In every second newborn, the skin turns yellow due to an increase in the level of bilirubin in the baby's blood. Depending on the cause of such an increase, different types of jaundice are distinguished, one of which is conjugation jaundice.
What it is?
This is the name given to jaundice in infants, associated with a problem in the metabolism of bilirubin. In particular, in conjugational jaundice, indirect bilirubin is not converted into a direct fraction of this pigment.
Causes
In most children, conjugational jaundice is physiological. Its occurrence is associated with the breakdown of fetal hemoglobin (it is replaced by normal hemoglobin), an insufficient amount of albumin, and the immaturity of the liver enzyme system.
With prematurity, jaundice appears more often due to an even greater immaturity of the liver, so this condition not only lasts longer, but is also characterized by a high risk of damage to the baby's brain by indirect bilirubin. This is why this jaundice is often treated.
Separately, breastfeeding jaundice is isolated, the cause of which is the presence in human milk of substances that interfere with the conjugation of bilirubin. If you stop breastfeeding for one to three days, the bilirubin levels in such jaundice immediately drop.
You can learn more about jaundice in newborns in the following video.
The causes of the pathological form of conjugational jaundice are:
- Gilbert's syndrome is a genetic disorder in which there is a lack of liver enzymes. With such a congenital pathology, the brain is not affected.
- Crigler-Nayyar disease is jaundice caused by insufficient or absent liver enzymes responsible for binding bilirubin. Pathology can be complicated by encephalopathy.
- Lucy-Driscoll Syndrome is a temporary lack of liver enzymes in which jaundice is often severe and can affect the brain. If a child suffers this condition, such jaundice does not bother him anymore during his life.
- Hyperbilirubinemia associated with asphyxiation during childbirth. The child's development of the liver enzyme system is delayed and there is a risk of kernicterus.
- Certain diseases of the endocrine system, such as hypothyroidism. With them, there is a deficiency of the enzyme responsible for the conjugation of bilirubin.
- Treatment of a newborn with certain drugs, for example, vitamin K in a large dosage, chloramphenicol, salicylic drugs.
Symptoms
With conjugative jaundice, the child's skin and sclera turn yellow. The color of urine and feces may remain natural (in physiological form) or change. The fact that a baby may develop nuclear jaundice will be prompted by the baby's sleepiness, throwing his head back, the appearance of episodes of vomiting with yellow milk or seizures.
Diagnostics
It is important to distinguish conjugational jaundice from such types of pathological jaundice as hemolytic (it is caused by increased breakdown of red blood cells), parenchymal (its occurrence is associated with damage to liver cells) and obstructive (it is caused by a mechanical obstruction of bile secretion). For this, the baby is tested for blood, liver and biliary tract.
Bilirubin rate
Bilirubin in a newborn baby immediately after birth is determined at a concentration of 51-60 μmol / l. Normally, by the third day of life, its level rises, but not higher than 205 μmol / l. Yellowing of the skin is observed at rates above 85 μmol / l in premature babies and more than 120 μmol / l in babies born on time. If the level of bilirubin rose above 172 μmol / L in premature babies and more than 256 μmol / L in babies who were born full-term, then they talk about pathological jaundice.
Treatment
Depending on the cause of conjugated jaundice, treatment will vary and will be determined by doctors. The baby can be assigned:
- Phototherapy. The baby is kept under ultraviolet lamps, as a result of which bilirubin becomes harmless and easily leaves the crumbs' body.
- Infusion therapy. The child is given intravenous saline solutions and glucose.
- Barbiturates. These drugs interfere with the conjugation of bilirubin.
- Blood transfusion. It is prescribed for the serious condition of the infant.
When does it pass?
Conjugative jaundice caused by physiological causes usually resolves by 10-14 days of life, leaving no consequences for the child. The duration of such jaundice in premature infants can increase to 21 days or more.
Tips
Mom should not stop breastfeeding, but apply the baby to the breast as often as possible, since breastfeeding at least 7 times a day promotes faster excretion of bilirubin with feces.
