Jaundice in newborns: when should it go away? Infant jaundice: symptoms, treatment methods, consequences for newborns Jaundice in newborns Komarovsky treatment

Jaundice in newborns is not just often - but it happens almost always. Any mother will easily notice the first symptoms. The baby becomes unusually swarthy or as if filled with yellowness, the whites of the eyes turn yellow. What is it - a disease or a feature of a small child? This will become clear later, after a few days of observation. Most often, there is no reason for concern, this condition is due to some physiological characteristics of the body of a newborn child.

Why does jaundice appear?

Bilirubin is primarily to blame here.. What is it and where does it come from? Everything is pretty simple. A child who has not yet been born has special blood with special (fetal) hemoglobin. It carries oxygen through the baby's blood vessels. When a baby is born, it begins to breathe with lungs. And then the composition of the blood changes: “live” hemoglobin appears in it, and fetal hemoglobin is destroyed. This is where bilirubin is formed. The child does not need it, and the small organism begins to get rid of it.

For a child, this is a very difficult task. Just like that, bilirubin cannot be removed. First, it enters the liver and mixes with special enzymes there, then it dissolves in the urine and even then it is easily excreted. If the liver fails and there is a lot of bilirubin in the blood, jaundice will begin.

Causes of pathogenic jaundice are completely different. They are most often caused by a violation of the outflow of bile from the body due to the following conditions:

blood type incompatibility;
Rhesus conflict;
viral damage to the liver;
genetic metabolic disorders;
hereditary diseases;
hormonal disorders;
mechanical damage to the biliary tract or liver.

VIDEO:

Norm of bilirubin

In the blood of a newborn baby, bilirubin should be from 8.5 to 20.5 µmol / l (micromoles per liter). The unit of measurement is quite complicated, but you can not delve into it. If it’s really interesting, the blood test takes place at the molecular level. If the results of the analysis show that the content of bilirubin is slightly higher than normal, the doctor understands that the baby's body does not have time to cope with the load. True jaundice occurs when the bilirubin level exceeds 35 µmol/L.

And yet it is different...

Why jaundice appears is already clear. And why in general there are difficulties with a conclusion of a bilirubin? Could this be a sign of pathology? Unfortunately yes. Doctors distinguish between two groups of jaundice - physiological and pathological. Consider all types of jaundice from the rarest to the most common.

Pathological types of jaundice

They are rare, but require mandatory medical supervision and treatment. With pathological jaundice, there are always additional symptoms. Some may be noticed by the mother or one of the relatives, others are recognized only by the doctor.

Hemolytic disease

Among all babies who develop neonatal jaundice, less than 1% are those suffering from hemolytic disease. Her reasons:

Rhesus conflict between mother and baby (most often);
blood type mismatch (very rare);
antigen incompatibility (almost never occurs).

However, such jaundice is quickly recognized. The skin and sclera of the baby do not turn yellow in a few days, but almost immediately after birth. The child looks lethargic and sleepy. The doctor, examining the baby, will feel an increase in the spleen and liver. All these signs show that the newborn urgently needs help, and then the doctors begin immediate treatment. The most severe case is kernicterus., in which bilirubin poisons the baby's brain.

Mechanical jaundice

Rare, but still pathological. There are several reasons for obstructive jaundice:

gallbladder problems;
violation of the patency of the bile ducts;
liver problems.

Most often, obstructive jaundice is caused by genetic disorders or birth injuries of the baby. The manifestations of this disease become noticeable when the baby is two to three weeks old. The skin at the same time looks not just yellow, but with a greenish tint. The baby's stool becomes abnormally light, almost colorless. The doctor will feel that the liver is thickened, and the spleen is enlarged. If obstructive jaundice is suspected, various additional examinations are prescribed - for example, ultrasound. Treatment will depend on the type of pathology..

There are also borderline conditions when prolonged postpartum jaundice turns into pathology:

Conjugative jaundice associated with poor liver function. Liver enzymes do not bind bilirubin well and cannot cope with its removal from the blood.
Nuclear jaundice occurs with a sharp increase in the level of bilirubin during postpartum jaundice. In this case, bilirubin penetrates the nervous system and exerts its toxic effect on it.
Hepatic jaundice appears when liver cells are damaged by viruses or bacteria.

Physiological jaundice

Now all doctors have recognized that this is not a disease, but one of the options for the normal state of a newborn child. However, even in this situation, the baby must be carefully monitored so as not to miss possible pathologies.

Breast milk jaundice

Another rare case. It occurs when a mother has a lot of estrogen in her milk (this is a female sex hormone). Then the baby's liver first of all begins to remove estrogen, and only then - bilirubin. In this case, the baby remains icteric for up to three months.. At the same time, the baby is developing well - he has a good appetite, sleep and an increase in weight and height. This condition is not dangerous and goes away on its own.

If a baby develops jaundice of breast milk, mothers often ask: isn't it better to wean the baby from the breast? There can be only one answer: no better! Yes, without breast milk, the baby will stop “turning yellow”. But how many useful and important things will he miss out on? So breastfeeding must continue..

neonatal jaundice

And finally, the most common type. This is jaundice, which appears in most children.. It is not a disease and does not require treatment. Such jaundice of newborns passes by itself and does not lead to complications. True, there is another view: if jaundice has appeared, then the baby’s liver is still overloaded. But the baby can be helped.

Symptoms

The main and indicative symptom of any type of jaundice is a change in the color of the skin and mucous membranes, the whites of the eyes. They become bright yellow, almost lemon in color.

When more than two weeks pass, and the baby's skin has not acquired a normal color, you should consult a doctor. Before treating jaundice, an analysis will be prescribed for the level of bilirubin in the blood. The level of bilirubin depends on many factors and it is impossible to unambiguously interpret the results of the tests. The doctor will draw conclusions about the state of health of the child according to the general picture of the state of health.

Symptoms of pathological types of jaundice are manifested in a change in the color of the skin. The differences are in the time of their appearance and some features of the manifestation:

change in skin color appears immediately after birth;
after three or four days the yellow becomes brighter, all symptoms increase;
yellowness of the integument persists for more than one month;
the onset of symptoms of jaundice is undulating: it will appear, then it will disappear;
in addition to yellow, skin color can also acquire a green tint.

In addition to the change in the color of the skin, other symptoms are added:

feces are discolored;
urine is dark in color
spontaneous bruising;
there is an increase in the liver and spleen;
the general well-being of the child is deteriorating.

With nuclear jaundice, the sucking reflex fades, severe drowsiness and convulsions occur.

If we are talking about pathology, then any therapy is prescribed by a doctor. Most often, the baby and mother go to the hospital, where they carry out all the necessary procedures.. For example, if the mother and child have a different Rh factor or other signs of blood incompatibility, then transfusions are most often prescribed. In one procedure, the baby can replace up to 70% of the total amount of blood. In difficult cases, transfusions are repeated several times.

These measures help to get rid of pathological bilirubin, but can weaken the baby. Therefore, additional therapy is often prescribed: antibiotics, physiotherapy, and so on.

Obstructive jaundice often requires surgical intervention. A well-founded decision is usually made by a whole commission of doctors who carefully examine the child and determine all the necessary measures. Such treatment and rehabilitation are also carried out in a hospital setting.

If the jaundice is physiological, then it is more likely not about treatment, but about helping the baby. The child will cope with his condition faster if:

attach the newborn to the breast as early as possible (this stimulates metabolic processes);
full breastfeeding;
diet of a nursing mother so that the baby does not have digestive problems;
sunbathing;
walks in the open air.

The last point, unfortunately, cannot be fulfilled if it is cold outside. But in spring, summer or in warm autumn, it is necessary to take the baby out into the fresh air. In summer, in calm sunny weather, you can open children's arms and legs for a few minutes. This is especially useful in a light shade - for example, under a tree, so that diffused light hits the child. The main thing is that the baby does not freeze.

Such care for the newborn will perfectly help to remove bilirubin from the child's body. As a result, the baby will not only have jaundice. The child will also become healthier and feel better.

The main way to treat and prevent neonatal jaundice is breast milk. That is why the newborn is applied to the breast from the first minutes. Colostrum (the first portions of breast milk) has a pronounced laxative effect. It promotes the excretion of a coloring matter (bilirubin) along with feces. Breastfeeding is the best cure for jaundice.

Sometimes, in addition to breast milk, irradiation with a special lamp for the treatment of jaundice is prescribed - phototherapy. During the procedure, the child's eyes are covered with a bandage or goggles and placed under a lamp. The course is 96 hours.

jaundice treatment lamp

Side effects may occur during phototherapy. The child may develop drowsiness, the skin begins to peel off and there is a disorder of the stool.

Sunbathing has the same effect. The baby's body in the light begins to actively produce vitamin D. It speeds up the process of removing bilirubin from the blood.

With severe jaundice, glucose and activated charcoal tablets may be prescribed by the doctor. Glucose helps to improve the active functioning of the liver. Activated charcoal absorbs harmful substances like a sponge, including bilirubin. Further, coal, together with bilirubin, is excreted naturally with feces.

The doctor develops a method for treating pathological types of jaundice depending on the diagnosis. All factors and circumstances of the birth of a child are taken into account. The course of childbirth and pregnancy, mother's diseases, the results of tests and ultrasound. Sometimes consultation of narrow specialists is required; surgeon or endocrinologist.

In the treatment of jaundice, different types of therapy are used:

Antiviral.
Antibacterial.
Choleretic.
Detoxification.
Immune.

They are used both individually and in combination under close medical supervision. It depends on the causes of jaundice.

Consequences and problems

In pathological conditions, it is impossible to predict how quickly the baby will recover. First of all, it all depends on the causes of the disease and its severity.. That is why it is especially important to observe the baby in the first days of life. What to pay attention to?

Jaundice arose a few hours after the birth of the baby (blood conflicts are possible).
The child develops poorly, he is sleepy and lethargic (a significant excess of bilirubin in the blood, including with hemolytic disease).
Jaundice is accompanied by convulsions, constant crying (this may be kernicterus). With such a diagnosis, the child may develop hearing impairment, motor pathologies, in the most severe case, the baby may die.
The newborn has birth trauma.

As soon as the newborn has jaundice, careful observation is necessary to prevent the development of pathologies. If the treatment is carried out on time, the baby will recover very soon and will grow up healthy..

Physiological jaundice does not cause any complications. It can last two to three weeks. Most babies get rid of jaundice when they are one month old. If the cause is in the mother's milk, then the condition may drag on for another one or two months. After that, the skin and eyes of the baby are completely freed from the yellow tint. All this time the child is fully developed. The main thing for him is the care of his mother, relatives and doctors. And then the baby will grow up healthy and happy.

Physiological jaundice in healthy children does not harm the body, does not affect the further development of the child. Pathological jaundice increases the risk of occurrence and development of cirrhosis or liver cancer with age. In 90% of children who have had hepatitis in infancy, the consequences of jaundice remain for life. This is expressed in a weakened immune system and poor liver function.

Transferred nuclear jaundice in the future can lead to deafness, complete or partial paralysis, mental retardation. The toxic effect of high levels of bilirubin on the nervous system has the most severe consequences.

Oh, how much they got nervous, and they continue to do it, I'm even scared to watch it myself. They were immediately taken to the hospital for observation and treatment. And I decided to conduct my own investigation and collect more information on this topic for my friend and for myself, so to speak, to improve the skills of an amateur medical mother.

It turns out that postpartum jaundice in newborns is quite common! Only distinguish between a dangerous and non-dangerous form of this condition. I decided to find out why this is happening.

If the child suddenly turned yellow on the 2nd-3rd day of life, and the sclera of the eyes also acquired a yellow tint, this is jaundice of the newborn. Distinguish physiological and pathological jaundice in children, which is detected in the first week of a baby's life.

Physiological jaundice occurs in 60% of newborns. As a rule, the skin and sclera turn yellow on the 2nd or 3rd day of life, and the whole thing goes away in 2-3 weeks.

What is the reason for the yellowing of the skin and mucous membranes in children? It turns out that this is due to the still immature liver of a newborn, which is not able to convert the bile pigment bilirubin and it begins to stain the skin, the whites of the eyes, and mucous membranes.

When a child is in the womb, his liver does not process bilirubin and a special type of hemoglobin is produced in the blood, saturated with oxygen from the mother's blood. When a child is born into the world, he begins to breathe on his own, and will be disconnected from the mother's umbilical cord, a supplier of blood and oxygen.

At this time, a large number of red blood cells are released into the small immature organism, and the "maternal" hemoglobin is replaced by its own.

Over time, the liver adapts and processes bilirubin fully, while normal hemoglobin is formed, and "unnecessary" bilirubin is excreted in the urine and bile from the body.

This happens in absolutely all newborns, but not all noticeably. And some, who are not lucky at all, may develop a dangerous form of jaundice - pathological.

Even in the maternity hospital, a mother and a neonatologist should observe the baby, check his skin and the whites of his eyes - are they yellowed? But, since the development of physiological jaundice falls at a time when almost everyone is already being discharged from the hospital, you need to monitor this at home as well.

Most often, physiological, that is, a non-dangerous form of jaundice, does not need treatment and goes away by itself. Nevertheless, at home, the child should be breastfed more often or given water if he is bottle-fed. Then the excess bilirubin comes out with the liquid. It is necessary to check the color of the urine and feces of the newborn.

If a doctor in the maternity hospital or a visiting local pediatrician sees a threat of jaundice in a child, they can prescribe special drugs and phototherapy. Phototherapy for jaundice - a common thing, carried out in a clinic or even at home with special white or blue lamps.

It is not recommended to take an undressed newborn into open sunlight, as this is not as effective. Moreover, frightened and nervous mothers can freeze a child or burn it in the sun, in pursuit of ridding him of jaundice with sunlight.

Of course, sunbathing is necessary, we all know about vitamin D, which is produced in the sun. But it’s better not to take risks in the first month of a child’s life, especially for inexperienced first-born mothers.

Many children jaundice norm- it's just some yellowing of the face and body, the whites of the eyes, which disappears by the end of the first month of life. If the yellowness intensifies - this is a good reason to urgently consult a doctor!

Often, jaundice is detected even in the maternity hospital and the child is placed under a lamp there. Tests for the level of bilirubin in the blood will clarify the picture. When the child turns yellow, the body is colored gradually.

First the face, then the body and legs. When the jaundice passes, the face will turn pink last.

Premature babies suffer from jaundice much more often, because their liver is even more vulnerable.

Jaundice of prematurity found in about 80% of children. In this case, the child is transferred to the hospital or left in the maternity hospital and undergo special treatment.

I was even more surprised to learn that there is jaundice from breast milk. This occurs due to the indigestibility of breast milk fats by the child's body. To recognize this, you need to observe the reaction of the child to breastfeeding.

If the baby turns yellow during feeding, and in between the yellowness subsides, the doctor may identify breast milk jaundice . At the same time, feeding does not stop. As the famous doctor Komarovsky said: “If a breast-fed baby turns yellow, but feels good, gains weight, and when feeding is stopped, the bilirubin level drops sharply, then this is not scary, it will pass by itself.” With other types of jaundice, the child does not gain weight.

The situation is worse if the jaundice turns out to be not harmless, but pathological, like that of my friend's son. This occurs in a number of cases for various reasons and threatens with complex, dangerous diseases that affect the brain.

Pathological jaundice is characterized by:

The field of birth is detected immediately or on the first day;
Accompanied by bruises, pallor, lethargy;
Lasts longer than 2-3 weeks;
The level of bilirubin: direct - more than 25 µmol / l, indirect - more than 220 µmol / l;
It passes in waves - then it falls, then it rises again.

These symptoms are most often detected by doctors in the hospital, and the child is quickly sent for treatment. If timely detection and treatment is not started, there is a significant risk of developing "nuclear" jaundice , which will lead to dangerous consequences - damage to the central nervous system and brain, cerebral palsy, deafness, backwardness.

As I myself found out, comparing the facts and the information I processed, my friend's baby had hemolytic jaundice , which arises from . She has a negative Rh factor, and the child has a positive, that's the problem.

And she was also afraid of getting pregnant because of this negative Rh. The pregnancy went well, but after the birth, the consequences of the pregnancy were reflected in the child. This can also occur with a conflict of blood types, if the mother has the first group.

Subsequent newborns, that is, the second and subsequent ones, are especially at risk. This is due to the production of antibodies in the mother's body during the first pregnancy.

Modern medicine has developed maternal immunoprophylaxis after the first birth, which has significantly reduced the incidence of hemolytic disease in subsequent children.

Hemolytic jaundice is detected on the first day after the birth of a child, while detecting low hemoglobin and an enlarged liver.

When this type of jaundice is detected on the 2nd–5th day, the clinical picture becomes clear, whether “nuclear” jaundice will develop.

Even the name itself is creepy, evokes terrible associations.

This does not mean that the child will turn into a special vigorous yellow color, sorry for the inappropriate humor. This means that this species is especially dangerous for the body with irreversible processes that cannot be treated.

Manifestations of "nuclear" jaundice:

General depression, lethargy, some lethargy, mild sucking reflex;
The child screams monotonously, a manifestation of irritability, muscles in hypertonicity;
Convulsions, apnea, bradycardia, high-pitched scream.

When the stage of "nuclear" jaundice is irreversible, the child falls into a stupor, and then into a coma. Then come irreversible brain damage, disability. In addition to a conflict with the mother's blood, this type of disease can develop due to congenital infections of the fetus (toxoplasmosis, rubella, herpes, syphilis).

conjugated jaundice may occur due to problems with the structure of the liver and bile ducts. The development of this type of jaundice is due to congenital cholestasis. Although cholestasis itself can occur with normal liver function.

Neonatal cholestasis also causes the release of bilirubin into the blood and the formation of jaundice, while bile accumulates in the ducts and gallbladder.

My information turned out to be useful for my friend, because doctors explain little to her, they only stuff her with medicines. I hope this article is useful to someone else. Share it on social networks using the buttons below.

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My children did not have a pronounced neonatal jaundice - somehow everything worked out well. But with the youngest son there was one not very pleasant incident. We were discharged from the maternity hospital after the CS on the 6th day. As expected, the next day the local pediatrician, 75 years old, showed up.

It was a bright sunny day in early June. Max slept peacefully in one diaper. And in the room where he slept, I hung joyfully orange curtains (I love this color). Accordingly, the entire room was bathed in a sunny orange light.

The doctor went into the room and looked at the child from afar. And suddenly she whispered in a terrible voice: “He is all yellow! You have JAUNDICE! We need to go to the hospital immediately!”

All my arguments that the child has dark skin, that we have orange curtains, the sun shines brightly and everything around seems yellow - even you and I - had no effect. She continued to insist on hospitalization ... I had to quickly say goodbye to her and the next time we saw her when Max was already 1 year old. Well, just to show her - what a healthy and not yellow baby turned out).

look video of Dr. Komarovsky "Jaundice of newborns" :

Moms, do not panic, everything is being treated! The main thing is to identify and seek help in time. Don't forget to subscribe - there is a lot of useful information ahead.

Young mothers, while still in the hospital, notice that the skin of the newborn becomes yellowish. At the same time, the pediatrician, examining the baby, also pays attention to this factor. Jaundice in a newborn makes a new mother worry. But is this condition so dangerous? And is it worth sounding the alarm prematurely?

Why does the baby turn yellow?

The skin of an infant is almost always stained for 2-3 days. Such jaundice in a newborn (photo in the article) is the norm. It is also called physiological. For some babies, this process goes completely unnoticed. For others, it may pose a threat. It depends entirely on the mechanism of bilirubin formation, as well as the ability of a small body to neutralize and remove it.

So, why does a newborn have jaundice? To answer the question, consider the mechanism of the small organism.

Bilirubin is a product obtained from the breakdown of blood cells. Its distinguishing characteristic is its yellow color. Bilirubin is found in every body and is involved in metabolic processes.

While the baby is in the womb, many red blood cells carry hemoglobin. After birth, the need for such a number of blood cells disappears. That is why the process of their disintegration takes place. As a result, bilirubin is formed. He must, together with the blood, enter the liver and be excreted with the first feces and urine.

However, the child's body is not yet perfect. Many systems are just getting ready to function properly and are not yet fully capable of coping with all the responsibilities. That is why bilirubin, reaching the liver, is partially absorbed into the blood of the child. It stains the mucous membranes and skin.

Thus, jaundice in a newborn is a physiological process that occurs in crumbs as a result of imperfect functioning of systems. There is no reason for concern in this case.

Signs of physiological jaundice

This condition in the crumbs occurs, as a rule, for 2-4 days. It is extremely important to remember when jaundice passes in newborns. The skin should acquire a normal healthy color after 2-3 weeks in children who were born on time, and after 3-4 weeks in premature babies. This is one of the most important indicators of the physiological process.

We can say that there is a norm of jaundice in newborns, if this condition disappears in infants without the intervention of a doctor and does not cause any disturbances in the baby's body. At the same time, a decrease in shade should begin to be observed already at the end of the 1st week of life.

Thus, the signs of a physiological state are as follows:

yellowish tint of the face of the newborn and mucous membranes;
the appearance of staining on average by the 4th day of life;
the whites of the eyes are yellow;
staining begins to gradually fade after the first week;
the condition of the baby is quite normal;
feces and urine of natural color.

In addition to visual signs, jaundice in a newborn, the photo of which clearly demonstrates this condition, is controlled by the bilirubin indicator in the blood.

Causes of physiological jaundice

Doctors identify a certain risk group. Jaundice in a newborn may occur if:

the baby was born prematurely;
the child's mother has diabetes;
twins were born.

Modern experts, conducting research in this area, have identified several factors that can affect this condition in crumbs. Causes of jaundice in newborns may lie in:

nutrition of a woman during pregnancy;
bad habits of the expectant mother;
deterioration in the health of the pregnant woman;
unfavorable state of the environment;
iodine deficiency during pregnancy;
woman taking certain medications.

All these factors can affect the underdevelopment of the baby in the womb. In addition, they can provoke premature birth. And in this case, the baby’s body does not have time to fully form in order to function perfectly.

As a result, the accumulated bilirubin does not reach the liver in a timely manner for removal. The previously discussed process of staining the skin occurs.

Pathological jaundice

Physiological jaundice in a newborn, discussed above, is a completely natural and completely harmless condition. However, sometimes the second type can also be observed. We are talking about pathological jaundice.

This state is not so safe. In this case, jaundice in newborns is caused by some kind of malfunction in the child's body. The norm of bilirubin in such babies is exceeded. We must not forget about the toxicity of this pigment. Exceeding a critical indicator entails poisoning the body.

Unfortunately, intoxication of the infant organism can provoke quite deplorable consequences of jaundice in newborns:

damage to the brain and nervous system;
deafness
mental retardation.

Therefore, it should be remembered that prolonged yellowness of the skin can be very dangerous. Such a baby is subject to immediate diagnosis and adequate treatment.

Symptoms of pathology

In most cases, physiological jaundice is found in newborn crumbs. Pathologies are extremely rare. And yet you should be very careful about the condition of the baby in the first days of life.

In order to recognize the disease in time or to make sure that the experiences are groundless, you should know what symptoms a newborn jaundice manifests in case of pathology:

staining of the skin occurs on the first day;
the child has a yellow skin tone for a long time (more than 3 weeks);
a blood test shows a high content of bilirubin;
the child is lethargic, drowsy, lethargic;
the baby refuses to eat;
there is an inhibited sucking reflex;
the newborn screams monotonously;
muscle hypertension is observed;
the presence of dark urine;
the stool is almost discolored.

These are the main signs characterizing the presence of pathology. Most of the above symptoms, parents are able to notice on their own, even without the help of a doctor.

If such a moment is missed, and treatment is not started in a timely manner, then the baby may develop new symptoms, more serious:

bradycardia;
convulsions;
piercing cry;
high lethargy - stupor;
coma.

Causes of pathology

Once again, young parents should be reassured. Pathological jaundice in newborns is diagnosed quite rarely. According to statistics, this form occurs in 50-70 babies out of 1000.

The main indicator of pathology is the period of its occurrence. Mucous membranes and skin acquire an intense yellow hue almost in the first hours after birth. A blood test of such crumbs indicates a high concentration of bilirubin in the blood.

The main causes of pathological jaundice include the following:

Hemolytic disease, provoked by the incompatibility of the Rh factors in the blood of the mother and the baby.
Intrauterine infection in a baby's liver.
The presence of hereditary pathologies in the crumbs.
Abnormal development of the bile ducts in a child.
Immaturity of liver cells in an infant.
Pathology of the pancreas.
Hypothyroidism - reduced functioning of the thyroid gland.
Introduction during childbirth of the mother of the drug "Oxytocin".
Premature birth of women diagnosed with diabetes mellitus.
Introduction to the baby of antibiotics, such as Cefazolin, Ampicillin.

Such pathology is more susceptible to children whose mothers had a difficult pregnancy. Often, these women had pronounced early, late toxicosis, threats of miscarriage. Significantly aggravate the condition of the transferred abortions, miscarriages. They can also become a source of development of such an unpleasant condition as pathological jaundice in newborns.

Norm of bilirubin

This concept is rather relative. The norms of bilirubin are different for newborns and adults. They differ for babies who appeared on time and premature babies.

For visual assessment of the level of bilirubin, the Cramer scale is used. It indicates that the skin of the newborn is stained unevenly. There is a certain pattern of yellowing of certain areas, depending on the biochemical indicator in the blood.

Initially, the face and neck of the newborn are stained. After that, the body turns yellow. Then comes the turn of the upper limbs. Behind them, the hands acquire yellowness. Then follow the lower limbs, feet.

If you look at the blood test of an infant who has yellowness of the arms and legs, you can see that the level of bilirubin is much higher than the critical indicator. This scale allows you to visually observe the dynamics of the course of this state. According to Kramer, when jaundice in newborns passes, the blood count will completely return to normal.

The level of bilirubin is determined using biochemical analysis. If it exceeds 60 µmol / l, then yellowness becomes noticeable.

There are the following norms of bilirubin for newborns:

on the first day (baby 24 hours) - the indicator should not exceed 119 µmol / l;
in the second (48 hours) - no more than 153 µmol / l;
on the third day (72 hours) - does not exceed 187 µmol/l;
by 4-5 days - 205 µmol / l.

With physiological jaundice, the level of bilirubin never exceeds 205 µmol / l.

Diagnosis of jaundice

Do not panic if the skin of the crumbs has acquired a characteristic shade. About such a phenomenon as jaundice in a newborn, Komarovsky says the following: "You should pay attention to the accompanying symptoms." The most important feature is, as previously noted, the period of skin staining. If yellowness came a few hours after the baby was born, this is a reason to examine the baby.

However, even if jaundice persists in a newborn, Komarovsky advises considering this condition in dynamics. If the baby is cheerful during the wakefulness period, actively suckles the breast, sleeps well, then do not worry.

In case of suspicion of a pathology, it is better to undergo a diagnosis. To do this, the following studies should be carried out:

blood tests, urine tests (general);
study of feces;
test for bilirubin in the blood, urine;
analysis for antibodies to various infections and viral hepatitis;
blood biochemistry (determination of liver enzymes, protein, cholesterol).

If necessary, the crumbs can be prescribed:

Ultrasound of the liver, biliary tract;
liver scan;
ultrasound of the spleen;
tomography;
duodenal sounding;

Treatment of jaundice

The physiological form of special measures of intervention does not require. This condition after a while passes in the baby on its own. At the same time, some methods make it much faster and easier to overcome such a phenomenon as jaundice in a newborn. Treatment depends entirely on the degree of its severity.

The very first and main cure for jaundice is mother's colostrum. On the baby, it acts as a laxative. Colostrum allows you to somewhat speed up and facilitate the process of meconium discharge. And together with the original feces, as you know, bilirubin is also excreted from the child's body.
Sunbathing can be an excellent treatment. In warm weather, it is recommended to walk with the baby, exposing the legs and arms. In cold weather, it is advisable to move the baby bed closer to the window. The sun's rays passing through the glass will still have a beneficial effect on the baby.
A special lamp for newborns from jaundice is often used. Such therapy is prescribed to the baby very carefully, given its full-term. Under the influence of light radiation, the conversion of bilirubin begins. After 12 hours, in most cases, it is excreted from the child's body with urine and feces.
If there is a more pronounced jaundice in the newborn, more intensive treatment is required. Assign the intake of glucose, activated charcoal. Glucose contributes to a significant improvement in the functioning of the liver. Activated charcoal acts in the intestines on bilirubin, binding it and removing it from the body with feces.
With an extremely severe form of jaundice, a blood transfusion is recommended for an infant. This procedure is very dangerous. And, unfortunately, it is not always possible. It is resorted to in case of severe pathologies to save the baby with bilirubin intoxication.

Consequences of jaundice

In most cases, this phenomenon is a normal physiological process of adaptation of the infant organism to independent existence. Therefore, after 2-3 weeks, the jaundice passes naturally. It does not provoke any complications or consequences. The baby is cheerful, cheerful and develops naturally.

But sometimes the picture is not so perfect. Complications may occur in the following cases:

mother and baby have incompatible blood groups and Rh factors;
the baby is diagnosed with genetic pathologies;
even in the mother's womb, the child suffered liver damage by a virus;
the baby has a bile duct disorder.

Such factors can lead to the pathological jaundice discussed above. It can go on for more than a month. The skin of the baby is stained with a greenish tint. The color of the feces in the crumbs becomes light, and the urine, on the contrary, acquires a rich dark shade. In this case, the liver and spleen may increase in size.

The baby's condition is deteriorating significantly. In this case, you should immediately resort to medical care, since ignoring such a pathology can provoke extremely serious consequences:

toxic poisoning of the brain, nervous system;
albuminemia;
deafness;
mental retardation;
an increase in seizures.

Conclusion

Jaundice in newborns is a fairly common occurrence. And it often goes away as quickly as it comes. Most importantly, be very attentive to your baby. Strength and patience to you to adequately cope with all the worries about the newborn.

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

Newborn jaundice is a condition characterized by yellowing of the skin and mucous membranes in newly born babies.

Pigmentation may be a variant of the normal development of the child, and may indicate the presence of pathology. Doctors will help to distinguish one from the other, but parents also need to know something.

Why does a baby develop jaundice?

In itself, staining the skin of a child is not a disease, but a symptom. The yellow color of the 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, things are more complicated.

In 70% of cases, jaundice occurs in newborns, the reasons for this prevalence: the liver is not yet fully coping with its functions. At the same time, the level of bilirubin in the blood of babies is high, since erythrocytes, which supplied oxygen to the child in the womb, decay in large quantities.

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

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

If jaundice in a child occurs due to insufficiently efficient liver function, then 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 attention. This condition is called pathological jaundice and can be caused by the following reasons:

conflict between mother and baby by blood type;
incompatibility of mother and child according to the Rh factor;
antibiotic therapy for a child;
liver problems in a baby;
certain genetic diseases;
violations of the synthesis of hormones;
blockage or damage to the bile ducts;
pancreatic dysfunction.

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

Varieties of jaundice in newborns

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

How to distinguish physiological jaundice

It is quite easy to diagnose physiological jaundice in newborns, symptoms occur 2-5 days after the birth of the baby:

Bilirubin rises, the skin acquires a yellowish or swarthy tint on the face, the whites of the eyes turn yellow, then the pigmentation spreads to the arms and chest of the child.
The tummy, legs and feet of a baby with physiological jaundice rarely stain.

The baby is in good health, the behavior is natural. Feces and urine do not change their color. Bilirubin does not exceed 256 µmol/l.

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, it’s hard to wake him up;
on the contrary, the child is in constant chaotic movement;
discoloration of secretions: urine darkens, feces lightens.

If no action is taken at this stage, bilirubin enters the baby's nervous system, poisoning it. Bilirubin encephalopathy sets in, or kernicterus of the newborn. The clinical picture is complemented by the following symptoms:

monotonous cry on one note;
convulsive syndrome;
pressure drop;
coma.

Nuclear jaundice often affects premature babies. The fact is that the cells of their brain have not yet fully formed, and with difficulty resist the toxic effects of bilirubin.

Among the pathological forms, there are types of jaundice in newborns due to the cause that caused the symptoms. Allocate:

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

Mechanical jaundice, in turn, happens

hepatic,
subhepatic,
suprahepatic.

Hepatic jaundice is associated with disorders 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 conjugational jaundice in newborns. Also, the liver can be affected by toxins, viruses, bacteria.

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

When does jaundice go away?

Physiological jaundice in newborns begins to subside when the baby is a week old. Completely signs of the disease 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 illness, the duration of which depends on the situation and can be determined by the doctor.

What to do if the jaundice drags on

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 a baby (confirmed by a blood test);
blockage (or infection) of the bile ducts, stagnation of bile;
galactosemia (this is one of those diseases that are screened for in the hospital);
lack of thyroid hormone (also checked in the hospital);
polycythemia (an increase in the number of red blood cells, monitored by a blood test);
breastfeeding jaundice.

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

Worthy of special mention breastfeeding jaundice, which occurs if breast milk contains a lot of pregnandiol (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, there are two opinions about breast milk jaundice:

Some doctors believe that an increased level of bilirubin still gives the baby's liver an additional load, so breastfeeding should be stopped.
Representatives of the other camp do not see anything wrong with the continuation of feeding.

If you are afraid of harming your baby, but still want to continue breastfeeding, the following method will suit you. It is necessary to express the milk and warm it in a water bath to a temperature of 70 °. >>>

Then cool it down and give it to the child. Under the influence of temperature, pregnandiol will disintegrate and will not have any effect on the rate of excretion of bilirubin.

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

How is jaundice treated

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

The baby is placed under special lamps that work in the blue spectrum. Under the influence of light, bilirubin is transformed into non-toxic lumirubin, which is quickly excreted from the body.

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

In large cities, a lamp for treating jaundice in a child can be rented. 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.

In this case, one should not forget to donate blood on time to determine the level of bilirubin.

Glow lamps prescribed for 96 hours with breaks for feeding. To protect the eyes, babies wear special bandages or pull on hats.

With phototherapy, the baby loses fluid, so when breastfeeding, you need to apply the baby on demand.

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

After the end of phototherapy, choleretic, 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 contents of the capsule in a small amount of water. Read also: When can I give water to a newborn?>>>
It is convenient to give the baby ursofalk, with jaundice of newborns, this drug is best purchased in the form of a suspension.

Ursosan and ursofalk lower bilirubin in the blood in a few days.

Of the homeopathic medicines, doctors may recommend galsten. Galstena with jaundice of newborns is taken in the form of drops, 3 times a day. Before giving the medicine to the baby, the drops are diluted in mother's milk.

In the treatment of severe forms of jaundice, blood transfusion is used. This helps to replace most of the erythrocytes in the blood and, thereby, lower bilirubin by half in one procedure.

In one transfusion, up to 80% of the baby's blood is replaced. Taking blood from the mother is not allowed, so the child is looking for another donor.

Physiological jaundice resolves on its own and does not require special treatment. However, the mother can help the baby get rid of excess bilirubin as soon as possible:

The best method of prevention is breastfeeding. It is important to attach the baby to the breast immediately after birth. Colostrum contains components that stimulate the intestines of the crumbs. Together with meconium (the first feces), bilirubin is removed from the body. Mother's milk is the best way to replenish fluids during phototherapy. >>>
Sunbathing. In late spring, summer or warm autumn, you can move the hood of the stroller 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, obtained by the baby, helps to remove bilirubin from the body.
You should not give your baby a glucose solution or a rosehip broth on your own; how glucose should be administered for jaundice in newborns, only a doctor knows.

What are the consequences of infantile jaundice?

Breastfeeding jaundice and physiological jaundice in newborns usually do not have consequences, when the yellowness of the skin passes, nothing reminds of the disease.

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

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

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

Untreated or untreated jaundice in newborns does not pass without a trace, the consequences may be as follows:

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

If the baby suffered bilirubin encephalopathy, and he was not provided with medical assistance, then 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 in order not to miss the development of severe forms of the disease and prevent dangerous consequences.

Health to you and your baby!