherapy is often accompanied by side effects: drowsiness and lethargy of the child, peeling of the skin, problems with stool. Sunbathing can have a similar effect. In a child's body exposed to light, the production of vitamin D is activated, which in turn begins to get rid of bilirubin faster.

If jaundice becomes aggressive, doctors prescribe glucose and activated charcoal. The function of glucose is to improve liver activity, and charcoal adsorbs harmful substances that enter the body. Thus, bilirubin leaves the body through feces.

After announcing the diagnosis, doctors begin to plan a method of treating the pathology, taking into account the totality of factors and characteristics of the birth of the baby. We are talking about the complexity of childbirth, the course of pregnancy, the mother’s illness, the tests obtained and ultrasound results. To make sure the diagnosis is correct, a commission of specialists in a narrow field gathers.

Types of therapeutic methods

There are various methods of therapy:

Antiviral;
Antibacterial;
Choleretic;
Detoxification;
Immune.

The application of these methods is carried out on an individual basis in hospital treatment. The prescription of procedures and medications depends on the type of jaundice and the reasons for its development in the child.

In the case of pathological forms of the disease described above, it is impossible to say with absolute certainty when the disease will end and the baby will finally recover. The duration of the disease is determined by the severity of the course and the characteristics of the body.

What should be done first in case of jaundice and how to determine the onset of the disease? If yellowing of the skin occurs in the first hours of a baby's life, all signs point to a conflict between the blood of mother and child. Poor development and drowsiness are considered confirmation of hemolytic disease and liver dysfunction. When sick children experience convulsions and cry incessantly, you should immediately seek help from specialists. Such severe symptoms may accompany kernicterus.

Kernicterus has serious consequences. We are talking about problems with hearing and the motor system. According to official medical sources, even deaths have been recorded.

At the first signs of jaundice, the child should not be left unattended, otherwise there is a possibility of missing signs of the development of pathology. A timely and correct course of treatment will speed up the recovery process and protect against consequences.

As mentioned earlier, there are no complications from physiological jaundice. Its duration usually does not exceed 2-3 weeks.

As a rule, by the age of one month, babies have already recovered from jaundice and are recovering. When the cause of the disease is mother's milk, the depression of the body is delayed for several months. Then the eyes brighten, and the skin loses its yellow tint.

Jaundice in a newborn is a condition characterized by yellowness of the skin and mucous membranes of recently born babies.

Pigmentation may be a variant of the child’s normal development, or it may indicate the presence of pathology. Doctors will help you distinguish one from the other, but there are some things that parents can also use to know.

Why does a baby develop jaundice?

In itself, coloring of a child’s skin is not a disease, but a symptom. The yellow color of a baby's skin is given by the pigment bilirubin, which is a breakdown product of red blood cells and is formed throughout life.

In adults, it enters the liver and is successfully excreted from the body. With a child the situation is more complicated.

In 70% of cases, jaundice occurs in newborns, the reasons for this prevalence: the liver does not yet fully cope with its functions. At the same time, the level of bilirubin in the blood of babies is high, since red blood cells that supplied the child with oxygen in the womb disintegrate in large quantities.

Thus, three out of four newborns develop jaundice. In most cases, it goes away on its own by the age of one month and does not require treatment. The causes of jaundice and high bilirubin levels in babies are:

multiple pregnancy;
smoking, drinking alcohol and certain medications during pregnancy;
iodine deficiency in the expectant mother;
other complications during the prenatal period;
premature birth;
drugs received to stimulate labor;
Mommy's diabetes.

If a child’s jaundice occurs due to insufficiently efficient liver function, it will disappear on its own as soon as all the baby’s organs are sufficiently adapted to life outside the mother’s womb.

However, sometimes jaundice is a symptom of severe pathologies in a child that require immediate medical intervention. This condition is called pathological jaundice and can be caused by the following reasons:

conflict between mother and baby based on blood types;
incompatibility of mother and child according to the Rh factor;
antibiotic therapy for the child;
liver problems in the baby;
certain genetic diseases;
disturbances in hormone synthesis;
blockage or damage to the bile ducts;
pancreatic dysfunction.

With pathological jaundice, it is very important not only to reduce bilirubin in the child’s blood, but also to eliminate the cause that caused its increase.

Types of jaundice in newborns

The most important is the classification that distinguishes physiological and pathological jaundice.

How to distinguish physiological jaundice

Physiological jaundice in newborns is diagnosed quite simply; symptoms appear 2-5 days after the baby is born:

Bilirubin increases, the skin acquires a yellowish or dark tint on the face, the whites of the eyes turn yellow, then the pigmentation spreads to the hands and chest of the child.
The tummy, legs and feet of a baby with physiological jaundice are rarely stained.

The baby is in good health and behaves naturally. Feces and urine do not change color. Bilirubin does not exceed 256 µmol/l.

For examples of this type of “jaundice” in newborns, see the photo:

Signs of pathological jaundice

This dangerous condition develops in 70 babies out of 1000. Pathology should be suspected if:

the baby “turns yellow” a few hours after birth ( neonatal jaundice in newborns);
bilirubin exceeds 256 µmol/l; >>>
the baby sleeps a lot, eats poorly, and is difficult to wake up;
on the contrary, the child is in constant chaotic movement;
change in color of discharge: urine darkens, feces lighten.

If measures are not taken at this stage, bilirubin enters the baby’s nervous system, poisoning it. Bilirubin encephalopathy begins, or kernicterus of newborns. The clinical picture is complemented by the following symptoms:

monotonous scream on one note;
convulsive syndrome;
decrease in pressure;
coma.

Kernicterus most often affects premature babies. The fact is that their brain cells have not yet fully formed, and have difficulty resisting the toxic effects of bilirubin.

Among the pathological forms, types of jaundice in newborns are distinguished according to the reason that caused the symptoms. Highlight:

Hemolytic(sometimes called suprahepatic). Hemolytic jaundice in newborns is associated with blood problems.
Mechanical- associated with problems of the child’s liver, gallbladder, bile ducts.

Obstructive jaundice, in turn, occurs

hepatic,
subhepatic,
suprahepatic.

Hepatic jaundice is associated with disturbances in the functioning of this organ. If there are not enough enzymes to remove bilirubin from the child’s body, then this condition is called conjugation jaundice in newborns. The liver can also be damaged by toxins, viruses, and bacteria.

The causes of the so-called suprahepatic jaundice are problems with the gallbladder, pancreas, and bile ducts.

When does jaundice go away?

Physiological jaundice of newborns begins to subside when the baby is one week old. The signs of the disease completely disappear by the age of one month.

Pathological jaundice as a symptom can be eliminated quite quickly, within a few days. Today there are ways to quickly and safely remove bilirubin from the patient’s body.

It should be remembered that sometimes pathological jaundice and high bilirubin are symptoms of a serious disease, the duration of treatment of which depends on the situation and can be determined by a doctor.

What to do if jaundice persists

It happens that physiological jaundice does not go away by the age of one month. The reasons for this course of the disease are as follows:

anemia in the baby (confirmed by a blood test);
blockage (or fusion) of the bile ducts, stagnation of bile;
galactosemia (this is one of those diseases that are screened for in the maternity hospital);
deficiency of thyroid hormone (also checked in the maternity hospital);
polycythemia (increased number of red blood cells, monitored by blood test);
Breastfeeding jaundice.

If the baby is already a month old and the jaundice still does not go away, you need to consult a doctor. The doctor will be able to exclude serious diagnoses.

Deserves special mention breastfeeding jaundice, which occurs if breast milk contains a lot of pregnanediol (a product of hormonal metabolism).

This substance inhibits the excretion of bilirubin. At the same time, the amount of pigment in the blood does not increase, but gradually decreases. The child is in good health.

In the medical community, you can find two opinions regarding breast milk jaundice:

Some doctors believe that an increased level of bilirubin still puts additional stress on the baby’s liver, so breastfeeding must be stopped.
Representatives of the other camp do not see anything wrong with continuing feeding.

If you are afraid of harming your baby, but still want to continue natural feeding, the following method will suit you. You need to express the milk and heat it in a water bath to a temperature of 70°. >>>

Then cool it and give it to your child. When exposed to temperature, pregnanediol will disintegrate and will have no effect on the rate of bilirubin excretion.

If the baby is diagnosed with jaundice, the mother should find a pediatrician whom she completely trusts and follow all his instructions.

How is jaundice treated?

The most effective method of reducing bilirubin in the blood is phototherapy.

The baby is placed under special lamps that operate in the blue spectrum. When exposed to light, bilirubin is transformed into non-toxic lumirubin, which is quickly eliminated from the body.

Phototherapy of newborns with jaundice can be carried out both in the maternity hospital and in a children's hospital.

In large cities, you can rent a lamp for treating jaundice in a child. Therefore, if bilirubin does not go off scale and the baby’s condition does not cause concern, then therapy can be carried out at home.

At the same time, you should not forget to donate blood on time to determine the level of bilirubin.

The lamps are prescribed for 96 hours with breaks for feeding. To protect their eyes, babies are given special bandages or caps.

During phototherapy, the baby loses fluid, so when breastfeeding it is necessary to feed the baby on demand.

Side effects of light treatment: peeling of the skin, frequent bowel movements. These symptoms disappear as soon as treatment is completed. >>>

After the end of phototherapy, choleretic and diuretic drugs are sometimes prescribed to complete the treatment:

Hofitol is given to newborns with jaundice in the form of drops, three times a day, mixed with water.
Ursosan is given to newborns with jaundice once a day, diluting part of the capsule contents in a small amount of water. Read also: When can you give water to a newborn?>>>
It is convenient to give Ursofalk to your baby; for newborn jaundice, it is better to purchase this drug in the form of a suspension.

Ursosan and ursofalk reduce bilirubin in the blood within a few days.

Among homeopathic medicines, doctors can recommend Galsten. Galstena for jaundice in newborns is taken in the form of drops, 3 times a day. Before giving the medicine to the baby, the drops are diluted in breast milk.

Blood transfusions are used to treat severe forms of jaundice. This helps replace most of the red blood cells in the blood and, thereby, reduce bilirubin by half in one procedure.

One transfusion replaces up to 80% of the baby's blood. Taking blood from the mother is not allowed, so another donor is found for the child.

Physiological jaundice goes away on its own and does not require special treatment. However, the mother can help the baby quickly get rid of excess bilirubin:

The best method of prevention is breastfeeding. It is important to put your baby to the breast immediately after birth. Colostrum contains components that stimulate the baby's intestines. Together with meconium (the first stool), bilirubin is removed from the body. Mother's milk is the best way to replenish fluid during phototherapy. >>>
Sunbathing. In late spring, summer or warm autumn, you can move the stroller hood while walking so that the sun's rays fall on the baby's face. In winter, you can stand with the baby on the balcony, just make sure that the child does not freeze. Don't let the sun get into your baby's eyes. Vitamin D received by the baby helps remove bilirubin from the body.
You should not give your baby glucose solution or rosehip decoction on your own; Only a doctor knows how glucose should be administered for jaundice in newborns.

What consequences can infant jaundice have?

Usually, breastfeeding jaundice and physiological jaundice in newborns have no consequences; when the yellowness of the skin disappears, nothing reminds of the disease.

Recently, neonatologists recognized these conditions as a variant of normal baby development.

The consequences of pathological jaundice depend on the reasons that caused it.

If you start treatment on time and do not deviate from the doctor’s recommendations, then most likely the disease will be completely overcome and will not leave behind any additional diseases.

Untreated or untimely treated jaundice in newborns does not go away without a trace; the consequences can be as follows:

the risk of liver cancer in the future is greatly increased;
weak immunity in the baby;
cirrhosis and other liver diseases.

If the baby suffered bilirubin encephalopathy, and he did not receive medical care, the consequences may be partial or complete hearing loss, developmental delays, and paralysis.

A child with signs of jaundice should be constantly monitored by a doctor so as not to miss the development of severe forms of the disease and to prevent dangerous consequences.

Health to you and your baby!

Often, while in the maternity hospital, mothers notice that the newborn’s skin takes on a yellowish tint. And if at the same time they hear an incomprehensible phrase from the attending pediatrician: “Your baby has jaundice,” they begin to frantically look for signs of the disease in their baby, to find out whether he has become infected.

Before discussing the topic of jaundice, you need to clearly know what this condition is and what causes jaundice in newborns.

Jaundice is a condition in which the level of bilirubin in the blood increases, which, when deposited in the tissues, gives the skin, mucous membranes and whites of the eyeballs a shade from lemon to orange.

Bilirubin is a pigment substance that is formed during the breakdown of red blood cells (erythrocytes) in the blood and is excreted from the body with the participation of special enzymes produced by the liver. This process occurs constantly in the body of every person. But in a newborn baby, due to a number of its physiological characteristics, bilirubin is formed in increased quantities and is excreted more slowly. There are many reasons leading to an increase in bilirubin levels, but the main ones include:

an increased number of special red blood cells necessary for the full functioning of the fetus in utero in conditions of low oxygen content and their rapid destruction at the birth of a child, with excessive release of bilirubin pigment;
functional immaturity of the baby’s liver, due to which there is a deficiency of a special protein that ensures the transfer of bilirubin through the membranes of liver cells and its excretion from the body.

Therefore, many newborns may normally have jaundice, called physiological. Physiological jaundice usually appears on the third or fourth day after the birth of the child. Jaundice of the skin persists for approximately 2–3 weeks, then the intensity of jaundice gradually decreases. In premature babies, jaundice can persist for up to a month, sometimes for a longer period. Physiological jaundice of newborns is not contagious, the general condition of children does not suffer. Physiological jaundice of newborns, as a rule, does not require any treatment and goes away without outside intervention.

The passage of meconium (original feces), fasting or hypothermia of the child contributes to a more intense increase in the level of bilirubin later (later than 24 hours). Therefore, the best prevention and treatment of physiological jaundice in newborns is early and frequent breastfeeding. Colostrum, or “early milk” of the first few days, acting as a laxative, helps to pass meconium faster and, as a result, promotes faster removal of bilirubin from the body. Therefore, in our maternity hospital, the staff is trying to make every effort to early restore the natural process of breastfeeding. Early breastfeeding is actively practiced, starting in the delivery room; stay together between mother and child from the first hours of life (if both are in good condition and there are no contraindications); if possible, early “unification” of a woman after a caesarean section with her baby.

Sometimes, most often in children with good weight gain and a large amount of milk from the mother, jaundice appears after the 1st week of life. This is also a type of physiological jaundice, but it occurs much less frequently (about 1% of cases) and is associated with the intake of mother's milk. The reason is that breast milk may contain large quantities of substances - estrogens, which prevent the natural excretion of bilirubin from the body or even increase its reabsorption. If this type of jaundice is suspected, it is necessary to stop breastfeeding for 24-48 hours. A decrease in the level of bilirubin in the baby’s blood after a break in breastfeeding will confirm the diagnosis. In this case, it will be necessary to wean the baby from the breast for several days and feed expressed breast milk, pasteurized in a water bath for 5 minutes.

However, parents should know that in addition to physiological jaundice, there is also pathological jaundice. This is the most common pathology characteristic of the newborn period. According to our maternity hospital, 50-70 children out of 1000 births suffer from pathological jaundice. The most common causes of the development of pathological jaundice are:

hemolytic disease associated with incompatibility of the blood of mother and newborn by group and/or Rh factor. Severe jaundice often occurs when the mother has the first blood group, and the child has the second or (less often) the third; or in a mother with a negative Rh factor, if the child has a positive one.
pathological jaundice can be an early manifestation of various congenital infectious diseases that require long-term special treatment.
Another reason for the development of pathological jaundice is premature delivery.
babies born to mothers with diabetes mellitus, even if it appeared “temporarily” during pregnancy (gestational diabetes mellitus), are more likely to develop severe and long-lasting jaundice.
Sometimes the source of increased bilirubin levels is various minor hemorrhages in a child.
Swallowed blood, for example from cracked nipples.
The introduction of certain medications to the mother during childbirth, such as oxytocin, and to the baby of certain antibiotics (ampicillin, cefazolin) can also provoke jaundice.
Parents should be alarmed when, along with jaundice that has persisted for more than three weeks, they notice that the baby’s urine is colored and the stool is discolored. These manifestations may be a sign of congenital biliary tract disease.

Any pathological jaundice will require treatment. The main treatment method for neonatal jaundice is currently phototherapy. In phototherapy, special lamps are usually used, the wavelength of which is selected in such a way that they break down bilirubin, turning it into a non-toxic derivative, which after 10 - 12 hours is intensively excreted in feces and urine from the child’s body. A very good combination of phototherapy and maintaining full breastfeeding. Therefore, the practice of working in the neonatal departments of our maternity hospital has introduced a method of conducting light therapy for a child without “separation” from the mother (staying together is maintained).

However, in more severe cases, with a high level of bilirubin in the blood or insufficient effectiveness of phototherapy, infusion therapy may be required for treatment, and in especially severe cases, an exchange transfusion operation is used.

There are situations when a long time is required to obtain the effect of the treatment measures being carried out or additional examination methods, careful monitoring and observation of the child are required. Then the baby is transferred from the maternity hospital to a children's hospital. In such cases, the mother and relatives need to clearly understand that the transfer is not a “whim” of the attending physician, but a necessary measure, since there is a danger of the negative effect of bilirubin on the infant’s still imperfect central nervous system.

However, in most cases, the average duration of treatment for neonatal jaundice reaches 96 hours. Therefore, with effective treatment, mother and baby can be discharged home very soon, and in the near future there will be no need to carefully look at the color of the newborn and compare it with a chicken or a lemon. And the staff of the newborn department of the maternity hospital can only wish their little patients and their mothers a happy journey, and look forward to meeting new babies.

Head of the newborn department Ilkevich N.G.

After birth, the baby's body undergoes significant changes, adapting to the new environment. Often on the third day after birth, the baby’s skin and mucous membranes acquire a yellowish tint. This is the so-called jaundice of newborns. This is basically the natural physiological state of the child.

It is explained by the characteristics of the newborn’s body and occurs in more than 50% of healthy children and 70-90% of premature babies. What other jaundice occurs in newborns, we will consider the causes and consequences of this disease further.

Jaundice in infants is called physiological (conjugative) and occurs approximately on the third day of a newborn’s life and does not require treatment. Signs of jaundice subside after a week and are almost not observed by two weeks.

This condition occurs due to an increase in the amount of bilirubin in the blood of the newborn. Bilirubin is a bile pigment.

The high level of bilirubin in the baby is due to the baby’s body adapting to new conditions. Bilirubin is produced by the breakdown of hemoglobin. Immediately after birth, the baby changes fetal hemoglobin (HbF) to hemoglobin A (HbA). Therefore, in the newborn’s body, hemoglobin HbF is intensively broken down and the bilirubin content increases sharply.

The baby's enzyme systems are also immature. Therefore, the liver cannot cope with removing large amounts of bilirubin, and the pigment gives the skin of some parts of the body and mucous membranes a yellow tint.

As the baby grows older, the enzyme systems begin to function in accordance with the norms and remove bilirubin, the yellow tint of the skin disappears and it becomes pale pink.

Premature babies have more immature enzyme systems. Therefore, in such children, jaundice may take longer to appear and develop into a dangerous nuclear form.

Sometimes a doctor may prescribe a newborn - do not neglect this examination, it is very important.

Bilirubin norms in infants

When a child is just born, the level of bilirubin in his blood is usually no more than 34 µmol/liter, but immediately begins to rise.

Over the course of five days after birth, bilirubin in the baby’s blood increases significantly and can reach more than 200 µmol/liter.

After about a week, the figure decreases to 165 µmol/l. The acceptable level of bilirubin in a premature baby is different. The data is shown in the table.

Child's age	Norm of total bilirubin (µmol/l)
Premature baby 3-5 days
Newborn up to 1 day
Newborn from 1 to 2 days
Newborn from 2 to 5 days
Child over 1 month	3,4 – 21

By about a month, the baby’s bilirubin levels return to the normal adult level and amount to 21 µmol/liter.

The amount of bilirubin in men is usually higher than in women.

Jaundice is caused by a deviation in bilirubin levels from normal. Jaundice can be both physiological and pathological.

The neonatal (postpartum) type of the disease is usually physiological in nature.

Pathological jaundice in newborns is not common. They require mandatory medical supervision and treatment if necessary. Please note that different types of illness have different causes and consequences.

Classification of the disease

Hemolytic jaundice or suprahepatic. It is formed if the liver cannot cope with the processing of bilirubin, which is massively formed as a result of increased breakdown of red blood cells;
Hepatic jaundice. This form is associated with the inability to remove bilirubin by the liver due to inflammatory diseases;
Mechanical or subhepatic forms, which are caused by impaired passage of bile through the biliary tract.

Hemolytic form of jaundice in a baby occurs due to incompatibility in the blood type or Rh factor of the mother and baby. This form of the disease usually has a favorable prognosis, but it can also be dangerous for the child’s health.

Hepatic or parenchymal jaundice caused by inflammatory processes in the liver parenchyma. These jaundices occur when certain bacteria or viruses attack the liver. This could be viral hepatitis, herpes virus, rubella, cytomegalovirus infection, toxoplasmosis and others.

With this form of the disease, children are often born premature, with low weight, developmental delays, and with signs of damage to other organs. Such jaundice appears immediately at birth, and the skin has a grayish tint.

Mechanical jaundice caused by stagnation of bile. The reasons that prevent the excretion of bile in an infant may be deviations in the development of the biliary tract, bile thickening syndrome, compression of the bile ducts by tumors, etc.

With this form, direct bilirubin accumulates in the blood, which causes jaundice with a greenish tint, the liver becomes enlarged, and the color of stool (almost colorless) and urine (darkens) changes.

A separate species is distinguished "mother's milk jaundice" or Arias syndrome. This type of disease can occur in babies who are breastfed.

The cause of this form of jaundice is the increased content of hormones in mother's milk, which reduce the function of bilirubin excretion by the liver. It accumulates and causes jaundice.

This jaundice usually appears towards the end of the first week after birth and goes away within four weeks.

To diagnose jaundice associated with mother's milk, the child is transferred to artificial feeding for a while. If the amount of bilirubin decreases at the same time, and later, when feeding is resumed, increases, then a connection with breast milk can be established. But you don’t have to give up breastfeeding. Such jaundice is not dangerous and will go away on its own in a month, as soon as the level of hormones in the milk decreases and the baby’s liver activity is established.

Reasons

Reasons physiological jaundice may be:

Premature birth (premature baby);
Some maternal illnesses during pregnancy;
Diabetes mellitus in the mother of the child;
Oxygen starvation in the prenatal period;

Reasons pathological jaundice:

Incompatibility of Rh or blood type between the baby and his mother;
Heredity;
Infectious liver diseases (hepatitis);
Anomalies in the development of the infant’s gastrointestinal tract (tumors, cysts, undeveloped bile ducts, etc.);
Overdose when taking medications;
Hemorrhages;
Pathological birth.

Symptoms

How to distinguish physiological jaundice from pathological? A doctor must make a diagnosis based on blood counts and observations of the baby’s health.

Symptoms physiological jaundice:

staining of the skin, mucous membranes or sclera of the baby’s eyes yellow on the third day after birth;
Reduction or disappearance of pronounced signs of jaundice by day 10;
A decrease in bilirubin levels by the 7th day of life and their normalization before the first month;
The baby's general well-being is not affected.

Symptoms pathological jaundice the following can be defined:

jaundice appears during the first days after birth;
bilirubin level is more than 220 µmol/liter and is increasing;
the duration of icteric staining is more than two weeks;
the appearance of jaundice after the 14th day of life;
change in stool color to almost colorless;
darkening of urine;
constipation (especially with jaundice caused by gastrointestinal pathologies);
liver enlargement;
deterioration of the child’s general well-being.

How is the degree of jaundice assessed?

The degree of jaundice is assessed using the Cramer scale. This method is based on examining the child in natural light and determining the correspondence between the coloring of the child’s body parts and bilirubin levels. You can study the method in more detail using the figure.

So, if only the scalp and sclera of the eyes or the oral mucosa are jaundiced, the total bilirubin is up to 100 µmol/liter. This is the first degree.

If there is jaundice of the head and body to the waist, then total bilirubin is up to 150 µmol/liter. This is the second degree. And so on.

An alternative method is TCB - the transcutaneous bilirubinometry method. It is used in developed countries, especially often with racial diversity of patients (with different skin colors), when it is difficult to assess the degree of jaundice of their skin.

Treatment

If we are talking about physiological jaundice, then it does not require treatment, only medical supervision. In this case, sunbathing, breastfeeding, and walks in the fresh air will help.

Treatment of pathological jaundice depends on its cause and is prescribed by a doctor after all the necessary studies and medical history. Most often, treatment is carried out in a hospital.

Hepatic jaundice caused by viruses and bacteria is treated with special antibiotics, antiviral drugs, and immunocorrective therapy is prescribed.

If jaundice is caused by pathologies in the development of the biliary tract or intestines, then most likely surgery cannot be avoided.

To liquefy bile, choleretics and cholekinetics are prescribed.

Enterosorbents (for example, enterosgel) can be used as adjuncts. Sometimes glucose is prescribed; how and how much to give is decided individually in each case.

In some cases, it is necessary to replenish vitamins and microelements and prescribe fat-soluble vitamins D3, A, E, and calcium, phosphorus and others.

Drugs that affect the activity of microsomal liver enzymes, so-called inducers, may be prescribed. In this case, the inducers are barbiturates (phenobarbital, benzonal and others).

Phototherapy

Phototherapy is most effectively used to treat jaundice with increased indirect bilirubin. This is treatment using special phototherapeutic lamps with an ultraviolet radiation spectrum with a wavelength of 400–500 nm.

With the help of light waves of this length, indirect bilirubin is transformed into a water-soluble isomer and excreted in the urine. Thus, the amount of bilirubin decreases.

Treatment is carried out if the level of bilirubin reaches values at which toxic damage is possible.

The break during a phototherapy session is 2-4 hours in a row. In cases where the bilirubin level is much higher than normal, light therapy can be carried out continuously. The average course of phototherapy reaches 96 hours.

How long the baby should lie under the device is determined individually in each case. The use of such lamps is very effective and often allows you to completely cure the disease.

During phototherapy, it is imperative to monitor the baby's fluid balance.

In some cases (for example, with a protracted illness), it is possible to carry out such treatment at home by renting a photo lamp.

In the treatment of pathological prolonged jaundice, infusion therapy is used. Drops of glucose, saline, and other medications may be used to maintain fluid balance and more quickly remove bilirubin from the baby's blood.

The following medications can be used to treat various types of disease: hofitol, ursosan, polysorb, ursofalk, galstena, elkar.

Attention! All medications must be prescribed by your doctor. None of the medicines listed here should be used without consulting a specialist.

In any case, the need for treatment of jaundice is determined by the doctor.

Find out all about it, contraindications and side effects.

Possible consequences and complications

With any forms of pathological jaundice, complications are possible due to late diagnosis and lack of adequate treatment.

Since the hemolytic form of jaundice is most often caused by a discrepancy between the Rh factor of the baby and his mother or their blood group, it is very important, if the mother has a negative Rh or first blood group, to be observed by a gynecologist and do all the necessary tests associated with this risk. In case of complications, doctors will be able to provide assistance in a timely manner, without serious consequences.

Not only total, but also direct and indirect bilirubin are assessed. Indirect bilirubin has a toxic effect on the body and affects the child’s central nervous system. This occurs when the amount of such bilirubin in the blood serum of a full-term baby increases to more than 342 µmol/liter. The degree of brain damage depends not only on the amount of indirect bilirubin in the blood, but also on the time it remains in the cells of the central nervous system.

If pathological jaundice is not treated in time, the baby may have decreased hearing, vision, and developmental delays.

Therefore, it is very important to take measures to reduce bilirubin, establish the correct diagnosis and, if necessary, undergo adequate treatment.

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

What's happened?

Jaundice in newborns is a fairly common phenomenon; it is observed in 50-60% of full-term and 80% of premature babies. You shouldn't treat it like a disease. The child’s skin turns yellow for completely 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, just like its liver. It is this organ that is responsible for the excretion of bilirubin, which is formed in all people during the breakdown of red blood cells. These blood cells are constantly renewed, hence the need to “recycle” aging cells.

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

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

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

How to treat?

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

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

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

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

Pathological situations

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

Such jaundice develops already in the first hours after the baby is born. As a result, severe anemia is observed in the newborn, his liver, central nervous system, and brain suffer. Doctors closely monitor bilirubin levels. When certain critical levels of this pigment in the blood are reached, a replacement blood transfusion is prescribed. Sometimes several such procedures are required to reduce 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 genetic error. This disease is very rare; according to official medical statistics, one out of 15 thousand children born is susceptible to it. This condition is eliminated surgically; the operation is very complex and high-tech, but it gives the child a chance for a further normal life.

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

Overdose of vitamin K. The drug "Vikasol" (a synthetic analogue of vitamin K) is used during childbirth to prevent or eliminate 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 due to the mother’s diabetes.
Genetic (hereditary) liver malformations. These are some types of genetic syndromes in which structural genetic errors have arisen at the level of organ formation in the fetus.
Intrauterine infections. Some infectious diseases that the mother suffered during pregnancy can cause pathologies in the development of the fetal liver.

Treatment of pathological jaundice

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

Quite often, when treating pathological types of jaundice, children are prescribed such a serious drug as Phenobarbital. Evgeny Komarovsky says that there is nothing unusual about this; this drug actually has the ability to activate enzymes that accelerate the binding of bilirubin in the liver. However, nowhere in the world is this medication used to treat young children, since the side effects that Phenobarbital has on the child’s nervous system are so destructive that its other properties lose relevance. Modern medicine has established for certain that the use of Phenobarbital at an early age always leads to a decrease in intelligence and learning ability at an older age.

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

The presence of physiological jaundice in a newborn is not a contraindication to hepatitis vaccination. There is no point in refusing vaccination just because the baby is yellow, says Evgeniy Komarovsky. With pathological jaundice, the risk of getting hepatitis increases significantly, and therefore Komarovsky considers vaccination even more necessary and useful.

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