Difference between jaundice and jaundice. Why is bilirubin encephalopathy, also known as kernicterus of newborns, dangerous? Why does jaundice appear?

Parents are extremely sensitive to the health of their children. Especially when it comes to newborns. But what if a baby, recently born, was given a strange diagnosis of “jaundice”? Do not be afraid of this word, because most often it characterizes a natural physiological process occurring in a young body. So, let's look at what jaundice is in newborns. Causes and consequences this phenomenon are set out in the article.

Characteristics of the condition

Jaundice in newborns, the causes and consequences of which are not clear to parents, causes some panic in mothers. Therefore, let’s first look at what it is.

To understand why a child’s skin takes on an orange tint, you need to remember the anatomy course.

Human blood contains red cells. Their main function is to distribute oxygen throughout the body. Such cells live for several months. Then they are destroyed. During their breakdown, the body produces a certain pigment that has yellow, - bilirubin.

This substance is neutralized by the liver, after which it is excreted from human body. However, if the pigment level is elevated, then malfunctions may occur. It is in this case that the phenomenon of jaundice occurs. Bilirubin is not completely eliminated from the body and stains the skin yellow.

For an adult, this is a signal of leakage. serious illnesses, which are based on liver destruction. But for a newborn, such a condition is a physiological, normal process. After all, the baby’s body is just learning to function independently.

Causes of jaundice

A similar condition is observed in almost 60% of newborn babies. Jaundice usually appears on the 2-3rd day after birth. It is more pronounced in premature infants.

Above we examined the mechanism of occurrence of such a phenomenon as jaundice in newborns. The causes and consequences of this condition require more detailed study.

Jaundice occurs as a result of the following factors:

There is an excess of red blood cells in the blood. In addition, red cells decay much faster than in an adult. That is why the baby is experiencing destruction large number red blood cells, resulting in the formation of free bilirubin.
It was said above that the pigment is excreted by the liver. In order for bilirubin to leave the body, it must bind in this organ. In a baby, the liver is not yet able to fully ensure such a transformation.
Bilirubin undergoes metamorphosis in the intestine under the influence of normal microflora and then excreted in urine and feces. But, again, the child’s body is just learning to adapt to independent functioning. The baby's intestines are gradually populated by microflora. That is why it is not able to immediately remove bilirubin from the body.

As a result, the baby develops physiological jaundice. This is absolutely not dangerous condition for the baby. But sometimes a newborn may develop pathological jaundice. In this case, the baby needs adequate treatment.

Sources of the pathological condition

Doctors say that the causes of such jaundice may be hidden in the following:

there is incompatibility between the blood of the child and the mother by group or Rh factor;
the baby's liver is not functioning properly;
the baby has underdeveloped bile ducts;
Inflammatory processes occur in the child’s liver.

Symptoms of physiological jaundice

Distinctive characteristics of the natural physiological process are the following:

Jaundice appears no earlier than 36 hours after the baby is born.
It reaches its maximum severity on the 3-5th day.
A yellow discoloration of the skin of the face, neck, and chest is observed. The skin below the navel does not take on an orange tint.
A blood test shows high bilirubin. However, the level does not exceed 205 µmol/l.
The child's behavior is active. Well-being, general state is not violated.

It is important to remember when jaundice in newborns goes away. In full-term babies, bilirubin begins to decrease on the 14th day. This is an important indicator that characterizes the physiological process. In premature babies, bilirubin declines by the 21st day.

However, it should be understood that sometimes there may be some deviations from the above standards. And at the same time, they do not always indicate the development in the body of such a phenomenon as pathological jaundice.

Komarovsky claims that premature babies may face more early manifestation similar condition. Often these babies develop yellowing on the second day of life. In addition, Dr. Komarovsky points out that twins or children whose mothers have diabetes may experience prolonged jaundice.

All infants must be monitored. Sometimes physiological jaundice can develop into a pathological form. And the latter condition requires timely treatment.

Signs of a pathological condition

What symptoms indicate a problem in a child’s body? Unfortunately, the border between pathological and physiological jaundice is very fluid. But still there are differences between them.

Suspect pathological condition possible based on the following criteria:

Jaundice occurs in the first 24 hours after birth.
A yellow tint of the skin can be observed on the 7th day of a baby’s life.
A blood test shows not only high bilirubin, but also its rapid increase. A daily rate exceeding 85 µmol/l is observed.
The baby's skin turns yellow not only above, but also below the navel. Yellowness of the palms and feet is observed.
The general condition of the baby is impaired. The child is excited or depressed.
The baby's urine becomes dark in color, and the stool becomes colorless.
The jaundice in a child drags on and can be wavy in nature.

What is the basis of the pathology?

The following factors can provoke this condition:

prematurity, immaturity of the baby;
delayed fetal development during the intrauterine period;
mother taking multiple medications during pregnancy and childbirth;
extensive hemorrhages, cephalohematomas;
lack of breastfeeding;
large weight loss in newborns;
pre-lactation formula feeding.

And don’t forget when jaundice in newborns goes away. Physiological process should not last more than 21 days. Therefore, if your baby still remains yellow after the above time, be sure to consult a doctor.

Possible consequences

Jaundice in newborns is most often a physiological condition. Therefore, it goes away on its own, without any treatment and does not leave any consequences.

But if the jaundice does not go away for a month, or there are other signs indicating a pathological phenomenon, then the small patient needs adequate therapy.

Every day the baby's condition worsens. The baby's skin becomes greenish, and the size of the liver and spleen may increase.

Without medical care Serious complications may develop:

Toxic poisoning of the brain and nervous system.
High levels of bilirubin can lead to a decrease in albumin, resulting in albuminemia.
If the pigment penetrates the brain, the baby will develop This pathology can cause deafness, frequent seizures, and mental retardation in the baby.
The late stage of the disease is characterized by involuntary contractions of muscle tissue. The child may lose control of motor functions.

Moreover, if the pathological condition is detected on early stages and timely treatment is carried out, then unpleasant consequences, as a rule, do not arise.

Diagnosis of the condition

Skin tone alone is not enough to confirm the presence of jaundice. To make a diagnosis, the following examinations are prescribed for the baby:

urine and blood tests;
study of pigment levels in serum and blood;

If necessary, the baby is referred for consultation to an endocrinologist, surgeon, or cardiologist.

Treatment of the baby

Many pediatricians, both domestic and foreign, argue that in most cases a newborn does not need drug therapy.

Jaundice, which lasts about three weeks, is not a disease. Therefore, this condition does not require treatment. A completely different picture is observed if jaundice is characterized as a symptom of a serious illness. The baby needs adequate therapy if bilirubin reaches a dangerous level in the body, and even more so continues to increase.

Treatment of jaundice depends on the level of pigment, the condition of the baby, and the cause of the development of the pathology.

The child may be prescribed the following activities:

phototherapy;
drug treatment;
blood transfusion (if the risk of developing kernicterus is high).

Phototherapy for babies

The simplest, but at the same time effective method, which allows you to treat jaundice is phototherapy. Today it is extremely successfully practiced in almost all clinics.

For phototherapy, a special lamp for jaundice is used. The waves emitted by it stimulate the process of breaking down bilirubin into non-toxic compounds. The latter, after lasting about 10-12 hours, are removed from the body of the crumbs naturally(with urine and feces).

This method allows you to avoid medications. In addition, it does not require the separation of the child from the mother. Therefore, breastfeeding is not interrupted.

The duration of phototherapy usually takes about 96 hours.

Drug therapy

If the bilirubin level significantly exceeds the limit value, or the effect of phototherapy is insignificant, the baby is prescribed medication.

Drug therapy consists of:

From choleretic drugs. Medicines are recommended that improve the functioning of the liver and remove excess bile from the body. The newborn is prescribed medications: Ursofalk, Hofitol. Both one and the second medication are approved for use from the first days of life. However, the drug “Hofitol” is preferable, since the drug “Ursofalk” contains many additional components (preservatives, flavorings) that can provoke allergies.
Sorbents. The drugs bind toxic substances and wastes and remove them from the small body. A newborn may be prescribed medications “Smecta”, “Enterosgel”, Activated carbon. As a rule, the first remedy is preferred. From the drug "Smecta", produced in powder form, a suspension for a baby can be easily prepared. In addition, this natural sorbent is absolutely safe for babies.
Vitamin complexes.

Home treatment

If a child has physiological jaundice, then, as mentioned above, the baby does not need therapy. Therefore, mother and baby will be discharged from the hospital home. However, you can help your baby cope with this condition more quickly.

Treatment of jaundice at home includes the following measures:

Sunbathing. Give your baby a chance to sunbathe. The sun is the best healer. Under its influence, bilirubin is destroyed. But remember that the baby should not be exposed to direct rays of the sun for a long time, so as not to cause burns on the baby’s delicate skin.
Diet. A nursing mother should strictly monitor her food. It is recommended to completely exclude foods with a pronounced taste from the diet. Avoid pickles and smoked meats. It is better to base your diet on vegetables and fruits. Don't forget about your drinking regime. A nursing woman needs to drink about 2 liters of water per day.
Rose hip decoction. The drink perfectly normalizes digestion and stimulates excretion harmful substances. The mother herself can use the decoction. Drink allowed and for babies.

Conclusion

Now you know what jaundice is in newborns. You also know the causes and consequences of this condition. Most often, an orange tint to the skin indicates the occurrence of a natural phenomenon. Despite this, the baby needs careful monitoring. If there is any deterioration, you must react immediately. This is the only way to protect your baby from serious consequences.

Sometimes, while still in the maternity hospital, on the 3-4th day, the mother notices that the baby’s skin has turned yellow and the whites of the eyes have also become yellowish color. Should I worry and what are the reasons for this condition? Jaundice in newborns is a common physiological phenomenon. At this time, doctors do not vaccinate while monitoring the baby. Depending on the type of jaundice, the infant's body may require serious treatment. Often, jaundice is not contagious and should go away without a trace. But there are also pathological cases. What causes them and what are their consequences?

Main types of jaundice

Doctors divide jaundice into: physiological (postpartum) and pathological.

Physiological jaundice of newborns (neonatal)– short-term normal process, manifested in the first week of life. It lasts for full-term babies up to 10 days, for premature babies about 14 days. The child's behavior and general well-being do not change.
Pathological jaundice in newborns– is considered a symptom of a serious disease and occurs in one baby out of 10 cases of neonatal jaundice. The liver and spleen enlarge, the urine becomes dark, and the stool becomes colorless. A sick child requires treatment and strict medical supervision.

The following types of pathological jaundice are distinguished:

mechanical;
hemolytic;
parenchymal;
conjugative;
dairy.

Causes of jaundice in children

The blood of a child in the womb differs from the composition of the blood of a born baby. Fetal hemoglobin, which carries oxygen through the fetal vessels, is destroyed during the first breath. Live hemoglobin appears. When fetal hemoglobin is destroyed, bilirubin is produced, which the child's body tries to get rid of. It is difficult to remove this substance, and it penetrates into the liver. Reacting with enzymes, it dissolves and is excreted in the urine.

Sometimes the newborn’s liver cannot cope due to immaturity, and toxic bilirubin accumulates. Spreading throughout the body, it causes pigmentation of the mucous membranes and skin. This is how postpartum physiological jaundice occurs. When the filtering organ matures and the baby’s blood is completely renewed, the jaundice will go away on its own.

Pathological jaundice develops in a newborn for several reasons:

Rhesus conflict;
genetic pathologies;
viral liver diseases – sepsis, hepatitis;
hormonal imbalance;
hemolytic disease of newborns;
abnormal development of the bile ducts;
maternal diabetes;
intrauterine infection.

Factors contributing to the development of pathological jaundice:

premature birth;
developmental delay in the womb, fetal immaturity;
underweight;
extensive hemorrhages;
birth injuries;
artificial feeding.

Children rarely suffer from hemolytic jaundice. Most often it is caused by the following reasons:

mismatch of blood groups;
antigenic incompatibility.

Doctors quickly identify hemolytic jaundice. The whites of the eyes and skin of a newborn turn yellow 2-5 days after birth. On palpation, it is felt that the spleen and liver are enlarged. If you don't start on time correct treatment, the baby’s body condition may worsen. Bilirubin is a toxic breakdown product of hemoglobin. If it accumulates strongly, it can poison the child’s brain. This pathology is called kernicterus.

Kernicterus of newborns requires urgent medical attention. The brain is protected by a blood barrier that prevents toxins from entering during physiological jaundice. The nervous system, tissues and brain cells remain safe, but only as long as the bilirubin level does not go beyond the limits. Exact numbers at which toxins will cause damage nervous system, No one knows. But there are standards that define the risk zone. When a three-day-old baby has an indirect bilirubin level of 380, this is extremely dangerous. Hemolytic and nuclear jaundice of newborns it is necessary to treat not at home, but in a hospital.

After 3 weeks, the child’s skin is still yellow and has acquired a greenish tint, the stool is abnormally light, and upon palpation the liver and spleen are enlarged - these are signs of obstructive jaundice. Its causes may be problems with the gallbladder, obstruction of the biliary tract, liver diseases, or bile duct cysts. Often, obstructive jaundice is caused by genetic pathologies and birth injuries. Such a child does not require hospitalization. But diagnostics and tests must be carried out. Based on the type of pathology, the doctor prescribes a course of treatment.

The causes of conjugation jaundice are poor liver function. Enzymes cannot degrade bilirubin and cope with its excretion. The disease has many congenital pathological types. Conjugation forms occur in premature babies born with birth injuries, and in children taking certain medications. Conjugation types of jaundice can be inherited.

Parenchymal (hepatic) jaundice in newborns occurs due to viral or bacterial infection of the liver.

Milk jaundice is rare. Appears due to a glitch in endocrine system Mom. A large amount of estrogen passes into milk. The baby's liver cannot cope with the removal of the breakdown products of fetal hemoglobin, as it intensively removes the hormone from the body. This is not a dangerous condition. The baby eats and sleeps normally, develops fully and the disease gradually goes away. At the same time, breastfeeding is calmly continued without weaning the baby from the breast. Mommy is recommended to express. The expressed milk is heated to 60 C, then cooled to room temperature and given to the baby. Heat treatment reduces the activity of hormones that can harm the child’s body.

Bilirubin standards and tests

When jaundice does not go away for a long time, it is necessary to conduct a diagnosis and identify the cause of this condition.

The doctor prescribes:

general blood tests;
tests that determine the level of bilirubin in serum and blood;
detection of antibodies by Coombs test;
consultation of narrow specialists.

Bilirubin levels from 8.5 to 20 micromol/liter are considered normal. When its level rises, the doctor diagnoses jaundice. The present disease occurs with levels exceeding 35 micromol/liter.

Physiological jaundice

Postpartum jaundice, called neonatal or transient jaundice, observed in a newborn, is recognized as a short-term condition. Almost all babies experience it. It is not contagious and not dangerous. Phases of neonatal postpartum jaundice:

3-5 days – rapid increase in bilirubin in the blood;
6-14 days - the bilirubin level remains the same for some time, then decreases and returns to normal.

Signs of the disease

The first signs that can be noticed without having medical education– yellowed head of a child. The face and whites of the eyes acquire a yellowish tint. Then the neck, torso, fingers and toes turn yellow. With neonatal jaundice, the doctor, after feeling the baby, does not detect any changes in the size of the internal organs. Urine and feces do not change color. The baby eats normally, gains weight and sleeps soundly.

Kernicterus, the most dangerous and severe form, is recognized by:

breast refusal or sluggish sucking reflex;
monotonous crying, throwing back the head;
convulsions, coma, difficulty breathing occur in severe cases.

You can distinguish physiological jaundice from the pathological form by:

long jaundiced skin color;
bilirubin levels are much higher than normal;
wavy yellowing – the child turns yellow, then becomes lighter. Later, the skin becomes even more yellow. Sometimes the skin may turn green;
signs of jaundice are noticed after two weeks of age;
the skin turns yellow below the navel.

TO common features added:

enlarged liver and spleen;
discolored stool, dark urine;
spontaneously appearing bruises;
poor general health, lethargy, apathy, drowsiness.

How is jaundice treated in an infant?

The pathological form must be treated depending on the type and severity of the disease. The mother and child are hospitalized, diagnosed, and prescribed a course of treatment. If the reason is a discrepancy between the Rh factor and the presence of antibodies, blood transfusions, antibiotic therapy, and physiotherapy are prescribed. Obstructive jaundice is treated surgically. A consultation is created to study the patient’s condition and treatment measures are determined. There is no need to treat neonatal jaundice.

You can help your child overcome this condition at home:

The newborn is put to the breast on demand. This stimulates the body's metabolism. The more the baby eats and poops, the more toxic bilirubin leaves the body.
Mom must follow a strict diet to avoid causing digestive problems that aggravate the liver condition. At the same time, nutrition should be balanced and correct.
It is necessary to ensure sufficient water intake in the mother's diet.
Adoption sunbathing.
Frequent walks in the fresh air. When the weather is warm, the arms, face and legs are opened and the stroller is placed under a tree in the shade. Diffused light is very useful. It removes bilirubin from the body.

Pathological jaundice must be treated, taking into account all factors - the course of pregnancy, mother's illness, ultrasound results, postpartum trauma, results of general analyzes.

Various therapies are used:

antiviral treatment;
antibiotic therapy;
taking choleretic drugs, hepatoprotectors (Ursosan, Ursofalk, which remove bile);
strengthening the immune system;
removal of toxins (Hepel, Enterosgel, activated carbon);
phototherapy.

It turns out how combination treatment, and individual. Accelerate the elimination of toxic bilirubin and neutralize it destructive effect can be diuretics and choleretic drugs. Doctors prescribe Hofitol in syrup, Ursofalk, Phenobarbital, Hepel, Galstena, Ursosan.

Hepel cleanses the body of toxic substances. Prescribed by doctors along with Magnesia and Enterosgel.
Galstena is a natural preparation. Includes phosphorus and sodium sulfate. Galstena reduces bilirubin, eliminates intoxication, and cleanses the liver. Consists of herbs celandine, milk thistle, dandelion.
Hofitol - in the form of syrup. Natural, herbal, vitamin-containing preparation. Chophytol stimulates the liver and is often recommended by doctors for prolonged jaundice in newborns.

You can prepare a natural, high-quality diuretic at home. This is a rosehip decoction. When breastfeeding, rose hips are brewed in a thermos, infused and drunk a glass three times a day. An infusion of rose hips will remove toxins, normalize the functioning of the gastrointestinal tract, and promote liver function. Rosehip contains vitamin C many times more than citrus fruits and vegetables. Consuming it in the spring-autumn period will be an excellent prevention. viral infections. Mommy will strengthen immune system both for yourself and for the newborn at home.

Doctors often recommend phototherapy. This is irradiation under special green or a blue lamp. Ultraviolet light decomposes bilirubin substances into forms that can dissolve in water and be excreted from the body naturally. A 2-3 day course of phototherapy, which is harmless to the baby, is enough. While he is under the lamp, the newborn's eyes are covered with a thick, light-proof bandage. It happens that they appear side effects from the radiation of the lamp - redness on the skin, diarrhea, rashes. It is important that while undergoing phototherapy, the newborn receives a sufficient amount of breast milk.

Glucose, activated carbon or Enterosgel is prescribed for severe jaundice in newborns. Glucose stimulates the liver, and charcoal naturally removes toxins and improves intestinal function.

What is the danger of jaundice (consequences)

Complications caused by jaundice depend on the form, type and treatment provided. If pathologies are not detected in a timely manner, serious consequences can occur:

toxic poisoning;
high level bilirubin can cause a reduction in albumin production. As a result, the baby may suffer from albuminemia;
with the development of nuclear jaundice, toxic substances that enter the brain cause deterioration of vision, hearing, and inhibited mental development, cerebral palsy, paralysis;
in the future, the risk of cirrhosis and liver cancer increases;
liver pathologies;
weakened immune system;
fatal outcome.

Postpartum physiological jaundice does not affect the development of the baby. It is not contagious and passes without a trace.

Prevention of jaundice in newborns

During pregnancy, the mother should eat well, rest and lead healthy image life. This will increase the chances of giving birth to a strong, full-term baby. The body of such children copes well with adapting to the new environment and their organs quickly remove toxic substances. Their signs of jaundice are mild or completely unnoticeable. Healthy plant foods support the mother's liver, which ensures normal nutrition for the baby. You can take a tincture of alfalfa leaves with dandelion root or leaves. These are sources of minerals and vitamins that stimulate the liver and intestines.

Breast milk is considered the main medicine for the treatment and prevention of physiological jaundice. It is important to put your baby to the breast from the very first minutes after birth. Valuable colostrum contains all the substances that help the tiny body cope with the jaundice problem.

Soon after birth, the baby's skin may turn yellow. A yellowish tint to your baby's skin isn't always a cause for concern. Consult your doctor first.

Almost half of newborns experience a phenomenon called “physiological jaundice.” This is a completely natural process, indicating that the child is adapting to new conditions. In 60% of babies born on time, jaundice appears on the third or second day of life. Passes within a week. In 80% of premature babies it occurs on the seventh or fifth day of life. After 2 weeks it goes away without a trace.

The skin turns yellow due to increased concentrations of a substance called bilirubin in the blood. It appears during the destruction of red blood cells (red blood cells). Every day, approximately 1% of them undergo decay. The lifespan of these cells is 4 months.

Bilirubin is toxic.

Therefore, he is able to provide negative impact on internal organs, for example, on the brain. Usually, once it enters the bloodstream, it is neutralized almost immediately. Bilirubin binds to special liver enzymes and is removed from the body through the bile ducts, ending up in the intestines. Bound bilirubin gives stool a dark color. Another part of it enters the kidneys and is removed from the body along with urine. Due to its content in it, urine also acquires a yellowish color.

After birth, the baby has a high level of hemoglobin in the blood. In its structure and structure, it does not resemble the hemoglobin of adults. Fruit hemoglobin, due to its special configuration, is able to hold a larger volume of oxygen. Gradually, fetal hemoglobin is being replaced with hemoglobin A, that is, with that in adults. Hemoglobin, which was formed before birth, is destroyed at an active rate, which leads to the release of large quantities of bilirubin into the blood. As a result, the skin begins to turn yellow. The skin of the head, neck, chest, limbs and abdomen turns yellow. In severe cases, the jaundice spreads to the feet and toes.

Another type of jaundice that does not pose a danger to the health of the baby is breastfeeding jaundice.

Breast milk contains substances that can block the action of liver enzymes. Yellowness of the integument makes itself felt on the third or seventh day of life. At this time the child receives a large number of mother's breast milk. However, bilirubin in such cases does not reach critical levels, so it is not recommended to stop breastfeeding. Gradually, its level decreases, and by 12-16 weeks it returns to normal.

If a yellowed baby does not show concern, then you have no reason to worry. The child eats normally, gains weight, sleeps well and his development process is proceeding normally. Although it is still necessary to see a specialist.

It can lead to the development of mental retardation, deafness, delayed motor development, decreased visual acuity and cause disability. The degree of disturbance will be determined by the concentration of bilirubin and the duration of its excessive presence in the blood.

Signs indicating bilirubin encephalopathy include:

monophonic scream, excessive irritability;
feeling of drowsiness, lethargy, lethargy, as well as loss of appetite;
in severe cases - bradycardia, convulsions, coma, sudden cry and cessation of breathing.

Among other things, diseases that lead to severe destruction of red blood cells or disruption of the processes of binding bilirubin and removing it from the body can lead to an increase in the concentration of bilirubin.

At the same time, jaundice can also be caused by high content bound bilirubin in the blood. Its occurrence is caused by cholestasis - stagnation of bile. It becomes a consequence of the active work of the liver to remove bilirubin from the body. Bile accumulates in the bile ducts. Its flow into the intestines is reduced, and bound bilirubin is absorbed into the blood.

Obstructive jaundice is caused by disruptions in the development and functioning of the biliary tract. In this case, you should undergo an appropriate examination in order to prescribe the necessary treatment.

We can talk about pathological jaundice if:

the child was already born with a yellow skin tone or became yellow in the first day of life;
after the jaundice passed, the baby turned yellow again;
jaundice does not go away within a week in full-term babies, and in premature babies it lasts over 2 weeks;
the nature of its course is wave-like, it either fades away or manifests itself with renewed vigor;
yellowness is observed in areas of the skin below the navel.

Treatment

The process of treating physiological jaundice is based on natural feeding of the baby and the organization of proper care. Usually it is enough to breastfeed her, and eat properly and drink the required amount of fluid.

The most popular treatment method is the use of phototherapy. Under the influence of ultraviolet rays, bilirubin loses its toxic properties and is gradually removed from the body. The baby is undressed as much as possible, but the eyes and genitals are left closed. These procedures are carried out once a day or three days in a row, depending on the level of bilirubin.

If at the time of discharge of the child from the maternity hospital he has already developed jaundice, then he should be closely monitored over the next 10 days. After this period, bilirubin encephalopathy usually no longer develops. It is necessary to monitor changes in the degree of skin coloring, the general condition of the baby, the color of its urine and feces.

So, usually the level of bilirubin in the baby's blood is lower than the level of anxiety. Most often this is physiological jaundice, which does not pose any danger to the baby.

Every mother looks forward to meeting her baby for nine months. When this happy event finally happens, the positive emotions are often overshadowed by the yellow body color of the baby. What is jaundice in a newborn and what are its causes and consequences? We'll talk about this in the article.

Jaundice in newborns (neonatal) is a common condition in which the baby's skin takes on a yellowish or dark tint. In most cases, when we talk about children in the first days of life, we mean the so-called physiological (postpartum) form of the disease.

Physiological jaundice is the process in newborns during which fetal hemoglobin turns into normal hemoglobin. In this case, the yellow color of the baby’s skin appears on the second or third day after birth. This condition is not pathological. IN medical practice it is considered a normal transition period. In its physiological form, jaundice disappears by the eighth day, and its most pronounced clinical symptoms approximately on the fourth day. If the yellow color of the dermis appears earlier or later, we are most likely talking about pathological jaundice.

Types of disease

As we have already found out, jaundice in newborns is divided into physiological and pathological. How long does the yellow color of the skin last and when should this symptom go away? The physiological one appears on the third day and completely disappears after 7-8 days. With this type of disease, the child does not have any other signs, and the blood shows moderate amount bilirubin.

With the pathological form of the disease, a yellow tint to the skin of a newborn may appear both on the first day after birth and later. A blood test reveals a high concentration of the toxin. In addition to the yellow tint of the dermis, the child also exhibits other symptoms, in particular from the nervous system.

ICD-10 code

Neonatal jaundice - ICD-10 code - P59.

Why does this disease appear and what does yellow body color mean? First, let's figure out what bilirubin is. This name is given to a specific bile pigment, which is synthesized in the body from hemoglobin and some other proteins containing iron. If the concentration of this substance in the human body increases, the skin becomes yellowish. Each type of disease has its own causes.

Physiological jaundice is not considered a pathology. This is a kind of adaptation of the newborn’s body to new conditions. The reasons for this condition include:

conversion of fetal hemoglobin into normal hemoglobin;
adaptation of the newborn to environmental conditions;
immaturity of the baby's enzyme system.

It is worth noting that fetal hemoglobin is the one that is contained in the fetus’s body before birth. This substance begins to be replaced by regular hemoglobin already during the third trimester. After the baby is born, the process of converting fetal hemoglobin into regular hemoglobin is greatly accelerated. Due to the fact that it does not have time to be eliminated from the body, a yellowish tint to the skin of the newborn appears. The liver helps remove breakdown products. At the same time, the concentration of the toxin in the child’s body begins to decrease, after which the skin acquires a natural shade.

The pathological type of the disease is jaundice, which appears later or earlier established deadlines in newborns and lasts for more than 14 days in a child. To the criteria pathological type diseases include:

increased bilirubin in the blood above 220 µmol/l;
bilirubin level increases every hour by 5 µmol/l;
yellowness of the child’s body appears on the first day;
The course of the disease takes two weeks or more.

There are quite a few causes of pathological jaundice in newborns.

They concern both the baby and the mother. Let's look at the main ones:

hemolytic disease of the newborn is a condition caused by Rh conflict in the baby and mother. In this case, a pathological breakdown of red blood cells occurs in the newborn, which entails a sharp jump in bilirubin. There are edematous, anemic and icteric types of this disease. The first option is considered the most severe, but the icteric form is also often Negative consequences for a child.
Excess vitamin K in the body. Synthetic analogue Vitamin K is Vikasol. The drug is prescribed to pregnant women for bleeding disorders and for the treatment of other diseases. An overdose of Vikasol can cause massive breakdown of red blood cells in a child, which leads to jaundice.
Hereditary liver diseases in a newborn. These include Gilbert's syndrome ( chronic pathology, which is characterized by periodic surges in bilirubin in the blood) and Crigler-Nayjar syndrome (failure of bilirubin metabolism in the liver as a result of disturbances at the enzyme level).
Diabetic fetopathy - develops in newborns whose mothers suffer from diabetes. Pathology leads to poor production of enzymes by the liver.

In addition, jaundice in newborns can be caused by taking certain medications by a woman during pregnancy. Antibiotics, hormonal agents can cross the placenta and enter the fetal liver. This inhibits the body's production of certain hormones.

Clinic of the disease with physiological jaundice

The main visible symptom of jaundice in newborns is the yellow color of the baby's skin. The mucous membranes also acquire the same shade. The color of the dermis varies from light yellow to dark orange. Sometimes the baby’s body even acquires a greenish tint.

With the physiological type of the disease, the yellow tint does not extend to the child’s palms, feet and legs.

As for laboratory manifestations, with jaundice in newborns there is a high concentration of bilirubin in the blood. In the first hours of life, these indicators rise to 150 µmol/l. On the third day, the concentration of bilirubin reaches its maximum level and is up to 200 µmol/l. From the sixth day of illness, the concentration of this substance drops and returns to normal by 8-10 days.

Features of development and symptoms of pathological jaundice

In the pathological course of the disease, as in its physiological form, the baby’s skin and mucous membranes acquire a yellowish tint. The main difference between this type of pathology is the spread of yellow color to the feet and palms. In addition, there are nervous disorders, stool and urine become colored, and other symptoms appear. These include:

yellow coloration of urine;
damage to the central nervous system;
discoloration of stool;
excessive excitability of the newborn or, conversely, his lethargy;
liver enlargement;
poor appetite;
sleep disturbance.

Bilirubin is a toxic substance. It affects the patient's nervous system. When it affects the brain, severe complications arise. In the physiological form of the disease, the newborn’s brain remains unaffected. This type can occur in both one month old baby, and in older children.

Critical level of bilirubin in the child's blood

For full-term babies critical level bilirubin is considered to be 340 µmol/l. At this concentration, the nuclei of the brain are affected. In this case, it is customary to talk about the so-called kernicterus.

For premature babies critical indicators numbers are considered to be 220-280 µmol/l. It is known that babies born prematurely have a more vulnerable nervous system. Hence, severe consequences can occur with much lower levels of bilirubin in the blood.

Classification of jaundice in newborns

This pathology in children is classified according to several criteria. These include the duration of the course, timing of manifestation and many others. Infant or physiological is divided into several types. It is pregnane or lactic (arising from mother's milk), as well as jaundice of premature babies. There are also conjugative, hemolytic and obstructive jaundice (for example, a tumor of the head of the pancreas).
Main types of disease:

prolonged or prolonged, protracted;
premature babies;
nuclear jaundice;
transient jaundice of newborns;
infectious;
hemorrhagic;
milk or pregnane;
arising from Rh conflict between mother and child;
carotene - develops with an excess of vitamin A in the body of a newborn.

Children with pathological jaundice remain in the hospital under the supervision of a doctor for quite a long time. Let's consider each type of disease in detail.

Protracted

Prolonged jaundice is an option physiological type diseases. Previously, we found out that the physiological type of pathology lasts up to 10 days. Protracted lasts up to 3 weeks or more. The consequences of this type depend on the reasons that provoked the increase in bilirubin and its concentration in the blood of the newborn. Often, prolonged jaundice signals some other pathology, for example, liver disease, pancreatic cancer.

Sometimes this type of disease is a consequence of intrauterine infections. The main treatment for this is phototherapy.

Jaundice in premature infants

Children who are born prematurely have an immature enzyme system and the entire body as a whole. The severity of jaundice will depend not on the body weight of the newborn, but on the degree of prematurity of the baby. So in babies born 2-3 weeks prematurely, the amount of bilirubin in the blood can reach 100 µmol/l. With prematurity at 4 weeks, the bilirubin concentration often reaches 200 µmol/l.

Transitional

Passing or transient jaundice in newborns usually appears in the maternity hospital 30-40 hours after birth. The child’s condition returns to normal on the eighth day. With this type of disease, the concentration of bilirubin does not exceed 200 µmol/l, and the hourly increase in this substance is no more than 2-3 µmol/l.
The most pronounced transient form of pathology occurs on days 3-4. By the tenth day, the baby’s blood test returns to normal. The transient type of jaundice rarely entails any complications.

Nuclear jaundice is characterized by damage to the cerebral cortex. This complication is observed when bilirubin levels in the blood are critical. The cerebral cortex becomes vulnerable to the effects of toxins when bilirubin concentrations exceed 300 µmol/l.

This type of pathology requires immediate treatment. In the absence of proper help death often inevitable. The disease can be cured through blood transfusions and other methods of therapy.

Infectious

As the name suggests, this type of jaundice in newborns is caused by infections. More often, the following diseases in a pregnant woman become the cause of an infectious type of pathology:

hepatitis A;
herpes;
toxoplasmosis;
cytomegalovirus and others.

Infection of the fetus occurs through the placental barrier or during the passage of the baby through the birth canal.

This type of disease is characterized by bleeding. In addition, the child’s liver and spleen enlarge. Bleeding develops due to a lack of vitamin K in a newborn, since it is he who takes an active part in the synthesis of proteins necessary for normal blood clotting. This vitamin is synthesized by liver cells. Therefore, with jaundice, its deficiency is observed.

Often the hemorrhagic type of pathology is diagnosed with underdevelopment biliary tract The child has. This congenital pathology. In this case, a yellow tint to the skin of a newborn appears already in the first days after birth. General health the baby suffers greatly. The child is capricious and refuses to be fed. In this case, the patient requires surgical treatment.

If there is severe stagnation of bile, the newborn needs surgery. Without proper treatment, children die within the first year of life.

Dairy

Infantile jaundice from breast milk develops in infants for unknown reasons. Some scientists suggest that this type of disease in infants occurs due to increased concentrations of pregnanediol in breast milk. It has been proven that this substance inhibits bilirubin metabolism. Milk jaundice usually lasts up to 6 weeks. If breastfeeding is stopped, the baby's skin will return to normal color. When feeding is resumed, the disease may return.

Jaundice due to Rh conflict between mother and child

Pathology can occur due to Rh conflict between mother and newborn or due to blood group incompatibility. The second option is less common. This incompatibility causes massive destruction shaped elements blood (red blood cells) in an infant.

This form of jaundice occurs in newborns in 5% of cases. Death occurs in 3% of cases.

Photo

In these photos you can see what the disease looks like in children.

It is not difficult to determine jaundice in a newborn by the yellow color of the skin.

For the convenience of measuring the amount of toxins in the body, the Cramer table is used.

By coloring areas of the child's body, you can determine the approximate concentration of bilirubin in the blood. Mild degree characterized yellowish tint face, cheeks, neck. The same color is diagnosed on the mucous membrane in the eyes and oral cavity. With more severe forms The chest, arms, back and entire body of the newborn are painted.

Is the disease contagious?

Children's physiological jaundice is not transmitted from child to child. The disease appears on the third day of life and goes away on the 8th day. The peculiarities of the disease are that this condition does not require special treatment.

Pathological jaundice can only be contagious if it is caused by a specific infection. But at the same time, from a sick baby you can become infected not with jaundice itself, but with the viruses and bacteria that provoked it.

How dangerous is the disease?

Bilirubin is a dangerous toxic substance. If it increases strongly, the consequences for the newborn can be the most negative, since this product decay affects the brain and nervous system little patient. An increase in bilirubin to 250-300 µmol/l, as well as a low amount of this substance over a long period, is dangerous for a child’s body.

As a rule, physiological jaundice does not pose a danger to the baby. With this type of disease, the toxin is quickly eliminated from the body. But it is important to note that doctors often call this condition borderline, because jaundice in newborns can cause other serious pathologies.

One of the most dangerous forms The disease develops when there is a Rh conflict between mother and child. It appears immediately after childbirth.

Treatment of the disease in newborns depends on its type. When it comes to physiological jaundice, the child does not need treatment, but rather assistance in overcoming this transition period. Here you should be guided solely by the doctor’s prescription. You cannot self-medicate and use pills that you learned about from friends or from the Internet. This will help avoid many negative consequences.

Tips for parents with jaundice in newborns:

walk outdoors more often;
take sun and air baths;
It is advisable to feed the baby breast milk;
mommy needs to stick special diet, exclude foods that burden the liver;
The baby should be fed on demand.

A special blue UV (ultraviolet) lamp is used. Such a device emits blue light, and when it comes into contact with the skin, it destroys excess bilirubin. Toxic substances leave the body in feces and urine. This procedure is carried out exclusively in a hospital under supervision medical personnel. Efficiency ultraviolet lamp quite high, it allows you to quickly remove dangerous substances from the newborn’s body.

During the treatment of jaundice, mommy should definitely adhere to a diet. It is important to remove fatty, fried, too salty, smoked, and pickled foods from the menu.

Phototherapy helps combat both physiological and pathological jaundice in newborns. The photolamp should only be used in a hospital as prescribed by a doctor.

For treatment with the device, devices such as Malysh, Bilitron 3006 and others are used. Such devices are prescribed only under the supervision of medical personnel.

If a newborn develops rashes on the body, the skin tone changes to brown or marbled, phototherapy is canceled. In this condition, the procedure is replaced with medication.

Use of medications

If there is no expected therapeutic effect from phototherapy, the newborn is prescribed 5 percent glucose and vitamin D. A dropper is used. Glucose reacts with bilirubin and helps get rid of the toxic substance.

In combination with glucose, the baby is often prescribed sorbent drugs. This includes the following medications:

Smecta;
Polysorb;
Enterosgel and others.

The dosage of all drugs is selected exclusively by the doctor. Taking this or that medication on your own is extremely dangerous for a newborn.

To maintain liver function, the baby may be prescribed hepatoprotectors. These are the following:

Ursofalk;
Ursosan;
Elkar suspension;
Ursodez et al.

Choleretic medications help remove excess bilirubin. List of choleretic medications:

Chophytol;
Galsten drops;
Hepel syrup and others.

Phenobarbital and Magnesia have anticonvulsant and antispasmodic effects. Among older children, medicinal mineral water is often used. Giving any medications to a newborn is allowed in strict dosages, in accordance with the instructions for use, only as prescribed by the attending physician.

The information is provided for informational purposes and is not a guide to action!

Is it possible to get the BCG vaccine?

The BCG anti-tuberculosis vaccine is given to babies in the maternity hospital. Many parents are concerned about the question: is it possible to do this vaccination for jaundice in newborns? It is not recommended to administer the vaccine for the disease in question, even if the yellowness of the dermis is slight, as it can provoke unwanted complications. In such a situation, you should wait for the baby to fully recover.

Treatment of jaundice in a newborn at home

If the disease is of a physiological type, it can be treated at home. What should parents do? Let's look at some recommendations.

Herbal medicine (herbal treatment) has a good effect on cleansing the liver and removing bilirubin. Infants can drink the decoction peppermint. To do this, you need to prepare the medicine correctly:

pour a tablespoon of herb with a glass of boiling water;
boil the product for 5-10 minutes;
leave the broth for 2 hours in a thermos;
Give the newborn a teaspoon after feeding 2-3 times a day.

If colic occurs, it is prohibited to treat the baby in this way.

Bilirubin leaves the blood well after using baths with the addition of herbs. Here you can use goldenflower, calendula, string, and rose hips. You can buy raw materials at any pharmacy. Their price is relatively low. To prepare the decoction, pour 2 tablespoons of the product into a liter of boiling water and leave for 2 hours. The finished product is filtered and added to the bathtub. The procedure time for a newborn should be 10-15 minutes.

It is forbidden to give laxatives and choleretic drugs to the baby at home. They will not help remove bilirubin, but will only disrupt the functioning of the gastrointestinal tract.

Pathological jaundice, as a rule, takes quite a long time to treat and poses a danger to the child’s body, unlike physiological jaundice. This type The disease can occur both from the first days after birth and in children older than 3-5 years. At risk are babies born prematurely, as well as boys and girls with congenital diseases and those who have had various infections. You can understand that a child has developed pathological jaundice using laboratory tests.

Let's consider methods of treating pathology depending on the causes of its occurrence:

When bile ducts are blocked in newborns, surgery which is called shunting.
If liver cirrhosis is diagnosed, an organ transplant is performed.
For hepatitis C it is prescribed drug therapy using interferon. For blood poisoning, antibacterial drugs are used.
If jaundice in a newborn is caused by Rhesus conflict, the baby is prescribed choleretic agents, in severe situations, blood transfusion is required.
Sometimes the disease in infants provokes hypothyroidism. In this case, hormonal drugs are used.

A yellow tint to the skin in babies and older children can be caused by a variety of factors. You shouldn't risk your baby's health. When alarming symptoms It is recommended to go to the hospital immediately.

Parents who are faced with jaundice in their child should strictly adhere to correct mode day for your child and strictly follow all doctor’s recommendations for treating a newborn.

In spring and summer, it is very important to take the baby out more often. Fresh air under open Sun rays. Ultraviolet light helps remove bilirubin from the body. Reviews from parents indicate the good effectiveness of this type of home treatment.

When sunbathing, you should follow these tips:

You should not leave your baby in the sun from 10 a.m. to 4 p.m.
The baby should not be left alone.
The newborn should be given a few spoons of water before and after the procedure. This will help avoid dehydration.
There is no need to completely undress the baby. He should be wearing panties and a thin T-shirt.
There should be a scarf or Panama hat on your head.

For the desired result with jaundice in a newborn, the time spent in the sun should not exceed 10-15 minutes. If the toddler cries or is capricious, he is hot, you should hide the newborn in the shade.

In autumn and winter time You can sunbathe through glass.

Features of feeding with jaundice in newborns

The best option is breastfeeding. If you put your baby to your breast on demand, he will go to the toilet more often. Consequently, toxic substances are more likely to be eliminated from the body. Sometimes it happens that a baby develops jaundice while receiving breast milk. This happens when there is a Rh conflict between the mother and the newborn. The female body produces antibodies, which, penetrating into the baby’s body through breast milk, poison it.

In addition, estrogen can cause the disease. This hormone inhibits the breakdown and excretion of bilirubin. If breastfeeding continues, the child’s well-being will gradually deteriorate. In such a situation, breastfeeding should be abandoned. For this type of jaundice, it is recommended to use an adapted infant formula, which your pediatrician will help you choose.

Conclusion

Jaundice in newborns is a common occurrence that does not pose any particular danger. Of course, this only applies to the physiological type of disease. If jaundice is caused various pathologies, immediate treatment should be carried out in a hospital setting. Be attentive to the health of your child, take care of him and be happy.

Video

What does the famous pediatrician Evgeny Olegovich Komarovsky say about jaundice in newborns? You can find out the doctor's opinion in this video.

Without examination, it is impossible to tell whether the jaundice is intense and whether it requires treatment. read the information about zhedtukha.
JAUNDICE IN NEWBORNS can be physiological or pathological. Physiological jaundice disappears without a trace within a short period of time. Pathological jaundice of newborns is caused by diseases and often requires close attention. medical control. Conditions in which newborn babies experience icteric staining of the skin, whites of the eyes and visible mucous membranes currently number more than 50. But, I repeat, this does not mean that your child will necessarily have this condition. And yet, now almost all types of jaundice in babies are successfully treated.
And yet the most common jaundice in children who have just been born is physiological. It occurs in approximately 60-70% of babies and appears 3-4 days after birth. Low birth weight and premature babies suffer more often, although not always. This condition is not a disease and goes away over time. It is associated with the immaturity of some systems of the child’s body responsible for the metabolism of a special substance - bilirubin.
To release oxygen from the mother's blood, the baby in her womb requires a high level of red blood cells (erythrocytes). Bilirubin is formed by the destruction of erythrocytes - red blood cells that contain hemoglobin and provide organs and tissues with oxygen. Before birth, until the baby breathes on its own, oxygen in its body is carried by red blood cells with special (fetal) hemoglobin. Immediately after birth, after his first breath, the baby stops needing oxygen from his mother; now he will receive it from the air. The child’s body no longer needs fetal hemoglobin, and it begins to lower the level of red blood cells. What to do with the extra red blood cells? Red blood cells are destroyed (one of the byproducts of the destruction of red blood cells is bilirubin, which is yellow or Orange color) and are excreted from the body with meconium (newborn feces) which has a black color and oily consistency, and part of it is excreted in the urine.
The liver of a newborn baby is still very weak; it is not able to quickly process all this bilirubin. This bilirubin is called indirect, or free. It is insoluble, so it cannot be excreted in urine. The liver is responsible for converting it into a soluble form and excreting it with bile. Even healthy children immediately after birth, there is often a lack of a special protein that ensures the transfer of bilirubin to the liver cells, where it is after a series of biochemical reactions combines with substances that make it soluble. This is necessary so that bilirubin does not have a toxic effect and is safely excreted from the body. Several enzyme systems ensure this transformation at once. In many newborns, these systems complete their maturation and begin to function fully only a few days after birth.
As a result, it is carried by the blood throughout the body, accumulates in the skin and gives it a characteristic yellow tint. This is why jaundice is especially common among premature babies with weakened bodies.
Bilirubin levels are measured in micromoles per liter of blood and average around 100 µmol/L for newborns on the third day. The critical level for premature babies is 170 µmol/l; for full-term babies this level is usually higher. After one, maximum two, weeks, the level returns to normal and the jaundice disappears. In most cases, no treatment is required.
The functioning of the bilirubin secretion system gradually improves. Usually, after 1-2 weeks, the icteric staining of the skin disappears without causing any harm to the child. It is now clear why neonatal jaundice in premature babies is more common, more pronounced and lasts longer than in full-term babies. And the severity of the increase in the level of bilirubin in the blood in premature infants depends not on body weight at birth, but on the degree of maturity of the fetus and the mother’s problems during pregnancy. Children turn yellow more often multiple pregnancy, newborns who had birth injuries, babies born to mothers with diabetes.

Bilirubin levels in newborns.
With physiological jaundice, the general condition of children, as a rule, does not suffer. Only if it is very pronounced, babies become drowsy, suck lazily, and sometimes vomit. The severity of jaundice is not judged by external manifestations, the intensity of skin color does not always correspond to the level of bilirubin, but according to the level direct bilirubin in blood. It reaches its maximum on the 3rd day of the child’s life. Children's body“fights” excess bilirubin by binding it to the blood protein albumin, thereby preventing it toxic effect. But this doesn't always happen.
With a very strong increase in bilirubin levels, albumin cannot “block” it completely, and it penetrates the nervous system. This can have a toxic effect, primarily on vital nerve centers, the brain. This condition is called “kernicterus” or “bilirubin encephalopathy”. Symptoms: severe drowsiness, convulsions, decreased sucking reflex. Among late manifestations– deafness, paralysis, mental retardation.
So, I'll let you down summary to the above (otherwise I wrote a lot and it’s not entirely clear).
Physiological jaundice:
- appears 24-36 hours after birth (and not born yellow from the very beginning, mind you);
- increases during the first 3-4 days of life, that is, while you are in the maternity hospital. And not when you are already at home;
- disappears in the second or third week of life, anything that lasts longer is a reason to think about the physiology of this condition and about donating at least blood to check the bilirubin level;
- skin have an orange tint, rather than lemon yellow or olive (this is already pathological types), although everyone’s color perception is different. It’s better to have a doctor evaluate this; when they are admitted to a medical university, they are tested for color vision.
- the child’s general condition is satisfactory, he is not lethargic, does not sleep constantly, sucks well,
- the size of the liver and spleen are not enlarged, you definitely can’t measure this yourself, but trust it to the doctor, I think he can handle it.
- the usual color of feces and urine, newborns have mustard-colored stools (see details in a separate article), and the urine is almost transparent. There should be no dark or discolored stool or urine.
- concentration of bilirubin in cord blood(moment of birth) – less than 51 µmol/l,

- hourly increase in bilirubin in the first day of life is less than 5.1 µmol/l/hour,
- maximum concentration of total bilirubin on days 3-4 in the peripheral or venous blood no more than 256 µmol/l in full-term, no more than 171 µmol/l in premature
- total blood bilirubin increases due to the indirect fraction
- the relative share of the direct fraction is less than 10%
- normal values of hemoglobin, red blood cells and reticulocytes in clinical tests blood
They will look at all this in the maternity hospital, and I think they will tell you if something is wrong.
What to do, you ask? I answer.
Previously, in case of increased free bilirubin levels, intravenous infusion of glucose solutions was used, ascorbic acid, phenobarbital, choleretic agents to accelerate its elimination. Now more and more specialists and clinics around the world are refusing to use drugs to treat physiological jaundice in newborns. Moreover, the use of some means has been found to be ineffective.
Today, the most effective and proven method of reducing the toxicity of bilirubin in physiological jaundice is phototherapy (light therapy). The baby’s skin is illuminated with a special installation (on average 96 hours per course). When exposed to light, bilirubin is converted into non-toxic derivatives, the main of which is called lumirubin. It has a different route of elimination, and after 12 hours it leaves the body in feces and urine. Side effect During phototherapy, peeling of the skin and frequent loose stool, and some children experience drowsiness.
After stopping treatment, all phenomena disappear without a trace. And after discharge from the maternity hospital, it is worth exposing the baby to indirect sunlight as often as possible during the day.
The best prevention and treatment of physiological jaundice is early and frequent feedings. Since children with increased level bilirubin, there is increased drowsiness, they must be woken up for feeding. Colostrum, or “early milk” during the first few days, acts as a laxative and helps the meconium (original feces) pass more quickly. Bilirubin, which is converted in the liver, is also excreted along with it. If the meconium does not pass quickly, bilirubin from the intestines can reenter the bloodstream, thereby increasing the level of jaundice.

Even with the oh-so-rare jaundice caused by mother's milk, it is not recommended to give up breastfeeding. This type of jaundice in newborns can be distinguished by its later appearance (after the 1st week of the child’s life). This condition is associated with the content of substances in mother’s milk that reduce the activity of enzymes that ensure the “conversion” of indirect bilirubin into soluble direct bilirubin.

Well, this is all clear, but what if this is not physiological jaundice, you ask? How to distinguish? Let's read.
Pathological jaundice most often appears during the first days after birth. Often, the liver and spleen become enlarged, feces may become discolored, and urine becomes dark in color; sometimes bruises spontaneously appear on the newborn’s skin and pinpoint hemorrhages. A blood test shows signs of increased breakdown of red blood cells (hemolysis) and anemia.
I repeat, please remember any deviations from “ normal course» physiological jaundice (earlier (before 24 hours) appearance or later (after 3-4 days) increase, long-term preservation(more than 3 weeks), wave-like course), the presence of pallor of the skin or a greenish tint, deterioration in the general condition of the child against the background of a progressive increase in jaundice, dark urine or discolored stool, an increase in the concentration of total bilirubin in the blood more than 256 µmol/l in full-term and more 171 µmol/l in premature infants), a relative increase in the direct fraction of bilirubin should be considered as signs of pathology. And this means you need to run to the doctor. For pathological jaundice, treatment is carried out by specialists. It depends entirely on the cause of this condition.

Let us dwell on the main types of pathological jaundice in more detail.
Hemolytic disease of the newborn (also called Rh factor or ABO incompatibility).
If mother and newborn are incompatible by blood type and/or Rh factor, massive destruction (hemolysis) of red blood cells occurs. Severe jaundice often occurs if the mother has blood type I, and the child has II or (less often III). It is believed that with each subsequent pregnancy the risk of such complications increases. It is for this reason that it is especially dangerous for women with a negative Rh factor to have an abortion.
Here are the main criteria by which this type of jaundice is identified:
- jaundice appears in the first 24 hours after birth (usually in the first 12 hours);
- increases during the first 3-5 days;
- begins to fade from the end of the first - beginning of the second week of life;
- the skin in case of AB0 conflict is usually bright yellow, in case of Rh conflict it may have a lemon tint (jaundice on a pale tone due to anemia in the baby);
- the general condition of the child depends on the severity of hemolysis and the degree of hyperbilirubinemia (from satisfactory to severe);
- in the first hours and days of life, as a rule, there is an increase in the size of the liver and spleen;
- usually - normal coloring of stool and urine; against the background of phototherapy, there may be a green coloration of the stool and short-term darkening of the urine;
- the concentration of bilirubin in the umbilical cord blood (moment of birth) - in mild forms of immunological conflict due to Rh factor and in all cases of ABO incompatibility is not higher than 51 µmol/l, in severe forms of immunological conflict due to Rh factor and rare factors - significantly higher than 51 µmol/ l.
- the concentration of hemoglobin in cord blood in mild cases is at the lower limit of normal, in severe cases it is significantly reduced.
- hourly increase in bilirubin in the first day of life is more than 5.1 µmol/l/hour, in severe cases – more than 8.5 µmol/l/hour.
- the maximum concentration of total bilirubin on days 3-4 in peripheral or venous blood is more than 256 µmol/l in full-term infants, more than 171 µmol/l in premature infants.
- total blood bilirubin increases mainly due to the indirect fraction.
- the relative share of the direct fraction is less than 20%.
- decrease in hemoglobin level, number of red blood cells and increase in the number of reticulocytes in clinical blood tests during 1 week of life.

Conjugation jaundice (hereditary diseases).
The destruction of red blood cells can also be caused by various genetically determined disorders, such as microspherocytosis (Minkowski-Choffard anemia), disturbances in the structure of hemoglobin (for example, in sickle cell anemia), changes in the shape and structure of the red blood cell itself, etc. In the treatment of conditions accompanied by destruction of red blood cells, exchange transfusions are often used to “wash out” the bilirubin and antibodies that cause hemolysis.
They are characterized by:
- appear no earlier than 24 hours after birth,
- continue to increase after 4 days of life,
- do not fade away until the end of 3 weeks of life,
- the skin has an orange tint,
- the general condition of the child is usually satisfactory,
- no increase in the size of the liver and spleen,
- normal color of stool and urine,
- bilirubin concentration in cord blood is less than 51 µmol,
- hemoglobin concentration in cord blood is normal,
- hourly increase in bilirubin in the first day of life is less than 6.8 µmol/l/hour,
- the maximum concentration of total bilirubin on days 3-4 in peripheral or venous blood is more than 256 µmol/l in full-term infants, more than 171 µmol/l in premature infants,
- total blood bilirubin increases due to the indirect fraction,
- the relative share of the direct fraction is less than 10%,
- normal values of hemoglobin, red blood cells and reticulocytes in clinical blood tests.

Hepatic jaundice (infectious and toxic liver damage).
A large group consists of jaundice, which occurs as a result of liver damage by viruses, bacteria, and protozoa. It is clear that without treatment infectious process in such cases it is impossible to get by. Unfortunately, there are currently not effective treatments for all congenital infections. This once again emphasizes the need for careful preparation for pregnancy, especially if there is infectious diseases, to reduce the risk of transmission of infection to the baby.
Such jaundice is characterized by:
- earlier appearance of jaundice and wavy character,
- enlargement of the liver and spleen,
- early appearance of hemorrhagic syndrome (that is, bleeding),
- inconsistent nature of acholia (that is, loss of color) of stool,
- dark yellow urine,
- biochemical cholestasis syndrome (stagnation of bile, characterized by itching),
- marked increase in ALT, AST (special enzymes in the blood that characterize liver function),
- violation of the synthetic function of the liver (decreased concentrations of albumin, fibrinogen),
- visualization of the gallbladder by ultrasound.

Mechanical jaundice (impaired flow of bile).
So called mechanical jaundice arise due to a violation of the outflow of bile with a bile duct cyst, annular pancreas, atresia (underdevelopment) of the bile ducts. In this case it is necessary surgical intervention. With pyloric stenosis and intestinal obstruction, the reason for the increase in the level of bilirubin in the blood is its reabsorption from the intestine. Surgeons can also help in such situations.
They are characterized by:
jaundice discoloration of the skin with a greenish tint (olive color),
- enlargement and thickening of the liver, less often – the spleen,
- dark urine, discolored stools,
- high levels of direct bilirubin, GGT, cholesterol and other markers of cholestasis,
- delayed, moderate increase in ALT, AST,
- Absence of disturbances in the synthetic function of the liver (normal serum levels of albumin, fibrinogen, PTI more than 80%).

Constitutional liver dysfunction (Gilbert-Meulengracht syndrome) – hereditary disease, very similar to physiological jaundice of newborns, is quite common. The reason for the failure in bilirubin metabolism in this case is a violation of its binding due to hereditary inferiority of liver enzyme systems. This condition usually requires treatment and is monitored by gastroenterologists.

Hormonal imbalances also cause jaundice in newborns. This happens, for example, with hypothyroidism – a decrease in functional activity thyroid gland. This form of jaundice is combined with other signs of insufficient production of thyroid hormones: large sizes abdomen, dry skin, low body temperature, a special, hoarse cry, constipation, swelling of the face, eyelids, delayed ossification processes, etc. Jaundice occurs with hypothyroidism on the 2-3rd day of life, lasts up to 3-12 weeks, and sometimes up to 4-5 months. Treatment is carried out under the supervision of an endocrinologist using drugs - thyroid hormones.
The most severe condition requiring immediate assistance is bilirubin encephalopathy and kernicterus.
A progressive increase in the concentration of unconjugated bilirubin in the blood in some cases is accompanied by its penetration through the blood-brain barrier and accumulation in the neurons of the brain. In this case, the subcortical nuclei of the brain acquire a characteristic yellow color, due to the accumulation of bilirubin in them - “kernicterus”.
Clinical picture of bilirubin encephalopathy:
1st phase. Dominance of signs of bilirubin intoxication: suppression of unconditioned reflex activity - apathy, lethargy, drowsiness, poor sucking, maybe a monotonous cry, regurgitation, vomiting, “wandering eyes.”
Phase 2. The appearance of classic signs of kernicterus: spasticity, stiff neck, forced situation bodies with opisthotonus (arched), “stiff” limbs, hands clenched into fists. Periodic excitement and a sharp cerebral cry, bulging of the large fontanel, twitching of the facial muscles, large-scale tremor of the hands, disappearance of the visible reaction to sound, sucking reflex, nystagmus, apnea, bradycardia, lethargy, convulsions. This phase takes from several days to several weeks. Damage to the central nervous system is irreversible.
Phase 3. The phase of false well-being and complete or partial disappearance of spasticity (2-3 months of life).
Phase 4. Formation period clinical picture neurological complications (usually 3-5 months of life): cerebral palsy, paralysis, paresis, deafness, mental retardation, etc.
Lead tactics.
Children need early (from the first hour of life) and regular breastfeeding.
If available clinical signs severe form hemolytic disease at the time of the birth of a child in a woman with Rh negative blood(pronounced pallor of the skin, icteric staining of the skin of the abdomen and umbilical cord, swelling of the soft tissues, an increase in the size of the liver and spleen), an emergency operation of the transfusion transfusion (replacement blood transfusion) is indicated without waiting for laboratory data (In this case, the technique of partial exchange transfusion of blood is used, in which replacement of 45-90 ml/kg of child’s blood with a similar volume of donor red blood cells of group 0 (1) Rh-negative).

Without being a specialist, it is impossible to understand all the intricacies of diagnosing such a large group of diseases as jaundice in newborns (jaundice). It is important to understand that the icteric discoloration of the skin persists for a long time. small child requires mandatory examination. It must certainly consist of general analysis blood, determination of the level of total bilirubin and its fractions in blood serum, liver function indicators, hemolysis test (Coombs test), ultrasound examination of the abdominal organs, if necessary, consultation with a surgeon or other specialist to clarify the diagnosis and timely treatment.
And in conclusion, I remind you again.
If the jaundice is small and appears on the third day, then the child is usually not touched for a month. Then, if it doesn’t go away, they begin to figure out what’s wrong.
And it could be:
1. the most common option. There is still a lot of estrogens in the child’s blood; they inhibit enzyme activity, so bilirubin binds slowly. It goes away on its own. Some are faster, some are slower.
2. bile ducts do not allow enough bile to pass through. Maybe just narrow - then as the child grows, the problem disappears. Maybe the bile is too viscous. We need choleretic drugs.
3. a sufficient amount of bile is not produced. Not enough enzymes. They take choleretic drugs and pancreatin. Gradually everything passes.
4. antigen constantly enters the child’s blood (sometimes with mother’s milk). Very rarely. Then - just a mixture. But this is very rare.
5. there is a possibility that the child’s immature liver did not react well to the hepatitis vaccine.
6. there is a possibility of congenital hepatitis.
I repeat, specialists should understand all this.