Jaundice in newborns is not just common - it happens almost always. Any mother will easily notice the first symptoms. The baby becomes unusually dark or yellow, the whites of the eyes turn yellow. Is it a disease or a feature of a small child? This will become clear later, after several days of observation. Most often, there is no reason for concern, this condition is due to some physiological characteristics of the body of a newborn child.
Why does jaundice appear?
Here, bilirubin is primarily to blame.... What is it and where does it come from? It's pretty simple. A child who has not yet been born has special blood with special (fetal) hemoglobin. It carries oxygen through the baby's blood vessels. When the baby is born, he begins to breathe with lungs. And then the composition of the blood changes: “living” hemoglobin appears in it, and fetal hemoglobin is destroyed. This is where bilirubin is formed. The child does not need it, and the small organism begins to get rid of it.
This is a very difficult task for a kid. Bilirubin cannot be removed just like that. First, it enters the liver and there it mixes with special enzymes, then it dissolves in the urine and even then it is easily excreted. If the liver fails and there is a lot of bilirubin in the blood, jaundice will begin.
The causes of jaundice of a pathogenic nature are completely different. They are most often caused by a violation of the outflow of bile from the body due to the following conditions:
- blood group incompatibility;
- rhesus conflict;
- viral liver damage;
- genetic metabolic disorders;
- hereditary diseases;
- hormonal disorders;
- mechanical damage to the biliary tract or liver.
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Bilirubin rate
In the blood of a newborn baby, bilirubin should be from 8.5 to 20.5 μmol / L (micromole per liter). The unit of measurement is quite complicated, but you don't have to delve into it. If it's really interesting - the blood test is done at the molecular level. If the analysis shows that the bilirubin content is slightly higher than normal, the doctor understands: the baby's body does not have time to cope with the load. True jaundice occurs when the bilirubin level exceeds 35 μmol / L.
And yet it is different ...
Why jaundice appears is already clear. Why are there any difficulties with the withdrawal of bilirubin? Could this be a sign of pathology? Unfortunately yes. Doctors distinguish between two groups of jaundice - physiological and pathological. Consider all types of jaundice from the rarest to the most common.
Pathological types of jaundice
They are rare, but require mandatory medical supervision and treatment... With pathological jaundice, there are always additional symptoms. Some can be noticed by a mother or someone from relatives, others are recognized only by a doctor.
Hemolytic disease
Among all babies who get sick with jaundice of newborns, less than 1% falls on those suffering from hemolytic disease. Her reasons:
- Rh-conflict between mom and baby (most often);
- mismatch in blood groups (very rare);
- antigen incompatibility (almost never occurs).
However, such a jaundice is quickly recognized. Baby's skin and sclera turn yellow not after a few days, but almost immediately after birth. The child looks lethargic and sleepy. The doctor, examining the baby, will feel an increase in the spleen and liver. All these signs show that the newborn urgently needs help, and then doctors begin immediate treatment. The worst case is kernicterus., in which bilirubin poisons the baby's brain.
Obstructive jaundice
Rare, but still pathology. There are several reasons for obstructive jaundice:
- gallbladder problems;
- violation of the patency of the biliary tract;
- liver problems.
Most often, obstructive jaundice is caused by genetic disorders or birth trauma to the baby. The manifestations of this disease become noticeable when the baby is two to three weeks old. At the same time, the skin looks not just yellow, but with a greenish tint. The baby's stool becomes abnormally light, almost without color. The doctor will feel that the liver is thickening and the spleen is enlarged. If you suspect obstructive jaundice, various additional examinations are prescribed - for example, ultrasound. Treatment will depend on the type of pathology.
There are also borderline conditions when prolonged postpartum jaundice turns into pathology:
- Conjugative jaundice associated with poor liver function. Liver enzymes poorly bind bilirubin and do not cope with its removal from the blood.
- Kernicterus occurs with a sharp increase in bilirubin levels during postpartum jaundice. In this case, bilirubin enters the nervous system and has its toxic effect on it.
- Hepatic jaundice appears when liver cells are damaged by viruses or bacteria.
Physiological jaundice
Now all doctors have recognized that this is not a disease, but one of the options for the normal state of a newborn child. However, in this situation, the baby must be carefully observed so as not to miss possible pathologies.
Breast milk jaundice
Another rare case. It occurs when a mother has a lot of estrogen in her milk (this is a female sex hormone). Then the baby's liver first of all begins to excrete estrogen, and only then - bilirubin. In this case, the baby remains jaundiced up to three months.... At the same time, the baby is developing well - he has a good appetite, sleep and gain in weight and height. This condition is not dangerous and goes away on its own.
If a baby develops breast milk jaundice, mothers often ask: is it not better to wean the baby? There can be only one answer: no better! Yes, without breast milk, the baby will stop “turning yellow”. But how much of everything useful and important will he receive less? So breastfeeding must be continued.
Neonatal jaundice
And finally, the most common type. This is the jaundice that most children get.... It does not belong to diseases and does not require treatment. Such jaundice of newborns goes away on its own and does not lead to complications. True, there is another view: if jaundice appears, then the baby's liver is still overloaded. But the kid can be helped.
Symptoms
The main and indicative symptom of any type of jaundice is a change in the color of the skin and mucous membranes, the whites of the eyes. They become bright yellow, almost lemon-colored.
When more than two weeks pass, and the baby's skin has not acquired a normal color, you should consult a doctor. Before jaundice is treated, an analysis will be made for the level of bilirubin in the blood. The bilirubin level depends on many factors and it is impossible to unambiguously interpret the test results. The doctor will draw conclusions about the child's health based on the general picture of the health status.
Symptoms of pathological types of jaundice are manifested in a change in the color of the skin. The differences are in the time of their appearance and some features of their manifestation:
- skin discoloration appears immediately after birth;
- after three to four days the yellow color becomes brighter, all symptoms intensify;
- the yellowness of the integument persists for more than one month;
- the onset of symptoms of jaundice is wave-like: it appears, then disappears;
- in addition to yellow, skin color can also acquire a green tint.
Plus, other symptoms are added to the discoloration of the skin:
- feces are discolored;
- the urine is dark in color;
- bruises appear spontaneously;
- there is an increase in the liver and spleen;
- the child's general well-being worsens.
With nuclear jaundice, the sucking reflex fades, severe drowsiness and seizures occur.
Jaundice treatment
If we are talking about pathology, then any therapy is prescribed by a doctor. Most often, the baby and mother are admitted to the hospital, where they carry out all the necessary procedures... For example, if the mother and child have a different Rh factor or other signs of blood incompatibility, then transfusions are most often prescribed. In one procedure, a baby can replace up to 70% of the total amount of blood. In difficult cases, transfusions are repeated several times.
These measures help to get rid of abnormal bilirubin, but can weaken the baby. Therefore, additional therapy is often prescribed: antibiotics, physiotherapy, and so on.
Obstructive jaundice often requires surgery. A reasoned decision is usually made by a whole commission of doctors who carefully examine the child and determine all the necessary measures. Such treatment and rehabilitation are also carried out in a hospital setting.
If the jaundice is physiological, then it is more likely not about treatment, but about helping the baby. The child will cope with his condition faster if:
- attach the newborn to the breast as early as possible (this stimulates metabolic processes);
- full breastfeeding;
- diet of a nursing mother so that the baby does not have digestive problems;
- sunbathing;
- walks in the open air.
The last point, unfortunately, cannot be fulfilled if it is cold outside. But in spring, summer or in warm autumn, it is imperative to take your baby out into the fresh air. In summer, in calm, sunny weather, you can open the baby's arms and legs for a few minutes. This is especially useful in a light shade - for example, under a tree, so that diffused light falls on the child. The main thing is that the baby does not freeze.
Such care for the newborn will perfectly help remove bilirubin from the child's body. As a result, the baby will not only have jaundice. The child will also become healthier and feel better.
The main treatment and prevention of neonatal jaundice is breast milk. That is why the newborn is applied to the breast from the first minutes. Colostrum (the first portions of breast milk) has a pronounced laxative effect. It promotes the excretion of dye (bilirubin) along with feces. Feeding your baby on demand is the best cure for jaundice.
Sometimes, in addition to breast milk, irradiation with a special lamp for the treatment of jaundice is prescribed - phototherapy. During the procedure, the child's eyes are covered with a bandage or goggles and placed under a lamp. The course is 96 hours.
Side effects may occur with phototherapy. The child may become drowsy, the skin begins to peel off and there is an upset stool.
Sunbathing has the same effect. The baby's body in the light begins to actively produce vitamin D. It accelerates the process of removing bilirubin from the blood.
With severe jaundice, a doctor may prescribe glucose and activated charcoal in tablets. Glucose helps to improve active liver function. Activated carbon absorbs harmful substances like a sponge, including bilirubin. Further, coal along with bilirubin is excreted naturally with feces.
The doctor develops the method of treating pathological types of jaundice depending on the diagnosis. All factors and circumstances of the child's birth are taken into account. The course of childbirth and pregnancy, maternal diseases, test results and ultrasound. Sometimes consultation of narrow specialists is required; surgeon or endocrinologist.
Different types of therapy are used in the treatment of jaundice:
- Antiviral.
- Antibacterial.
- Choleretic.
- Detoxification.
- Immune.
They are used both individually and in combination under close medical supervision. It depends on the cause of the jaundice.
Consequences and problems
In pathological conditions, it is impossible to predict how quickly the baby will recover. First of all, it all depends on the causes of the disease and its severity.... This is why it is especially important to observe your baby in the first days of life. What to look for?
- Jaundice occurred a few hours after the birth of the baby (blood conflicts are possible).
- The child does not develop well, he is sleepy and lethargic (a significant excess of bilirubin in the blood, including in hemolytic disease).
- Jaundice is accompanied by seizures, constant crying (this can be kernicterus). With such a diagnosis, the child may develop hearing impairments, movement pathologies, in the most severe case, the baby may die.
- The newborn has birth trauma.
As soon as the newborn has jaundice, careful observation is necessary to prevent the development of pathologies. If the treatment is carried out on time, the baby will recover very soon and will grow healthy..
Physiological jaundice does not cause any complications. It can last two to three weeks. Most babies get rid of jaundice when they turn one month old. If the reason is in the mother's milk, then the condition may drag on for another one to two months. After that, the baby's skin and eyes are completely freed from the yellow tint. All this time the child is fully developing. The main thing for him is the care of his mother, family and doctors. And then the baby will grow up healthy and happy.
Physiological jaundice in healthy children does not harm the body, does not affect the further development of the child. Pathological jaundice increases the risk of developing and developing cirrhosis or liver cancer with age. In 90% of children who have had hepatitis during infancy, the consequences of jaundice remain for life. This is reflected in a weakened immune system and poor liver function.
Postponed kernicterus can further lead to deafness, complete or partial paralysis, mental retardation. The toxic effect of high levels of bilirubin on the nervous system has the most severe consequences.
