Causes, consequences and treatment of jaundice in a newborn
Jaundice in a newborn is a medical term used to describe the corresponding color of the skin. This condition of the child has nothing to do with a real illness, but most often it is caused by an excess of bilirubin. Bilirubin is a biochemical that can accumulate in the blood. During fetal development, oxygen is carried by red blood cells and attached to a special hemoglobin. When a child is born, the need for these red blood cells is no longer needed, they are destroyed, and as a result of this destruction bilirubin is formed. Since the liver of a newborn is not always mature enough, sometimes it is not able to remove it completely from the body.
Physiological jaundice in newborns, according to statistics, occurs in 60% of children born into the world. Most often it is observed in premature babies. This condition is also referred to as conjugational or neonatal jaundice.
Content:
- Causes of jaundice in newborns
- Consequences of jaundice in newborns
- When does jaundice go away in a newborn?
- Why doesn't baby jaundice go away after 21 days?
- Treatment for jaundice in newborns
Causes of jaundice in newborns
The accumulation of bilirubin in the blood in large quantities can be caused by the following reasons:
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Increased production of bilirubin due to hemolysis (increased destruction of red blood cells). If jaundice forms as a result of this factor, it will be called hemolytic. The reason for the occurrence lies in the Rh-conflict between the mother and the fetus. In this case, the woman in labor must have a negative Rh factor, and the fetus must have a positive one. According to statistics, hemolytic disease occurs in 10% of children with Rh-conflict. Also, hemolytic disease can be caused by large blood loss during childbirth, hereditary factors, etc.
- Lack of transition of free bilirubin to bilirubin bound. This is most often due to imperfection of the liver enzymes that are responsible for this process, or due to their weak activity.
- Liver enzyme deficiency, inherited. This disease in medicine is named after Crigler-Nayar.
- Reaction to breastfeeding. This jaundice begins to appear more often in the second week of life. It goes away on its own without canceling natural feeding and specialized treatment by 3 months. The reason lies in the fact that the milk received by the child from the mother contains a large number of hormones that affect the activity of liver enzymes, reducing it.
- Drug reaction. Jaundice can occur when taking certain antibiotics, hormones, sulfa drugs. This is due to their ability to influence the process of bilirubin binding.
- Hypoxia and asphyxia during childbirth can cause jaundice.
- Infections.
- Birth trauma.
- Diabetes mellitus in the mother.
- Congenital hypothyroidism. In addition to changing the color of the skin, the child has dry skin, swelling, rough crying, and developmental delay.
- Infection of the bile ducts (complete or partial), or underdevelopment of the bile ducts, which is a mechanical obstacle to the outflow of bile. These reasons are related to congenital malformations.
- Bowel obstruction.
- Thickening of bile, which is observed if the child suffers from hemolytic disease.
- Pyloric stenosis is a congenital narrowing of the pylorus. It is more common in male infants.
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Congenital hepatitis caused by intrauterine infection (rubella, syphilis, toxoplasmosis, cytomegalovirus, etc.).
- Hepatitis acquired after birth.
Consequences of jaundice in newborns
If jaundice of newborns refers to a physiological phenomenon, then it will pass naturally, without causing any consequences and complications. The situation is different if the child suffers from pathological jaundice. It lasts more than a month, while the feces become discolored, and the skin becomes greenish, urine, on the contrary, darkens. Ultrasound often shows enlargement of the liver and spleen.
If such signs are observed, then it will not be possible to do without medical help.
If treatment is not prescribed on time, then this threatens the newborn with such consequences as:
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Excess bilirubin will accumulate in adipose tissue, in the membranes (lipid) nerve pathways, in the nuclei of the brain. At high concentrations of this biochemical substance, toxic poisoning of the body occurs.
- Bilirubin encephalopathy may develop.
- Delay in neuropsychic development, which may not appear immediately, but at an older age.
- The high content of bilirubin causes albuminemia, as it reduces the amount of albumin in the blood. The condition is further aggravated by increased capillary permeability in newborns. The development of albuminemia will be indicated by edema and the presence of protein in the urine, with a high level of bilirubin.
- The appearance of an increase in seizures, the development of deafness, which is associated with the accumulation of bilirubin in the brain and the development of nuclear jaundice.
- If the disease is started, then it is fraught with frequent involuntary muscle contractions, loss of control over one's own movements. Oligophrenia may develop.
The consequences of the disease directly depend on what caused the jaundice of the newborn. If this is a pathological condition, then it definitely needs treatment.
When does jaundice go away in a newborn?
The time it takes for jaundice to pass may vary depending on the causes of it and other factors. So, in premature babies, it is somewhat more complicated than in full-term babies, the yellowness of the skin can be observed for two weeks. Even such a factor as insufficient nutrition, with low lactation in the mother, can cause jaundice to stretch for a longer period.
On average, in full-term babies, the last symptoms of jaundice disappear after a week. The maximum period at which residual effects can be observed is 21 days. But in this case we are talking about physiological jaundice, which does not require specialized treatment.
Why doesn't baby jaundice go away after 21 days?
Jaundice in infants, if it is due to physiological factors, must definitely go away completely after three weeks. When this does not happen, you should look for another reason for this color of the child's skin.
After 21 days, the jaundice may not go away because the child is suffering from hemolytic disease. Because of this pathology, the level of bilirubin in the blood is constantly at a high level, and red blood cells are constantly being destroyed.
The jaundice may not go away because the baby's liver is not functioning properly. This can happen for a number of reasons, such as hepatitis.
Even a newborn may experience obstructive jaundice, in which the function of bile outflow is impaired. It also happens for a number of reasons, such as if there is a cyst that blocks the bile duct, or the pancreas is ring-shaped, or there is atresia of the bile ducts.
In order to determine the reason why the jaundice did not go away after 21 days, it is necessary to pass a number of blood tests (general, to determine the level of bilirubin, ALT, GTT, ALP and AST, to serum proteins, to conduct a Coombs test, to undergo an ultrasound of the abdominal organs) cavity) and consult the necessary specialists. After that, you should proceed to the treatment of jaundice.
Treatment for jaundice in newborns
There are several ways to treat jaundice:
- Phototherapy or treatment of disease with light.
- Infusion therapy. It aims to restore water balance after phototherapy has been performed. Besides. Allows to reduce the toxic effect of fat-soluble bilirubin. There are a number of indications for infusion therapy, these are regurgitation and vomiting syndrome, large fluid loss, sepsis, gastroenteritis. Most often, the treatment regimen includes drugs such as membrane stabilizers with glucose solution, cardiotrovics, soda, electrolytes, and means to improve microcirculation.
- If there are violations of the bilirubin-conjugating system, then the child is prescribed drugs such as Zixorin, Benzonal, Phenobarbital, which are inducers of liver microsomal enzymes. But since these drugs have a negative effect on the respiratory function, the first scheme is preferred.
- The auxiliary methods include the intake of enterosorbents, such as Polyphepan, Enterosgel, etc. They are necessary in order to interrupt the circulation of bilirubin between the liver and intestines.
If there is a risk of developing kernicterus, then the child is prescribed a blood transfusion. Sometimes the drug Ursolfak can be prescribed. This remedy is not contraindicated even for newborn babies and is used as a suspension. It is used in cases of cholestasis (a decrease in the flow of bile into the duodenum, itching of the skin, impaired absorption of fats, etc.).
In some cases, the replenishment of fat-soluble vitamins and some trace elements is indicated.
If metabolic disorders become the cause of jaundice, then conservative methods of treatment are used. With lactose intolerance, newborns are transferred to lactose-free mixtures. If tyrosinemia is observed, then the corresponding mixtures are shown, without methionine, tyrosine and phenylanine.
Sometimes cirrhosis of the liver can form, for example, with Alagill's syndrome, with perinatal sclerosing cholangitis. There is no cure, an organ transplant is required.
Phototherapy for jaundice in newborns
One of the most affordable, natural, simple, and safe treatments for neonatal jaundice is phototherapy. A phototherapy lamp is used to implement this method. This method belongs to methods of physiological treatment and does not require medication. It reduces the toxicity of bilirubin and avoids the potential consequences of neonatal jaundice.
Phototherapy is based on the effects of the ultraviolet spectrum of sunlight, which has a specific wavelength. When this light hits the skin of a child, certain changes occur in his body and the bilirubin contained in the blood is transformed into an isomer. If the excretory system of a newborn is not always able to cope with unchanged bilirubin, then the isomer is removed much easier. In addition, it has no toxic effect.
The procedure itself is simple and painless. The technique of its implementation is reduced to the fact that the child is completely undressed and placed in a special incubator. In this case, it is necessary to wear glasses on the eyes to protect them from ultraviolet radiation. If a male child is exposed, the doctors cover his genitals. For this, a regular gauze bandage is used.
A short distance of 50 cm from the child is placed a lamp emitting ultraviolet light. As practice has shown, 4 lamps give the maximum effect: 2 ultraviolet and 2 daylight. The course can last up to 4 hours. If the level of bilirubin is high, then the course is carried out almost continuously. The average number of hours is 96.
It is important that the child does not stay in one position. Therefore, the doctor turns it over every hour. In order to avoid overheating, it is necessary to control body temperature, which is carried out every 120 minutes.
During the procedure, it is necessary to increase the amount of fluid consumed by the baby. The increase is up to 20%. It is best if the baby with elevated bilirubin levels continues to feed on breast milk.
To monitor the child's condition, doctors must take blood samples every day for biochemical analysis. Phototherapy is discontinued if the total bilirubin level has decreased, but free bilirubin has not increased.
Sometimes during the procedure, dryness and peeling of the skin are observed, frequent stools, an allergic reaction in the form of a rash, the skin may acquire a bronze tint, the child may be drowsy. Do not be afraid of such phenomena, as they all completely disappear after the course of phototherapy is completed.
The author of the article: Sokolova Praskovya Fedorovna | Pediatrician
Education: Diploma in the specialty "General Medicine" received at the Volgograd State Medical University. A specialist certificate was immediately received in 2014.
