26.01.2021

Jaundice in newborns

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

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

Classification

Jaundice in newborns is of two types: physiological (transient) and pathological. The first variety is diagnosed in 60–70% of all newborn babies. It is not a consequence of the disease. This is a normal condition of the newborn.

Symptoms appear on the third day after birth. They do not require treatment, but pass on their own within 3-5 days. Sometimes the symptoms disappear after 2-3 weeks. The child necessarily needs an examination to prevent the transition of such a condition into pathology.

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

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

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

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

There are two types of this jaundice:

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

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

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

Causes of pathological jaundice:

  • Rhesus conflict, which occurs due to the fact that the child has a positive blood type, and the mother’s negative;
  • intrauterine infection;
  • different blood groups, especially if the newborn has a second or third, and the mother has the first;
  • diabetes in the mother;
  • incompatibility by antigens;
  • hormonal disorders in the baby;
  • diseases of the circulatory system;
  • hemorrhages in an infant, which are an additional source of bilirubin;
  • premature birth;
  • the introduction of antibiotics to the infant or the use of drugs during childbirth during the labor process;
  • bowel, liver, or gall bladder diseases in a newborn;
  • violation of patency of the biliary tract.

The reason for physiological jaundice is an increase in the level of bilirubin due to the production of “new” hemoglobin and disposal of the “old”. The crumbs liver can not cope with such a load, therefore, jaundice appears.

Yellowing of the skin in newborns provokes asphyxia and fetal hypoxia. Postpartum jaundice can occur as a result of injuries during the birth process.

Symptoms

The severity of symptoms depends on the concentration of bilirubin in the blood and the characteristics of the skin. The sclera of the eyes, the sky and the face turn yellow faster.

Signs of pathological jaundice:

  • staining of the mucous membrane and skin in yellow;
  • a change in the biochemical analysis of blood, an excess of the normal level of bilirubin;
  • drowsiness and lethargy.

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

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

According to the following signs, physiological jaundice can be distinguished from pathological jaundice:

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

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

How long is the jaundice?

When should jaundice pass in newborns? Dates are individual for each baby, on average, all symptoms disappear in 5-10 days, in rare cases, this period stretches to 2-3 weeks.

In infants who are breastfed, traces of physiological jaundice pass faster.

Why doesn’t jaundice last a month? This indicates a pathological condition. If symptoms persist for more than two weeks, then you should show the baby to the doctor. In rare cases, we may talk about jaundice of breast milk, then jaundice remains for 2 months, and sometimes 3.

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

Diagnostics

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

Diagnostics include:

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

If palpation is suspected of an enlarged liver or spleen, an abdominal ultrasound is performed.

Norm of bilirubin

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

Bilirubin is a yellow pigment that is involved in the exchange of hemoglobin. It is released from red blood cells during the death of blood cells. This substance must be excreted from the body, because it is toxic.

There are two types of bilirubin: direct and indirect. When diagnosing, the first form is taken into account. The norm of bilirubin in a newborn is 8.5–20.5 μmol / L. If the indicators reach the level of 35 μmol / l, then jaundice appears.

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

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

  • for full-term children – 324 micromol / l;
  • for premature infants – 150–250 µmol / l.

While the child is in the hospital, it is necessary to measure the level of bilirubin 2-3 times over the entire period to make sure that its concentration does not increase.

Treatment

A newborn needs treatment if it is a pathological jaundice. All medical measures are carried out in a hospital where the mother and child are placed. At home, newborns can be treated only with a slight increase in bilirubin.

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

In the treatment of jaundice in a newborn, antiviral, antibacterial, choleretic, immunostimulating drugs and even antibiotics are used. Do not do without detoxification therapy.

The treatment is as follows:

  • Reception of enterosorbents. These drugs accelerate the removal of bilirubin from the blood. Apply Smecta, Enterosgel, Polysorb.
  • The introduction of drugs to restore water balance after phototherapy. Apply a solution of glucose, soda, electrolytes.
  • Cholagogue and diuretics. They are used if bilirubin is approaching a critical point. Apply Hofitol, Essential Forte, a solution of magnesia for oral administration, a rosehip broth in the form of tea.
  • Hepatoprotectors. They protect and repair liver cells. Ursofalk, Phosphogliv, Ursosan, Ukrliv will do.
  • Homeopathic remedies. They improve bile secretion, remove toxins and normalize stool. Effective medicines – Hepel, Galstena.
  • Drugs to improve metabolism. Elkar drops will do. They increase immunity and improve appetite. The medicine must be diluted with glucose. The dosage will be prescribed by the attending physician.
  • Antibacterial agents. Bifidumbacterin is suitable.

An emergency measure in the treatment of jaundice is blood transfusion, especially when it comes to the nuclear form of the disease.

In case of ICD in a child (urolithiasis), diuretics should be used with caution.

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

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

At home, you can continue phototherapy. Instead of a lamp for newborns from jaundice, direct sunlight will do. They contribute to the disappearance of symptoms. Sunbathing promotes the production of vitamin D, which speeds up the elimination of bilirubin from the blood.

Consequences and Complications

What is the danger of jaundice in newborns? A threat to health is only a pathological appearance. A high level of bilirubin poisons the body of crumbs, it affects the functioning of the brain and central nervous system, which leads to impaired development of the child. These are the most severe consequences of jaundice in newborns.

Other hazards:

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

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

Prevention

True jaundice, a newborn can get sick on the first day after birth, since the body of the crumbs is no longer protected and has not yet adapted to new living conditions. The best prevention of the disease is breast milk. You need to apply the newborn to the chest in the first minutes after birth, so that he receives the most valuable drops of colostrum.

Other preventative measures:

  • dieting by mom;
  • walks in the fresh air with a child;
  • sun baths.

It is necessary to feed the child on demand, and not according to the regimen. Breastfeeding helps the baby’s body get rid of bilirubin.

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

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