Jaundice in newborns
Child Development / / August 12, 2017
Can jaundice in newborns be physiological - put it another way, right?And what if the newborn ikterichnost (colored yellow) skin and sclera of the eye?
Types of jaundice in newborns
Jaundice in newborns are physiological and pathological.Physiologic jaundice disappears within a short period of time.Pathological jaundice is caused by diseases of newborns and often requires close medical supervision.A condition in which the newborn baby is jaundiced skin staining, whites of the eyes and the visible mucous membranes, currently there are more than 50!
Yet the most common jaundice in children, has just emerged into the light, - physiological.It occurs in approximately 60-70% of children and appears 3-4 days after birth.This state - is not a disease and eventually passes.It is related to the immaturity of some of the child's body systems, responsible for the exchange of a particular substance - bilirubin.
neonatal bilirubin is formed by the destruction of red blood cells - red blood cells containing hemoglobin and provide organs and tissues with oxygen.Before the birth, until the crumb is not breathing on his own, in his body of oxygen transfer erythrocytes with a particular (fetal) hemoglobin.
These red cells after birth as useless are destroyed to produce large amounts of bilirubin.This is called indirect bilirubin or free.It is insoluble, so it may not stand out in the urine.Converting it to a soluble form in the bile and excretion is engaged in the liver.Even in healthy children shortly after birth often lacks specific protein that provides the transfer of bilirubin in the hepatic cells, where after it is connected to a series of biochemical reactions with substances which make it soluble.
This is to ensure that the bilirubin is not toxic and safely eliminated from the body.Provide this transformation several enzyme systems.Many of these systems of newborns complete their maturation and are beginning to fully work only a few days after birth.
gradually improved, and bilirubin work allocation system.Usually 1-2 weeks jaundiced skin staining disappears without causing any harm to the child.It is clear now why the neonatal jaundice in preterm infants is more common and more pronounced and lasts longer than full-term babies.And the severity of increase in blood bilirubin in preterm does not depend on body weight at birth, and the degree of maturity of the fetus and mother during pregnancy problems.Most "yellow" multiple pregnancy babies, newborns, who were birth injuries, babies born to mothers with diabetes.
neonatal bilirubin under physiological jaundice general condition of children, as a rule, does not suffer.Only if it is highly expressed, the kids are sleepy, lazy suck, sometimes they sometimes vomiting.About severity of jaundice is judged not by appearances, and the level of direct bilirubin in the blood.It reaches a maximum on day 3 of life.Children's bodies are "struggling" with an excess of bilirubin, associating it with the blood protein albumin, thereby preventing its toxic effects.But this is not always the case.
With a very strong increase in the level of bilirubin albumin can not "block" it completely, and he gets into the nervous system.It could be toxic, especially to vital nerve centers, brain.This state is called "kernicterus", or "bilirubin encephalopathy."Symptoms: severe drowsiness, seizures, decreased sucking reflex.Among the later manifestations - deafness, paralysis, mental retardation.
Previously, in case of increase of free bilirubin using an intravenous infusion of glucose, ascorbic acid, phenobarbital, cholagogue to accelerate its elimination.Now more and more specialists and clinics around the world refuse to use drugs for the treatment of neonatal jaundice.Moreover, the use of some means found to be ineffective.
Today, the most effective and proven method to reduce bilirubin toxicity at physiological jaundice - phototherapy (light therapy).The skin of the baby cover the special unit (an average of 96 hours per course).
exposed to light bilirubin is converted into non-toxic derivatives, the main of which is called "lyumirubin".He has a different way of removal, and after 12 hours, he goes out of the body in the feces and urine.Side effects of phototherapy may cause skin peeling and frequent watery stools, and some children experience drowsiness.
after cessation of treatment all phenomena are without a trace.After discharge from the hospital is as often as possible during the day to expose the baby indirect sunlight.The best prevention and treatment of physiological jaundice - early and frequent feedings.Because children with elevated levels of bilirubin can be increased sleepiness, they should be sure to wake up for feeding.
Colostrum, or "early milk" the first few days, act as a laxative and helps to quickly get out meconium (feces firstborn).Bilirubin, which is converted in the liver, is also displayed along with it.If not meconium goes quickly from the intestine bilirubin can re-enter the bloodstream, thus enhancing the level of jaundice.
Even with a rare jaundice, caused by the mother's milk is not recommended to give up breastfeeding.To distinguish this kind of jaundice in newborns allow a later date the appearance (after the 1st week of life).This condition is associated with the content in the mother's milk of substances that reduce the activity of enzymes that provide "transformation" indirect bilirubin into direct soluble.
Pathological jaundice usually appears during the first days after birth.Often at the same time increasing the liver and spleen may become discolored feces and urine becomes dark in color, sometimes spontaneously newborn skin bruises and petechial hemorrhages.In the analysis of blood shows signs of decay enhanced red blood cells (hemolysis), and anemia.When pathological jaundice treatment by specialists.It depends entirely on the cause of this condition.
When incompatibility of blood groups of the mother and the newborn and / or Rh factor occurs massive destruction (hemolysis) of red blood cells.Severe jaundice is often the case, if my mother I group of blood and a child II, or (rarely III).It is believed that at each subsequent higher risk of pregnancy complications.For this reason, women with Rh-negative is especially dangerous to have an abortion.
destruction of red blood cells can be caused by a variety of genetically determined disorders, such as microspherocytosis (anemia-Chauffard Minkowski), disorders of hemoglobin structure (for example, sickle cell anemia), changes in the shape and structure of the red blood cell and so forth. In the treatment of conditions, accompanied by destruction of red blood cells, often use exchange transfusion, in order to "clean up" the bilirubin and antibodies that cause hemolysis.
large group of jaundice resulting from liver injury by viruses, bacteria, protozoa.It is clear that without the treatment of infection in such cases it is impossible to do.Unfortunately, at present, not all congenital infections there are effective treatments.This once again emphasizes the need for careful preparation for pregnancy, especially in the presence of infectious diseases, to reduce the risk of transmission to the baby.
so-called mechanical jaundice occur due to violations of the outflow of bile cyst bile duct, annular pancreas, atresia (hypoplasia) of the bile ducts.It should surgery.
With pyloric stenosis and obstruction of the intestine cause of increased bilirubin level in blood is the reabsorption of his intestines.In such situations may also help surgeons.
Constitutional liver dysfunction (Gilbert-Meylengrahta syndrome) - a hereditary disease that is very similar to neonatal jaundice - occurs quite frequently.The reason for failure in the metabolism of bilirubin in this case - a violation of its binding due to hereditary inferiority of the liver enzyme systems.Usually, this condition requires treatment and is observed by gastroenterologists.
Hormonal disorders also cause jaundice in newborn babies.This happens, for example, hypothyroidism - decreasing the functional activity of the thyroid gland.Combined with a form of jaundice, other signs of insufficient production of thyroid hormones:. Large size of the stomach, dry skin, low body temperature, particularly, in a hoarse cry, constipation, swelling of the face, eyelids, delayed ossification processes, etc. There is jaundice, hypothyroidism 2-3th day of life, lasts up to 3-12 weeks and sometimes up to 4-5 months.Treatment is carried out under the supervision of an endocrinologist, using drugs - thyroid hormones.
not being a specialist, it is impossible to understand all the intricacies of the diagnosis of such a large group of diseases such as jaundice in newborns (zheltushki).It is important to understand - long-term preservation of jaundice skin coloring a young child requires mandatory testing.It certainly should consist of a general analysis of blood, determination of total bilirubin and its fractions in blood serum, liver function tests, tests for hemolysis (Coombs), ultrasound of the abdominal cavity, if necessary, consult a surgeon or other specialist for further diagnosis andtimely treatment.