– The most accurate way to determine the level of bilirubin in the blood is a biochemical blood test. It is he who will be prescribed by the doctor if he suspects the development of pathological jaundice, ”says Anna Levadnaya, pediatrician, candidate of medical sciences, author of the Instagram blog on pediatrics. – There is also a percutaneous test – a special device that determines the approximate level of bilirubin in the blood through the skin. This test is the fastest, but very approximate, so it is used as an auxiliary.
But in order to distinguish normal physiological jaundice from pathological jaundice, in addition to the indicator of the level of total bilirubin in the blood, the doctor must take into account other factors, so additional tests can be prescribed for the newborn. For example, check the level of hemoglobin and red blood cells. With physiological jaundice, these values remain normal. The level of direct and indirect bilirubin in the blood is also taken into account. With physiological jaundice, direct bilirubin is less than 20 percent.
The norm for babies born on time is an indicator of 256 μmol / L. If the baby was born prematurely, the figure is considered normal 171 μmol / L.
In this case, the skin, sclera of the eyes and the mucous membrane can still have a yellowish tint, without posing a danger to the life and health of the crumbs. As a rule, such pigmentation passes by itself already in 7-10 days after the baby is born.
The critical indicator for children born on time is considered to be 324 μmol / l, and for premature babies – 150-250 μmol / l. With these results, specialists usually insist on medical treatment. And their fears and demands are fully justified. The lack of treatment can provoke the development of serious complications or pathologies of a chronic nature.
Immediately after birth, umbilical cord blood is taken from the baby to determine the level of bilirubin and some other indicators. In newborns, blood taken from the heel can also be examined. Before taking the baby’s blood, it is advised not to feed for four hours. Blood is placed in a special tube, and then examined, determining the level of total bilirubin, and, if necessary, its fractions.
The norm of bilirubin in newborns by the day in the table
The maximum value in micromoles per liter of blood
First hours after birth
Bilirubin is a bile pigment, which is a product of the breakdown of red blood cells. The mechanism of bilirubin formation is as follows: hemoglobin is released from spent red blood cells. Gems are released after the destruction of the protein, which, under the influence of enzymes, is converted into bilirubin.
Simply put, bilirubin is processed hemoglobin, which is normally released from old red blood cells in an amount of about 300 mg per day. The pigment fraction is divided into 2 types: indirect and direct. The first form is toxic in contrast to the second, which is already neutralized by the liver and is rapidly excreted from the body.
The bound (direct) fraction is excreted in urine and feces, the second option is first transported to the liver, where it must be converted into direct bilirubin. As for newborns, they always have an increase in this pigment.
This article will discuss the causes of increased bilirubin in newborns, as well as the treatment and consequences of this phenomenon.
Bilirubin in newborns in the blood is evaluated as an indicator of the correct functioning of the baby’s internal organs. If the concentration of this pigment is exceeded, immediate treatment is required. High rates are primarily indicated by a yellow tint of the skin.
Each parent should know what this means, how high the value can be dangerous, and how to fix this problem.
In the first days of life after birth, the baby undergoes a blood test for multiple tests. Among the latter is the determination of the concentration of bilirubin in the body. In this regard, most mothers are concerned about the question of where the blood is taken from the baby.
Special laboratories are equipped with professional equipment, with which you can set the level of the enzyme to the nearest tenth of a micromole.
Thanks to this device, it becomes possible to determine the most accurate value of bilirubin in the blood fluid in the baby and to conduct timely treatment before the first symptoms of jaundice begin to appear.
The analysis is carried out according to the following scheme:
- for the first time, blood is taken from the umbilical cord immediately after the baby is born;
- every other day, the fence is carried out from the heel;
- subsequent analyzes are carried out daily.
In babies who are at risk, that is, those born with a complicated pregnancy, blood fluid is taken from a vein on the head. To do this, use a special thin needle.
There is another way that allows you to control the level of bilirubin – bilitest. It is used only as a preventative measure or in the absence of suspicion of jaundice.
This test is carried out with a special device that examines the color of the skin at the place of application. The tester allows you to measure the yellowness of the epidermis of the newborn, as well as establish the concentration of pigment.
The level of bilirubin is the most significant indicator, which allows us to generally assess the health of only the child born.
Experts do not recommend ignoring the analysis, because thanks to it, you can detect the development of jaundice and other pathological abnormalities and begin timely treatment. The main thing is to remember that the lack of therapy can lead to not the most favorable consequences.
Materials are published for reference, and are not a prescription for treatment! We recommend that you contact a hematologist at your hospital!
Co-authors: Markovets Natalya Viktorovna, hematologist
After the birth of a child, doctors immediately examine him, take a blood test. Among other indicators of the analysis, the amount of bilirubin in the blood is determined. What is bilirubin and what function does it play in the body of children? What is the danger of high bilirubin in a newborn and what to do to get rid of the problem?
Physiological jaundice does not harm the baby’s health and usually disappears before the first month of life. The reason for its development is most often due to violations of the liver, which is not able to work at full strength or can not cope with increased bilirubin. Often, the cause of jaundice can be breastfeeding, when the mother’s breast milk contains high levels of hormones, which affects a decrease in the activity of liver enzymes and an increase in bilirubin.
The main symptoms of this condition are:
- Yellowing of the skin of the face, chest, neck, to the level of the navel.
- The general condition of the child is satisfactory, the baby eats well, sleeps.
- The decrease in bilirubin is slow and begins 10 days after birth.
Due to the fact that in newly born children, bilirubin increases due to imperfection of liver enzymes, during treatment it is necessary to promote its maturation and help the liver work. Enzyme activating drugs such as Zixorin are primarily prescribed. It is prescribed in precisely calculated proportions, according to the scheme and strictly limited course. It connects a substance capable of processing bilirubin to work.
As an aid, with the main treatment, vitamins are prescribed: B; A; E and D, as well as folic acid and glucose solution. When administered intravenously, these drugs enhance the metabolic processes in the liver, and helps to extract bilirubin from the blood and transform it into a non-toxic substance.
In a severe form of the course of the disease, when bilirubin rolls over and threatens to affect the brain, the baby is given a replacement blood transfusion. Take a small portion and replace it with a compatible but clean substance. Thus, you can upgrade to 75% of the blood. These manipulations are carried out for 4-6 days and in most cases severe toxic poisoning recedes.
The biomaterial for the study is serum of venous or capillary blood. Venous blood should be preferred, since the risk of coagulation and hemolysis (destruction of red blood cells in vitro) is significantly reduced for this type of biomaterial. Correct taking of biomaterial for research allows avoiding the need for repeated blood sampling, which is so unpleasant for babies.
To eliminate false results, it is important to properly prepare the child for analysis. Newborn babies take blood before feeding or a few hours after it. Babies from 3 to 7 years are recommended to take a break after the last meal 3 to 4 hours and only then go to the laboratory. It is advisable for older children to withstand 6 to 8 hours before donating blood.
You should reassure the child as much as possible, since emotional stress can adversely affect the reliability of the data. Sit quietly for about 15 minutes, and then go into the treatment room.
Bilirubin is a bile pigment that is formed as a result of the breakdown of protein compounds: hemoglobin, cytochrome and myoglobin. Bilirubin is the most important component of bile not only in the human body, but also in animals. Once in the blood, it begins to have a toxic effect, so the body immediately gets rid of it.
The liver of a newborn baby does not yet contain a sufficient number of enzymes that are responsible for the “utilization” of bilirubin, therefore the content of this component in the baby’s blood in the first days after birth is almost always increased.
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- What is bilirubin?
- Bilirubin and its fractions
- Norms of Values
- How to lower a high rate
- Decreased bilirubin in the blood of a newborn
- What is bilirubin?
- Reasons for the increase
- What is bilirubin?
- Treatment and prevention
- Photolamp Treatment
- Popular questions and answers
- Types of pigment in the body
- Related Videos
What is bilirubin?
Bilirubin and its fractions
Bilirubin – a component of bile, a pigment, is a diamond in the form of crystals. Appears after the decomposition of old blood proteins containing iron. The process of decomposition of red blood cells in the liver, spleen, bone marrow and lymph nodes occurs. From there, bilirubin enters the bile, then into the intestines and goes out with feces.
There are two fractions of pigment:
- free fraction – direct bilirubin, easily leaves with feces and urine;
- bound – indirect bilirubin, not water soluble, first enters the liver, where it passes into the free fraction, and only then can leave the body.
Under the general bilirubin understand the combination of direct and indirect. Their proportion in the body usually looks like this: 75% and 25%, respectively.
After the birth of most newborns, the number of crystals increases. The reason is simple – the baby was born. Until that moment, red blood cells from the mother’s body delivered oxygen to him. But now he is switching to independent breathing, and those who have completed their work and now are not needed cells are being utilized. Therefore, an increase in bilirubin in newborns is perceived as normal, unless, of course, it is within the boundary indicators.
Bilirubin is formed in the spleen and bone marrow as a result of the death of red blood cells (red blood cells). The maximum lifespan of mature red blood cells is 120 days. After death, they are destroyed with the release of the iron-containing part – heme. Destruction of the heme leads to the elimination of ferrous iron, and the remaining protein component is converted into bilirubin.
The function of bilirubin in the body is a cellular antioxidant. It slows down oxidative processes, improving the renewal and functioning of the cell membrane.
Bilirubin is also an essential component of bile.
Total bilirubin is divided into 2 fractions:
- indirect – bile pigment, a product of heme decay after erythrocyte degradation. Special property: toxicity and the ability to penetrate the blood-brain barrier. It does not dissolve in liquid and is not excreted in its pure form from the body. Delivered to liver cells (hepatocytes);
- direct – a complex of indirect fraction with sugar-containing substances (glucuronic acid) is formed in the liver. The fraction is soluble in water and non-toxic. After formation, it is excreted into the systemic circulation with bile and delivered to the intestinal tract.
Further metabolism of the direct fraction leads to acid cleavage with reduction to urobilinogen bodies. Some of them are reabsorbed and returned to the liver, and the remaining amount is transformed by the intestinal microflora and excreted in the feces.
Norms of Values
Determination of the norm of total bilirubin and each fraction separately has a high diagnostic value and is used for the differential diagnosis of pathologies.
Using the colorimetric photometric method, the norm of total bilirubin and direct fraction in the blood of newborns and older children is determined. The value of the indirect fraction is calculated by the formula: total bilirubin minus direct.
For decoding, a convenient table of the norm of bilirubin in newborns by day of life is convenient. Data is relevant for both sexes.
total bilirubin, µmol / l
|1 – 2 months||8,5-20,5|
|In older age||3,4 – 20,5|
The direct fraction should not exceed 5 μmol / L in the blood test, the remaining amount is indirect.
The highest bilirubin in newborns is observed in the first 2-4 days of life and is a variant of the physiological norm (with the exception of atresia).
– An increase in the level of bilirubin in the blood is observed in almost all newborns in the first 3-4 days of life, says Anna Levadnaya. – In about half of full-term and almost all premature babies, this is accompanied by staining of the skin in icteric color. This is noticeable to the eye if the level of bilirubin in the blood is above about 68 micromoles.
With physiological jaundice in full-term infants, total bilirubin is less than 256 micromoles, in premature babies – less than 171 micromoles. If these numbers are higher, and there are a number of other signs, for example, an earlier appearance and prolonged increase in jaundice, dark urine and discolored stools, anemia, then additional examinations are required.
If we talk about the norm of bilirubin in the blood of a newborn (full-term), then you should focus on such indicators.
With physiological jaundice, when the bilirubin level is slightly exceeded, the child feels well, no measures should be taken to reduce it. The level of bilirubin is gradually normalizing, as a rule, this occurs by the end of the first month of life.
If we are talking about a more serious condition, when the level of bilirubin in the blood of a newborn is higher than 256 μmol / l, additional examinations and mandatory treatment are required.
“The modern method of reducing bilirubin is phototherapy,” says Anna Levadnaya. – Its duration and intensity depend on the body weight of the baby at birth, as well as how much bilirubin is exceeded. In severe cases, a newborn may be prescribed an exchange blood transfusion. The need for transfusion, its multiplicity and volume is determined by the doctor.
Increased bilirubin in newborns is a fairly urgent problem. Almost half of the babies in the first 7-10 days of life show the first signs of jaundice.
The skin and mucous surfaces (sclera of the eyes, the surface of the tongue and others) can acquire a yellowish tint in the first days of an infant’s life. Such a manifestation is quite normal.
But this does not mean that the listed signs can be left to chance. If you do not pay attention to jaundice in newborns, it can become chronic and cause complications.
Over time, the amount of fetal hemoglobin in the body decreases. The liver gradually processes dead blood cells, as a result of which the skin and mucous membranes acquire a normal shade, and the condition of the crumbs is normalized.
You can get full information about acceptable indicators by looking at the data in the table.
|Baby age||Bilirubin, μmol / L|
|12-24 hours||to 85|
|36 hours||to 150|
|48 hours||to 180|
|3-5 days||to 225|
|6-7 days||to 145|
|8-9 days||to 110|
|10-11 days||to 80|
|12-13 days||to 45|
|from 14 days and more||to 20.5|
Exceeding the indicators indicated in the table is an alarming call for specialists. In such cases, immediate medical measures and constant monitoring of the condition of the child are required.
The upper limit of bilirubin in newborns is the norm indicators for infants indicated in the table in accordance with the days of life. In case of significant deviations from the norm, mandatory intervention of specialists is required.
Each newborn in the first days of life increases the rate of bilirubin in the blood. Normally, by the month of bilirubin is significantly reduced and does not further increase to such high rates. If the child has a strong yellowing, which does not go away and intensifies, then you must definitely go to the hospital.
The appearance of jaundice in a newborn baby is a very common problem associated with an increase in bilirubin levels. Every expectant mother should find out what kind of compound it is, why it appears in the blood of a newborn and causes yellow skin color, as determined in a child’s body, as well as what they do to increase performance.
These indicators are associated with increased education and slow elimination of bilirubin from the child’s body. In the erythrocytes of the fetus in the womb, for better oxygen transfer, hemoglobin has a different structure than hemoglobin in adults and already born children. Such hemoglobin is called fetal.
- The norm of bilirubin in a newborn is from 50 to 60 μmol / L on the first day of life, while indirect bilirubin in an infant should be 10% of the total.
- From 2 to 7 days – the maximum value should not exceed 256 μmol / L.
Thus, every day until a certain point, the bilirubin in an infant grows. For comparison: in an adult, the normal level of bilirubin should be in the range from 8,5 to 20,5 μmol / L. This means that the breakdown product of hemoglobin leaves the body in accordance with the established norm.
As mentioned above, the maximum pigment concentration is observed in newborns after 3-5 days and should not exceed 256 μmol / L. Otherwise, this serves as a signal that the child began to develop jaundice.
- At 1 month, the norm usually corresponds to the values that an adult should have. However, often even by a two-month period, bilirubin can range from 9 to 21 μmol / L.
Normal bilirubin levels in infants may fluctuate. At birth, the limit is from 51 to 60 μmol / L, but hemoglobin continues to decay. As a result of this, tests can show overestimated values already on the 3rd day of the baby’s life. Further indicators are reduced.
Below is a daily table that reflects the rate of bilirubin.
Norm for premature babies
more than 14 days
After a week of life, the high concentration of the enzyme decreases. Stabilization of the substance level occurs already by the 21st day. In a child of one month, pigment indices should be constant. The monthly table only displays threshold values. When overestimation of bilirubin is noted at 2-3 months of life, immediate therapeutic intervention is required.
General indicator (μmol / l)
8,5 – 20,5 (bilirubin can range from 9 to 21 micromol / l, even up to two months of age)
In preterm infants, jaundice is diagnosed in almost 80 percent of cases. The concentration of the enzyme in them, in contrast to that in healthy children, will be less. In addition, bilirubin in this case is most often indirect.
A high bilirubin in the blood leads to negative consequences for the central nervous system and the brain of the baby. In addition, overestimated values can provoke the development of bilirubin encephalopathy, which is manifested by symptoms such as:
- enlarged spleen or liver;
- lowering blood pressure;
- prolonged sleep or, conversely, insomnia;
- lack of appetite.
A reduced amount of the enzyme in the absence of therapeutic measures can lead to rickets, the determination of which is carried out by underweighting the baby for several months.
The rate of bilirubin in a newborn is significantly different from an adult. So, in a child after the first month of life and in an adult, bilirubin from 8,5 to 20,5 μmol / L is considered the norm, and in a newborn, it can exceed 205 μmol / L.
It is worth noting that the rate of bilirubin in a newborn changes every day or even hourly, so if a child has an increased level of this pigment, doctors will observe for several days.
Basically, bilirubin rises in newborns on the 2nd or 4th day after birth. If the jaundice is physiological, then the skin color of the child will be almost imperceptible. Such bilirubin does not harm the baby’s health and normalizes within 3-4 weeks after birth.
But there are times when the baby’s yellow pigment does not decrease, but grows, which is an alarming symptom.
With increased bilirubin in a newborn, it is important to monitor the dynamics of its decrease or increase in blood plasma, as well as assess the general condition of the child, the work of the liver and biliary tract.
The first blood test of an infant occurs immediately after birth. The fence is made of the umbilical cord, when it is cut. The analysis allows you to establish not only the blood group of the newborn, but also the bilirubin content.
The organs of a newly born baby are imperfect. Therefore, the liver does not have time to process and remove a large amount of bilirubin formed. And its plasma level is increasing. But over time, it falls and about the fourth day after birth, there is a minimal content of this substance. With the growth of the child, permissible norms also change significantly.
How to lower a high rate
If a disease is suspected due to an increase in bilirubin, the following diagnostic measures must be taken:
- tracking the dynamics of bilirubin indicators;
- monitoring the condition of the child;
- additional research.
Additional studies are prescribed by a doctor in case of deterioration in the general condition of the child, as well as a long course of the pathological process. High The following laboratory and instrumental studies are carried out:
- analysis for bilirubin;
- KLA, including the determination of the number of red blood cells;
- blood chemistry;
- Coombs test;
Doctors take a special analysis from the circumcised umbilical cord in the first minutes of life, then the blood is re-examined after 2-3 days. A digital bilirubinometer is also used to determine bilirubin. It allows you to evaluate the degree of yellowness of the skin and measure the level of pigment in the subcutaneous tissues.
How to remove and neutralize a substance if its performance is steadily increasing? Usually, with increased bilirubin in newborns, doctors prescribe a treatment consisting of:
- intake of enterosorbents, vitamins and choleretic drugs;
- the introduction of saline and glucose after treatment under a medical lamp;
In especially severe cases, the baby needs a blood transfusion.
- Light ray treatment is an effective procedure, although it is used less and less, and children are increasingly being treated with drugs that have a toxic effect.
After phototherapy, the child may begin to lose hair or peel off the skin, but these manifestations will immediately disappear after the end of the course.
- Quartzing (phototherapy) can give results only in the initial stage and in the first days of a newborn’s life, but in other cases, as a rule, medication is used.
- Before you start using the drugs, you must consult a doctor, as well as familiarize yourself with the instructions for use. In addition, the pediatrician, if necessary, can prescribe choleretic drugs, vitamin C and glucose.
- It must also be remembered that breastfeeding actively promotes the elimination of toxins with increased bilirubin.
As a rule, for a baby whose jaundice was discovered, normal observation by specialists will be sufficient. Often the symptoms disappear after 1-2 weeks, even without the use of a serious medication.
Sun baths are an effective way to lower bilirubin in the blood.
If the baby was born in spring or summer, the mother can open the stroller hood during the walk so that the sun’s rays fall on the arms, legs and face of the newborn. In winter, there are fewer sunny days, so providing your baby with natural sun baths will not be so easy.
If the parents managed to catch a sunny day, you can take the crumbs out into the street and expose his face under the rays of the sun. Both in winter and in summer, it is necessary to ensure that the sun’s rays do not shine in the open eyes of the baby. Despite the obvious benefits of the sun, a newborn should not be exposed to direct sunlight for more than 10 minutes.
On summer days, sunbathing from 11 am to 17 pm is not recommended. During this period, the sun is especially harsh and can harm the health of the child.
To eliminate jaundice in the hospital, phototherapy procedures can also be performed. This requires special equipment.
The baby is placed under a blue lamp, the rays of which contribute to the conversion of toxic bilirubin into normal and its painless excretion from the body. In this case, the child without fail put on special glasses or a hat, since the rays of the lamp are harmful to vision.
After the procedure is completed, many babies experience the appearance of flaky skin or thinning of the stool. In particularly difficult cases, babies can be given droppers and even a blood transfusion.
The appearance of an increased level of bilirubin can be caused by:
- Prematurity of the baby.
- The development of diabetes in the expectant mother.
- Acute pregnant diseases.
- Hypoxia in a baby during gestation.
- Asphyxia in childbirth.
- Premature birth.
- An increased amount of estrogen in breast milk.
- Incompatibility of the blood type of the mother and baby.
- Rhesus conflict during gestation.
- Refusal of breastfeeding immediately after childbirth.
- Big weight loss in the first days after childbirth.
- Pathologies of fetal development.
- Infectious liver disease.
- A mechanical type of jaundice.
- Intestinal obstruction.
- The destruction of red blood cells due to genetic diseases.
- The use of medications to stimulate labor.
- Hepatic dysfunction in an infant.
- Hormonal disruption in a toddler.
Most babies develop jaundice, which is called physiological. It manifests itself after the penetration of bilirubin into the surface layers of the skin, which occurs when the level of this pigment is above 120 μmol / L in healthy full-term babies and above 85 μmol / L in infants born prematurely.
With an increase in the level of bilirubin in a full-term newborn more than 256 μmol / L, and in premature infants over 172 μmol / L, a diagnosis of “pathological jaundice” is made. The increase in the level of bilirubin in this state is more than 5 μmol / l per hour, while in physiological jaundice this increase does not exceed 3,4 μmol / l per hour.
Begins from 2-5 days of life
It can start from the first day of life, and after 14 days of life
Lasts an average of 2-3 weeks
From the 4th day of life, the intensity of jaundice and the level of bilirubin decreases
Differs in a wavy current
Yellowing begins with the face and upper body
The body turns yellow below the navel, feet and palms are orange
The child is not disturbed
The child may be overly excited or signs of depression of the nervous system are observed.
Stool and urine staining normal
Sometimes the feces become light and the urine darkens
Possible disruption of the liver
The most simple, affordable and harmless way to treat jaundice in newborns is phototherapy. A child with a risk of increasing bilirubin to toxic levels is placed for a certain time under special lamps, the light from which transforms indirect bilirubin into a non-toxic substance called lumirubin. Within 12 hours, bilirubin leaves the body of the baby with feces and urine.
Phototherapy is carried out with interruptions in feeding. The baby should lie 20-40 cm from the lamp, and his genitals and eyes should be covered with a tissue that does not allow light to pass through. Side effects of this treatment can include diarrhea, tanning, fever, dehydration and peeling of the skin. To eliminate them in the body of a newborn, it is important to maintain a constant water balance.
It is equally important to attach the baby to the breast as early as possible and often feed, since this stimulates the removal of meconium from the intestines of the child, which contains a large amount of bilirubin.
With pathological jaundice, such treatment is connected:
- Infusion therapy. Special solutions are administered intravenously to the child, and if the baby’s condition is complicated, then the baby will receive blood transfusions.
- Enterosorbents. The baby is given smecta, enterosgel and other drugs to prevent the reabsorption of bilirubin from the intestine.
- Specific treatment depending on the identified pathology.
- Quartzing (phototherapy) can give results only in the initial stage and in the first days of a newborn’s life, but in other cases, as a rule, medication is used.
- Before you start using the drugs, you must consult a doctor, as well as familiarize yourself with the instructions for use. In addition, the pediatrician, if necessary, can prescribe choleretic drugs, vitamin C and glucose.
- It must also be remembered that breastfeeding actively promotes the elimination of toxins with increased bilirubin.
If increased bilirubin is diagnosed in newborns, this is the first sign that jaundice has begun to develop. It has two forms:
- physiological jaundice, which in most cases is not dangerous and passes on its own by the 4th week of the baby’s life, but constant monitoring of the baby’s condition is required, since the disease can go into a complicated form;
- pathological, in which immediate treatment is required, in its absence, the risk of adverse effects increases.
The reasons for the high values of the enzyme are as follows:
- severe pregnancy;
- complications in the process of labor;
- fetal asphyxiation during pregnancy or childbirth, for example, when the baby is wrapped in an umbilical cord.
The values of the indicators with the pathological form of jaundice can be off scale. In this case, the provoking factors are those listed above. In addition, excessively high bilirubin can indicate problems such as:
- hormonal disorders;
- rhesus conflict;
- pathology of the liver in an infant;
- bowel obstruction or biliary tract;
- diseases at the genetic level, against which erythrocyte membranes are destroyed.
Jaundice of a pathological form can be triggered by some medications that a woman took during the period of bearing a child.
If jaundice has been diagnosed, therapeutic measures are aimed not only at its treatment, but also at eliminating the underlying cause, the provocateur.
If a large level of the enzyme is found in the blood fluid of the baby, immediate consultation with a specialist is required. He will establish the cause of the increase in pigment concentration and prescribe the necessary treatment.
To reduce bilirubin, the following therapeutic measures are carried out:
- Infusion therapy. The main objective of this method is to make up for the lost fluid that the body lost during phototherapy. For these purposes, the child is injected with soda, glucose solution, membrane stabilizers and substances that contribute to the improvement of microcirculation.
- Phototherapy. To carry out the procedure, the newborn is placed in a crib over which an ultraviolet device is installed. When exposed to radiation, an excess amount of the enzyme begins to be rapidly excreted from the body. Before starting treatment with ultraviolet, the baby’s eyes are covered with a special bandage. Duration under the lamp can be several hours a day. The child is pulled out of the crib only for the duration of hygiene procedures. The course lasts a few days.
- Purpose of enterosorbents (Smecta and Enterosgel). The main purpose of taking drugs is to prevent the reverse absorption of bilirubin into the blood fluid. To normalize the level of electrolytes, infants are put droppers. To restore the liver and remove toxic substances from the body, hepatoprotectors (Essentiale or Silibor) are prescribed.
Decreased bilirubin in the blood of a newborn
The main danger of an increased amount of bilirubin in the baby’s blood is its negative effect on the nerve cells and other systems of the child’s organs. Encephalopathy, an increase in the spleen and liver, increased drowsiness, decreased blood pressure, seizures, developmental delays, hearing problems, and even paralysis can result.
Physiological jaundice should be distinguished from pathological jaundice.
In the first case, this is a normal process, since the body rebuilds and adapts to the conversion of fetal hemoglobin to normal.
As a rule, yellowness of the skin is most pronounced on the third or fourth day, and by 7-8 days it should pass. This condition does not require treatment and goes away by itself without medical intervention.
However, there are cases when it is urgent to lower the pigment content. The following signs indicate the development of pathological jaundice:
- bilirubin in the blood exceeds 308 μmol / l;
- increased irritability or depression of the child;
- dark color of urine;
- white stool;
- the spread of yellowness in the area below the navel, on the palms and feet;
- bad state of health;
- the appearance of jaundice on the first day after birth;
- jaundice lasts more than two weeks;
Why does the level of bile pigment increase in the blood of newborns? This is due to the features of the functioning of the body, but sometimes there is a pathology that requires treatment. The amount of bilirubin in the body of the child may increase due to the following reasons:
- pathological processes occurring in the liver, including hepatitis;
- infectious diseases;
- metabolic disorders or hypothyroidism (low concentration of thyroid hormones);
- active decay of red blood cells;
- hemolytic disease of the newborn (mismatch of the Rhesus factors of the blood of the mother and child)
It should be noted that a decrease in red blood cells may be the result of a disease, rather than occurring on its own. For example, this phenomenon can be observed with blood loss, including intestinal bleeding.
Thus, jaundice during this period can be evidence of an extremely dangerous condition for the health and life of the newborn, therefore it is urgent to seek medical help.
- An overdose of vitamin K and taking medications by a pregnant woman can also lead to a pathological condition.
- In addition, the fetus during pregnancy may be affected by high blood sugar in the mother, who has diabetes.
- It is worth noting that most drugs penetrate the placental barrier with blood flow to the fetal liver, disrupting enzymatic processes.
- Among the reasons can also be noted a severe pregnancy and complicated childbirth, lack of oxygen in a child.
- Hormonal disorders, obstruction of the intestines or biliary tract can also lead to a high level of pigment.
With pathological jaundice, there is not only a change in the color of the skin, but also a violation of the nervous system. In addition, other organs may be involved in the pathological process.
Pathological jaundice is divided into five main stages, depending on the spread over the skin:
- face and neck surface – 80 micromol / l;
- upper torso – 150;
- the whole body except the lower limbs to the knees;
- the entire skin, in addition to the feet and hands;
- completely the whole body.
- exclude too sweet, spicy and fried foods from the diet;
- drink up to two liters of clean water;
- Do not go on diets and prevent overeating;
- eat more fresh vegetables and fruits that do not cause an allergic reaction in the baby;
- steam dishes or bake in the oven.
When diagnosing pathological jaundice, the following medications are prescribed:
- Hepel. Helps accelerate the outflow of bile, eliminate the symptoms of loose stools, maintain the normal activity of the gallbladder and liver.
- Ursofalk. It is recommended to apply in the form of a suspension. Taking medication is prescribed if weakness of the gallbladder is detected.
- Elkar, under the influence of which the destruction of excess enzyme and cleansing of the liver from the accumulation of toxic substances occurs.
When diagnosing a complicated form of jaundice, a blood transfusion is performed.
Reduced bilirubin is diagnosed in extremely rare cases. Among the main causes of this pathology are:
- lack of iron;
- malnutrition on an ongoing basis;
- low fetal hemoglobin.
Often a small value of the indicator is observed in violation of the rules for performing analysis on bilirubin. Certain medications, including ascorbic acid and antibiotics, may contribute to the distortion of the results of the study.
Sometimes a decrease in pigment indicates various pathological processes, such as:
- chronic form of hepatic and renal failure;
- acute leukemia;
- aplastic anemia;
Also, a low enzyme can indicate various diseases of an infectious nature.
The following factors can provoke high bilirubin in newborns:
- pregnancy pathology;
- chronic diseases of the mother;
- taking certain medications during pregnancy;
- fetal hypoxia.
Increased bilirubin during pregnancy can be associated with various causes described in an article on our website.
There are other reasons that can cause an increased content of bilirubin in the blood of a newborn baby, but in any case, a doctor should monitor its amount: pediatrician or neonatologist.
A high concentration of pigment in the blood is negatively displayed on the general condition of the child, as well as the work of internal organs and systems. First of all, the central nervous system, the brain suffers, since it is there that bilirubin accumulates. This condition leads to severe intoxication of the body, which entails the death of brain cells and nerve endings. The following conditions or diseases can be a complication of pathological jaundice:
- Mental underdevelopment.
- Decreased or loss of hearing, vision.
- Disruption of the liver, which increases in size and is not able to perform its functions.
- Cerebral paralysis.
- Cerebral edema.
Children with severe pathological jaundice have a poorly developed sucking reflex, they are restless, often wake up, often cry. Complications of jaundice often have irreversible and severe consequences, so if bilirubin is beyond the norm, you need to contact a doctor who will prescribe therapy after a series of laboratory and instrumental studies.
The cause of the appearance of newborn jaundice is an increased level of bilirubin in the blood. The word, of course, is new for young mothers, causing a lot of questions and even panic. Therefore, it will be correct if a pregnant woman familiarizes herself with such a concept in advance and understands what it is and whether increased bilirubin is dangerous for newborns. And perhaps the knowledge gained will help protect the future crumbs from the pathological course of the disease.
There is another table, distributed by type.
In premature babies, the level of bilirubin is less and should not exceed 170 μmol / l. High levels of bilirubin can also be in full-term newborns, many factors affect its increase.
The body of the baby after birth is under great stress and tries to adapt to new conditions of existence. The manifestation of jaundice during this period indicates the mass death of the red blood cells of the fetus, the composition of which does not at all resemble the hemoglobin of a newborn. The epidermis and mucous crumbs acquire a light olive shade. This condition is more inherent in premature babies, the percentage of births on time is much less.
Starting usually on 3-4 days from the moment of birth, this phenomenon at 3-5 weeks of life disappears on its own and is not able to harm the baby. With breastfeeding, physiological jaundice passes in a shorter period. This is due to the fact that breast milk has a laxative effect, and bilirubin comes out naturally with feces.
Children who hastened to appear ahead of time, in this state need phototherapy. Under the influence of light from a special lamp, bilirubin penetrates more actively into bile and urine and leaves the body faster. The procedure time is calculated separately for each child, taking into account his weight. Several sessions are allowed in one day, the tanning time is determined by the doctor.
Signs of physiological jaundice:
- Cannot appear earlier than 36 hours after birth.
- The icteric hue acquires only part of the body, to the waist.
- Bilirubin does not go beyond 205 μmol / L.
- The kid is active and feels good.
For children born on time, there is the concept of “immature”. Those. the child can be born between 37 and 39 weeks, but his liver has not yet fully formed, is “matured”, therefore it cannot process hemoglobin into bilirubin and remove excess so that jaundice does not appear.
But it also happens that physiological jaundice goes into pathological. The reasons that can lead to complications are explained by the following factors.
- Different blood types and incompatible Rh factors in mom and baby.
- Genetic abnormalities of the child.
- The infant’s liver was exposed to the virus before birth.
- In infants, the outflow of bile is impaired.
- Intrauterine growth retardation, immaturity, premature birth.
- Feeding with mixtures.
- Uncontrolled intake of various drugs by the mother during gestation.
All these factors provoke the development of pathological jaundice. The baby’s skin becomes greenish-yellow in color, feces are lighter, and urine, on the contrary, darkens, the size of the spleen and liver can increase.
The baby is getting worse every day, it will not be possible to do without the help of doctors. Inaction of parents can lead to the next stage of pathology and possible complications:
- Poisoning of the nervous system and brain by toxins.
- The real possibility of developing albunemia. (drop in albumin, the main blood protein).
What is bilirubin?
- Indirect (free), which is formed as a result of the fact that the rate of decay of red blood cells is higher than the ability of the liver to bilirubin. Free bilirubin is a substance that is typically soluble only in lipids (fats). Due to the inability to dissolve in water, the pigment is very toxic, accumulates in the bloodstream, causing a characteristic staining, and can interfere with the normal functioning of cells, freely penetrating into them.
- Direct (bound) bilirubin is formed directly in the liver. After biochemical interaction with organic acids of the uronic group and liver enzymes, which reduce the toxicity of the pigment, it becomes soluble in water and is easily excreted from the body along with bile and urine.
Reasons for the increase
In order to fully analyze the situation, the content of all bilirubin fractions in the blood is determined. This helps to establish not only the type of jaundice, but also the reasons for its transition to the pathological stage.
After receiving the results of the analysis, they are compared and the rate of bilirubin in newborns. The table by month contains threshold values. If the amount of coloring matter significantly exceeds them, the situation necessarily requires treatment.
To begin the fight against high bilirubin should be using light exposure. It is carried out in a special cuvette with the obligatory use of safety glasses. This method is recognized as the most innocuous, but at the same time quite effective and fast. Side effects of this procedure can be diarrhea and peeling of the skin. In case of termination of treatment, the negative effects of it very quickly disappear.
However, you should know that phototherapy is effective only with physiological jaundice. If over time, the level of the substance is higher than the value located in the line “The norm of bilirubin in newborns is 1 month” (the table is presented above), it will not be possible to do without drug treatment.
Many do not consider jaundice in newborns to be quite a serious problem. But it is necessary to know and understand that this is not true in all cases. Without proper attention and treatment, the problem can have serious consequences.
The condition is characterized by typical clinical manifestations:
- moderate staining of the proteins and skin of the child in a yellowish tint;
- decreased appetite;
- mild weakness and drowsiness;
- a high level of bilirubin in the blood of a newborn (not exceeding the upper limit of normal);
- lack of signs of central nervous system damage.
The reason is the insufficient development of the liver in a newborn child, as a result of which the indirect fraction does not transform into direct bilirubin in full. The gradual launch of the full-fledged work of the enzymatic system contributes to the spontaneous disappearance of the symptoms of physiological jaundice.
The maximum severity of symptoms is characteristic for 3-4 days of a baby’s life.
Is physiological jaundice required? If the symptoms disappear after 2 weeks, while the absolute norm of bilirubin in newborns is recorded in a blood test, then this condition does not require treatment.
Patients may be shown exposure to the sun or short courses of phototherapy.
If the severity of symptoms and their duration is more than two weeks, the doctor determines the tactics of treatment. The preferred treatment is phototherapy. The kid is illuminated with special rays of blue light (the wavelength is in the range from 460 to 490 nm), which accelerates the process of decomposition and removal of bilirubin from the body.
In pathological types of jaundice (nuclear jaundice with damage to the central nervous system, hemolytic anemia, etc.), emergency treatment is indicated in the department of neonatal pathology or resuscitation.
Upon reaching critical indicators, blood transfusion is indicated.
Pathology is extremely rare, 1 case per 20 thousand newborns. It was noted that more often atresia is recorded in girls.
The disease is characterized by obstruction of the biliary tract or their complete absence. Symptoms
- a yellowish-green shade of the proteins of the eyes and skin of the baby progressing with time;
- unnaturally pale color of feces;
- urine acquires a dark brown color.
In the first days of life, the disease is no different from physiological jaundice. However, it does not disappear over time, while phototherapy and blood transfusion do not give a positive therapeutic effect.
The reasons are not fully established. It is reliably known that pathology is not a consequence of the side effects of medications or vaccinations that were administered to the mother during pregnancy.
Bile duct obstruction is associated with the transfer of an infectious disease (herpes, cytomegalovirus or rubella) to a pregnant woman. As a result of infection, the cells of the liver and endothelium of the bile ducts of the developing embryo are damaged. Subsequently, this leads to proliferation of connective tissue and the impossibility of a normal flow of bile.
There is isolated information when atresia developed in a baby after birth as a result of infection and sclerosis of the bile ducts.
The absence of bile ducts is the result of a mutation and improper laying of an organ during ontogenesis. The gallbladder is also absent or is the only link in the external biliary tract.
The prognosis is rather unfavorable. The lack of timely and adequate treatment reduces the life of the child up to 16 months. The only method of therapy is surgery: liver transplantation or reconstruction of the bile duct. A favorable prognosis is achieved in 30 – 40% of cases.
- indirect (the original type of bilirubin, which practically does not dissolve and cannot be excreted from the body naturally);
- direct (associated bilirubin, which is formed in the liver from indirect by combining with glucuronic acid);
- total (total amount of bilirubin contained in blood cells).
To diagnose pathologies in humans, the content of direct and total bilirubin is studied. If the obtained values are much higher than normal, the child may be suspected of pathology of the liver and gall bladder or ducts: cirrhosis, hepatitis, atresia of the biliary tract, etc.
In newborns, blood is taken from the heel for analysis. After receiving the results, the indicators are compared with the normal values established for a particular age. If the content of the coloring pigment is much higher than normal, the child will be assigned a comprehensive examination and treatment, if necessary.
In most hospitals, a special device is used to measure bilirubin, which is a photocell. It is brought to the forehead of the newborn and the skin color is fixed, and a special program recognizes the pigment content in the skin. This method is more gentle, as it does not cause pain and can be used when the baby is sleeping.
But parents should know that the data obtained cannot be considered completely reliable, since the device has an error (the value is set for each category of devices). In addition, this method does not allow measuring bilirubin fractions, which is necessary to compile a complete clinical picture and determine the cause and degree of pathology (in cases where an increase in the total amount of pigment is determined).
Important! Measurement of bilirubin with a photographic device is allowed if the baby is healthy, and the total bilirubin is within normal limits. If any deviations are determined, it is better to use a blood test (more accurate and reliable).
What is bilirubin?
In especially severe cases, if bilirubin continues to increase and there is a risk of brain damage (hemolytic disease), they resort to a noticeable blood transfusion.
Treatment and prevention
On-demand feeding is also considered an effective preventative measure. Traditional medicine advises mothers, whose children suffer from jaundice, to milk the baby with broth of wild rose, sweet water and other drinks for babies.
Such a judgment is erroneous. None of the listed fluid options can lower the level of bilirubin in the body. It is better to put the baby to the chest more often. In this case, mom’s milk is the best prophylactic and therapeutic agent to normalize elevated bilirubin levels.
In newborns, physiological or transient jaundice usually occurs, which appears as a result of the body’s adaptation to new conditions. Transient jaundice occurs in 60-70% of cases and often does not require medical intervention. Pathological jaundice is much more dangerous and can lead to serious violations in the central nervous system and brain. An increase in bilirubin to a critical level may result in the death of the infant.
The norms of bilirubin for a newborn are up to 34 units per liter of blood. On the second day, indicators increase and can reach 150 μmol / liter. On the third day, the maximum rate is 250 μmol / liter. After the third day of life in a child, bilirubin begins to gradually decrease. By the month it should be 9-20,5 μmol / liter. All indicators are checked only using a blood test.
In addition to bilirubin, doctors look at other blood counts that may indicate abnormalities in the body. In some cases, the first signs of jaundice can appear only on 4-7 days, which is caused by a large mass at birth and good appetite.
One of the important factors in the successful withdrawal of bound bilirubin is regular bowel movement and urination. Factors that cause transient jaundice include:
- Premature or complex birth;
- The presence of chronic diseases in the mother, including diabetes, diseases of the hematopoietic system;
- Rhesus conflict;
- Stimulation of labor;
- Emergency delivery by caesarean section;
- Lack of breastfeeding;
- Anomalies in the development of organs and systems;
- Sudden weight loss after birth;
- Oxygen starvation of the child.
For babies who were born earlier than 34 weeks of gestation, critical bilirubin values are half the norm than in full-term babies. Initially, an increase in bilirubin can be detected using a special device that determines the concentration of a substance in the blood by a photometric method. When suspicions appear, doctors conduct more detailed studies and take blood for analysis.
The most effective way to reduce bilirubin in babies to normal levels is to use photolamps. Phototherapy can be carried out only in medical institutions, which is due to the features of the procedure. Lamps are able to destroy bilirubin in the skin and turn it into lumirubin, which is easily excreted by the body.
In addition to phototherapy, it is important for the child to drink a large amount of liquid. Breast milk is the best option, but electrolyte is also suitable. It helps to remove toxins and decay products of bilirubin from the body. Depending on the symptoms, additional medications can be prescribed, the effect of which is aimed at maintaining the health of the body.
This type of disease is quite dangerous for a newborn child, since the growth of bilirubin in the blood can increase daily, which disrupts the functioning of the internal organs, the general condition of the baby. A severe form of jaundice is considered to be a condition when the growth of bilirubin per day increases by 85 μmol / L, while at the initial level it was higher than 256 μmol / L. The following symptoms are considered the main signs of pathological jaundice:
- Pronounced yellowing of the skin, including the area below the navel.
- Yellowing of the palms and feet.
- The increased excitability of the child.
- Discoloration of urine and feces.
With a pathological form, the child should constantly be under the careful supervision of a doctor who prescribes a comprehensive treatment to reduce yellow pigment in the blood. The form, stage of jaundice, as well as the treatment, is prescribed by the doctor individually for each small patient.
Very quickly, physiological jaundice can become pathological. Severe forms are accompanied by a significant increase in the level of bilirubin: almost 90 µmol / L every 24 hour. In addition, newborns may initially have a very high value: more than 250 μmol / l.
– yellowing of the body surface below the navel;
– orange color of the palms, as well as feet;
– dark urine and too light feces.
The disease is usually protracted and proceeds in waves. In addition, the general condition of the child can be broken: there is depression, as well as excessive arousal.
1. Hemolytic is manifested in the conflict of the Rh factor in the baby and the mother, as well as genetic diseases.
2. Parenchymal jaundice occurs when liver damage to congenital forms of hepatitis, cytomegalovirus, toxins.
3. Conjugation type is manifested in the case of violations of the enzyme system, as well as bilirubin binding.
4. Mechanical jaundice occurs when the outflow of bile is impaired with anomalies of the gallbladder, as well as the hepatic ducts.
Moms can keep this topic under control and ask the doctor whether such a test was taken from the child and what the results of the laboratory study were.
It is this approach that allows timely detection of jaundice and prescribe measures appropriate for the condition of the child to treat this ailment.
Experienced specialists, as a rule, accurately determine the severity of the disease and all kinds of risks, unlike the advice of friends and general information on the Internet
In this case, young mothers should have patience, and if the child needs to stay under the supervision of a doctor for some time, do not give up, do not take responsibility, and do not put your child’s life and health at risk.
After carrying out all the necessary studies – visual and laboratory specialist makes an appointment and gives recommendations.
Phototherapy is considered the main and effective method of treating jaundice in newborns. The therapeutic result gives a feature of light waves of a certain length to act on bilirubin. The child is freed from clothes and a special lamp is sent to his body. Bilirubin molecules during the absorption of light radiation are converted into a soluble substance – lumirubin, which is harmless to the child’s body, since it is completely non-toxic and easily excreted from the body with urine and bile.
For this procedure, in addition to lamps, special glasses, a blindfold, mattresses and blankets are provided. The manipulation is completely painless and comfortable, does not require emotional stress – for its implementation, the baby does not need to part with his mother. In addition, in maternity hospitals, the use of special lamps in joint wards is practiced, where mom can independently monitor the condition of the child.
Long-term herbal medicine brings good results, and the baby can be exposed to light from several hours to several days during one session. In between procedures, you need to take time to feed the child, care for him and rest.
If the number of procedures during the stay in the hospital is not enough and the level of dangerous pigment in the blood rises, the baby is weaned and transferred to a more intensive treatment.
For a full and comprehensive treatment, doctors prescribe drugs that help babies overcome the complications of jaundice:
- Elkar. The active substance of the drug is a special amino acid L-carnitine, which is responsible for the normalization of energy metabolism. Due to the stimulation of lipid metabolism, the content of bilirubin in tissues, bloodstream and organs can be minimized. This increases the functional ability of the liver – it neutralizes bilirubin, reduces its toxic effect, which gives hope for a favorable prognosis.
For infants, this medication is available in drops and solution for injection with a 20% content of the main substance. If intravenous and intramuscular injections are recommended to be carried out in a hospital, in order to make it easier to monitor the infant’s reaction to the drug, then after discharge at home, the child can be given drops on his own. The main thing is to follow the doctor’s recommendations and act strictly according to the instructions.
- Ursofalk. A new generation of the drug, which is designed to eliminate the symptoms and signs of a diseased liver, has a wide spectrum of action, helping the liver activate its functionality. As a result of this stimulation, the body begins to bind bilirubin more actively, neutralize it and remove it from the body. Doctors really appreciate the ability of this medicine to relieve toxic stress, reduce the likelihood of brain damage and prevent a complication of the disease, such as nuclear jaundice.
Popular questions and answers
Where can I check bilirubin? According to the testimony, the level of bilirubin is determined by the newborn in the hospital. It can also be done in the laboratory. If the child is at home, and the district pediatrician suspects a serious excess of bilirubin and the development of pathological jaundice, then the newborn is sent to a hospital to check the level of bilirubin, examination and treatment.
When is it necessary to consult a doctor? In most cases, pathological jaundice is diagnosed by doctors in the maternity hospital, since it is characterized by an earlier appearance. Nevertheless, if the level of bilirubin does not decrease for a long time, jaundice does not decline and does not pass by the end of the first month of life – this is an occasion for seeking medical attention and examination. Dark urine, discolored stools, and pallor of the skin should also be alerted.
Why treatment may not help? The duration and intensity of phototherapy, which is used to treat jaundice, as we have already noted, is individual, and depends on the indicators of bilirubin and the weight of the newborn. Treatment may not help if it is chosen incorrectly. But such situations are very rare.
“One of the reasons for maintaining high levels of bilirubin in the blood of a newborn may be the so-called“ jaundice from breast milk, ”when the level of bilirubin rises because certain hormones enter the baby’s body along with mother’s milk, says Anna Levadnaya. – With such jaundice, the level of bilirubin may remain elevated longer than usual – more than 6 weeks.
An accurate diagnosis can be made if, after canceling breastfeeding for 2-3 days, the bilirubin level begins to decrease. If the numbers are not high, and the manifestation of jaundice is visually reduced, then after a day or two, breastfeeding is resumed and continued. At the same time, a woman should not forget to regularly express herself during a pause in order to maintain lactation.
Do I need to refuse vaccinations with an elevated level of bilirubin? Young mothers ask this question quite often, refuse vaccinations against hepatitis B, the first of which should be done in the hospital, immediately after birth.
– Physiological jaundice, when bilirubin values are not exceeded significantly, is not a contraindication to routine vaccination, – our expert explains. – Hepatitis B vaccination cannot be the reason for an increase in the level of bilirubin, since it affects the liver no more than any other vaccination.
- the norm of bilirubin in the blood of newborns is selected taking into account age, in the first month – separately for each day;
- in newborn babies, increased bilirubin in most cases is a variant of the physiological norm, and extremely rarely – severe pathology (atresia);
- you should not try to lower your child’s bilirubin, especially folk remedies. Such behavior can significantly aggravate the severity of the pathology and lead to an irreversible adverse outcome.
Types of pigment in the body
The fact that a few days after being outside the womb of the mother, bilirubin in newborns begins to increase is explained by the physiological peculiarity of the rebuilding of the body. The following processes are characteristic of this period:
- as unnecessary a large amount of hemoglobin, it begins the process of decay;
- deforming, red bodies release bilirubin – a special pigment that participated in the formation of an iron-containing protein – hemoglobin and in an abnormally large volume is thrown into the blood;
- the accumulation of bile pigment in the bloodstream increases;
- the dermis and sclera are painted in the tone of the pigment – yellow mustard.
At the beginning of life outside the womb, the baby’s liver is simply not able to cope with a high bilirubin level, since its functionality is not yet fully operational. This condition is considered transient (transient, temporary), and corresponds to the norms of the physiological development of the child. Such jaundice is called physiological and does not require special treatment.
Like jaundice of breastfeeding. After childbirth, the concentration in the milk of hormones that lower the activity of liver enzymes is high, and when naturally fed, they penetrate the baby’s body, causing jaundice. With an increase in the amount of milk in the chest, everything returns to normal, and the baby recovers.
Bilirubin is a greenish yellow bile pigment. It is formed as a result of the decay of obsolete fetal blood cells (erythrocytes), which after birth become useless for the baby.
Since the baby’s liver is immature, it is unable to cope with the full load and process the entire volume of dead blood cells.
Bilirubin present in the baby’s blood can be of 2 types:
- direct (connected). It is excreted in the feces and urine. This is a water-soluble substance that is formed in the liver and leaves the body without problems;
- indirect (free). It enters into a compound with albumin and enters the liver, after which it is processed by the body and excreted from the body along with the decay products (urine and feces) in the same way as direct. It is insoluble in water. When this enzyme enters the cells, the cellular mechanisms malfunction, resulting in the toxic effects of free bilirubin on the body.
Also, specialists use the concept of total bilirubin. This is the sum of the intermediate products (bound and free) in serum.
If your child had high bilirubin numbers, you should not switch to feeding formulas in the first six months.
Doctors also advise walking with the child in the fresh air. Ultraviolet will fulfill its function of reducing bilirubin in the blood. If necessary, they prescribe drugs that activate the liver and excretion of bilirubin.
If, with repeated donation of blood to bilirubin, its value has not reached the norm by 2 months, this indicates a clear pathology. Therefore, you should consult your doctor for a full examination.
An increase in bilirubin is extremely dangerous for a newborn baby. Moreover, the consequences of this process, a person can feel as an adult. First of all, the brain and nervous system suffer. The accumulation of the substance leads to serious intoxication, since bilirubin is very toxic.
Brain cells and nerve endings are destroyed under his influence, which subsequently leads to even greater complications. Among the serious consequences are the following:
- loss of vision;
- mental disorders;
- impaired or complete hearing loss;
- mental underdevelopment and other abnormalities.
If a newborn’s bilirubin level rises and there is suspicion of the development of pathological jaundice, the child must be under the supervision of a doctor.
The pediatrician should monitor changes in bilirubin in the blood, so as not to miss the occurrence of a critical moment and in time to begin the necessary treatment. If it is not possible to reduce the level of bilirubin, this means that treatment is necessary in a hospital setting.
- children whose mothers have diabetes.
In order to timely recognize the pathology in the newborn, blood is immediately taken from the umbilical cord for analysis at the time of birth and again, on the third day of life. This allows doctors to keep the situation under control and, if necessary, take emergency measures to preserve the health and life of the baby.
If, even after 2-3 weeks, signs of jaundice continue to manifest actively, doctors may suspect pathological jaundice, as a result of an increased concentration of bilirubin in the blood. The causes of this condition can be:
- Hemolytic disease of the newborn. This serious illness occurs against the background of Rhesus – conflict between mother and child. Manifested by congenital internal edema of the subcutaneous tissue, enlarged spleen and liver, damage to the central nervous system.
- Genetic failure. In this case, one of the conditions can be observed in a newborn: a defect in the formation of liver enzymes (Gilbert’s syndrome), decreased enzyme activity (Krigler-Najar syndrome) and a deficiency of necessary enzymes (Lucey-Driscola syndrome). With timely treatment, full compensation is possible, provided that there is no severe damage to the brain nuclei.
- Damage to the liver by dangerous infections while the baby is in the womb. Toxic agents and viruses reduce the ability to bilirubin and provoke parenchymal jaundice. This condition is characterized by prolonged jaundice, an increase in lymph nodes, darkening of urine and lightening of feces, a change in the biochemical analysis of blood.
- Blockage (obstruction) of the bile duct, which occurs due to intrauterine gallstone disease, the presence in the body of a tumor that compresses the bile ducts, bile condensation syndrome. This type of jaundice is called obstructive. The problem is solved by surgery.
Watching the baby and knowing the signs of jaundice, mothers will be able to recognize a pathological or safe course of the disease and seek medical help in time. Only in this case it will be possible to avoid such serious complications as:
- acute intoxication of the body;
- albuminemia, when albumin levels decrease and do not allow plasma to fully transport vitamins and nutrients;
- deafness, mental retardation, convulsions due to the penetration of bilirubin into the brain;
- involuntary motor reflexes that are uncontrollable;
- leg cramps.
Very rarely, but still there are cases when the most undesirable and very dangerous complication occurs – nuclear jaundice, which symptomatically passes from one phase to another:
- Braking. The baby becomes lethargic, practically unable to suckle, all his reflexes are depressed.
- Irritation. The child is in hypertonicity, wringing his back, twisting, screaming heart-rendingly.
- Imaginary recovery. At first glance, the stage is favorable, when it seems to everyone that everything is behind and the disease has completely passed the child. However, this is only a temporary lull, during which you need to pay special attention to the child, try not to miss a single symptom.
- Complication. Bilirubin attacks the brain, affecting the nucleus, affecting the nervous system, causing serious disorders in the body, can result in cerebral palsy.
For the diagnosis of complicated jaundice, biochemical, radiological methods are used, as well as a biopsy.
Elevated bilirubin is dangerous for the health of infants, as it can cause severe intoxication of the brain. Toxic coloring pigment is able to accumulate in the tissues of the nervous system and brain space.
The death of nerve endings and brain cells can lead to tragic consequences, including:
- loss of vision;
- hearing impairment;
- mental disorders and abnormalities;
- gross retardation of physical and intellectual development;
- persistent decrease in immunity.
Treatment of children older than two months is carried out according to the same scheme as therapy in adult patients. This is due to the rate of spread of intoxication and the severity of possible complications.
Parents should immediately consult a doctor if the crumbs have the following symptoms:
- weakness of the sucking reflex;
- yellowness of the skin and eye sclera;
- lethargy, lack of appetite;
- restlessness, disturbed sleep;
- nervous tic;
- enlarged spleen and liver.
During a routine examination of the child, the pediatrician may suspect a pathology due to reduced blood pressure and other signs characteristic of this problem.
Jaundice in newborns is not such a harmless problem as it might seem at first glance. In some cases, the reasons can be very serious. For example, with atresia of the biliary tract, the child needs urgent surgical treatment – otherwise, the child is likely to die. Therefore, you should not be frivolous with such an analysis as measuring bilirubin in the blood.
Timely treatment and preventive measures of the mother during pregnancy will help protect the baby from the most serious consequences and reduce the risk of postnatal complications.
The development of the disease depends on the causes that caused it, an early visit to the doctor and timely treatment. Subject to these rules, it is possible to avoid complications and dire consequences.
Signs of pathological jaundice:
- It appears on the first day after birth.
- An increase in bilirubin in 24 hours is greater than 85 μmol / L.
- Yellowing below the waist, palms and the entire foot of the baby.
- Poor condition, lethargy, or vice versa overexcitation.
To correctly assess the severity of the disease, it is recommended to examine the child in natural light, the electric light gives the skin a brighter color. A baby born to a mother with negative Rhesus disease is at risk and should be closely monitored by doctors.
There is such a thing as milk jaundice. Bilirubin baby rises due to breastfeeding. It is believed that the cause of its appearance, contained in mom’s milk fatty acids and a high indicator of hormones. These elements can disrupt the liver and inhibit the conversion of bilirubin.
To identify the connection of jaundice and milk, you need to transfer the baby for a short time to the mixture and control bilirubin. If his indicators began to fall, then the assumption is true.
But to conduct such a test, it is not necessary to deprive the mother’s milk crumbs. You can feed expressed milk, preheating it at 50 degrees and then let cool to body temperature. This treatment helps to reduce the activity of substances in milk, which prevented the baby’s enzymes from working at full capacity.
Such jaundice cannot cause complications. Breastfeeding can be continued, it is recommended even as often as possible to apply to the breast so that bilirubin leaves with meconium more quickly.
High concentration in the blood adversely affects the health of the baby. This applies in particular to the situation when the norm of bilirubin in newborns (2 of the month) has not been restored. The table makes it clear that by this age the value should correspond to that of an adult healthy person.
First of all, high bilirubin is dangerous for the brain and the nervous system of the child. The danger is that the coloring matter can accumulate here. Such a situation can lead to severe intoxication of the body and, as a result, the death of brain cells and nerve endings. Subsequently, this can lead to problems with hearing and vision, mental disorders, dementia and other problems.
All this leads to the fact that the pediatrician continuously monitors the possible presence of jaundice in the child. At the slightest suspicion, a blood test is done, on the basis of which it becomes clear whether the values of the pair “detected bilirubin is the norm in a newborn” match. The table at the same time helps doctors make the right conclusion.
– lethargy and drowsiness;
– decreased sucking reflex;
– cramps, tics, restless behavior;
– an increase in the size of the spleen and liver;
– lowering blood pressure.
High bilirubin in a newborn can cause:
- drowsiness or increased activity;
- oppression of appetite;
- enlargement of the liver, spleen;
- hearing loss.
There are situations when a high rate can even threaten the life of a newborn baby.
If a child has increased bilirubin, urgent measures must be taken to reduce intoxication. Due to the fact that in most cases it is practically impossible to establish the cause of the disease, the symptoms are treated.
Bilirubin is an important indicator of health for both adults and babies in the early days of life. Therefore, mothers of newborns should in no case refuse to give the blood of a newborn for analysis for bilirubin.
In this case, parents should be prepared for the fact that the rate will be increased, and not to panic about this. Timely measures taken to eliminate the pathology and complete control of the health status of the crumbs by experts will quickly get rid of the violation, eliminating the development of complications and chronic pathologies.
It is important for parents to monitor the level of bilirubin in the blood of children, not to be afraid of high numbers at birth, to observe changes in the indicator in dynamics in some cases. High bilirubin numbers may indicate the development of parenchymal and hemolytic jaundice, which requires a special approach to treatment in each case. Do not miss the opportunity to help your child while it is still possible.
In any case, if your newborn baby has a physiological or pathological jaundice, there is no reason to panic. With the proposed hospitalization, it is better to agree and go with the child to the department, where he will be provided with timely and qualified medical care. Another plus of hospitalization after the maternity hospital is that the mother and the baby will undergo all the necessary examinations, as they say, without leaving the ward.
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