Komarovsky jaundice in newborns causes and consequences of bilirubin norm

Types of jaundice in newborns

Jaundice in a newborn is a fairly common occurrence. It is caused by an increased level of bilirubin in the baby’s blood and skin. Bilirubin is a reddish-yellowish pigment formed during the breakdown of hemoglobin. If it is deposited in excess in the child’s tissues, then the baby’s skin and mucous membranes acquire a typical yellow color.

First of all, mothers should know that there are 2 types of jaundice in newborns: physiological and pathological. Let's try to learn as much as possible about each type of jaundice.

Signs of physiological jaundice

The baby's skin becomes colored 2-3 days after birth. Such jaundice in a newborn does not go beyond normal limits and usually disappears without a trace after a few days. In some children, the jaundiced skin color is barely noticeable, in others it is quite pronounced. The degree of manifestation of jaundice depends on the rate of formation of bilirubin, as well as on the ability of the small organism to remove it. This type of jaundice also includes the so-called “breastfeeding jaundice.” In this case, the child’s general well-being does not suffer, urine and feces retain their natural color, the liver and spleen do not enlarge.

You need to know that normally the skin acquires its natural color in the third week in full-term babies and after 4 weeks in premature babies; this is the main sign of a physiological phenomenon. This condition resolves in children without medical intervention and does not have any harmful consequences for the baby’s body. The yellowness should begin to decrease at the beginning of the 2nd week of life. Normally, physiological jaundice lasts no longer than 3 weeks and completely disappears by the end of the 1st month of the child’s life.

Komarovsky jaundice in newborns video – Pregnancy – 2021

In a baby in the postpartum period, when hemoglobin is replaced with normal one, red blood cells that age also disintegrate, but the poorly functioning liver cannot yet remove bilirubin. This bile pigment, which remains in the body, causes the skin to turn yellow. This metamorphosis usually occurs with a newborn on the third day after birth.

Another type of harmless jaundice is breastfeeding jaundice. According to Komarovsky, breast milk contains special substances that slow down the binding of bilirubin in the liver. This situation is normal and does not require treatment, much less the abolition of breastfeeding and the transfer of the baby to feeding with adapted formulas.

How to treat?

Komarovsky advises using regular “white” lamps at home if there are no LED lamps, since any bright light neutralizes the toxicity of bilirubin.

Walking with such a baby will also have a healing effect. It needs to be taken outside more often so that the child has contact with indirect sunlight. If the weather and season permit, a child with jaundice should spend most of the day outdoors.

Pathological situations

When certain critical levels of this pigment in the blood are reached, a replacement blood transfusion is prescribed. Sometimes several such procedures are required to reduce the toxic effects of bilirubin on the body and all its systems.

In the case of rapid and severe hemolytic disease, death can occur.

There are other reasons for the appearance of jaundice that is abnormal for a newborn:

Treatment of pathological jaundice

However, nowhere in the world is this medication used to treat young children, since the side effects that Phenobarbital has on the child’s nervous system are so destructive that its other properties lose relevance.

Modern medicine has established for certain that the use of Phenobarbital at an early age always leads to a decrease in intelligence and learning ability at an older age.

Advice from Dr. Komarovsky

With physiological (normal) jaundice in a newborn, he must be given water to drink. Glucose is very useful for the baby.

It is not the parents, but the doctors who should decide whether a child has normal or pathological jaundice. Komarovsky urges that in all cases where the baby’s skin has changed color to yellow of varying intensity, be sure to visit a doctor.

You can see more details about the jaundice of newborns in the following video.

Copying site materials is possible only if you install an active link to our site.

Signs of physiological jaundice

You need to know that normally the skin acquires its natural color in the third week in full-term babies and after 4 weeks in premature babies; this is the main sign of a physiological phenomenon.

This condition resolves in children without medical intervention and does not have any harmful consequences for the baby’s body. The yellowness should begin to decrease at the beginning of the 2nd week of life.

Normally, physiological jaundice lasts no longer than 3 weeks and completely disappears by the end of the 1st month of the child’s life.

Pathological jaundice: how to quickly recognize the danger?

darkening of urine and feces to an unnatural color,
jaundice appears already on the first day of life,
the baby is lethargic, inactive, sucks poorly,
high level of bilirubin in the blood,
yellowness of the skin lasts longer than 3 weeks,
enlarged spleen and liver,
baby spits up frequently
pathological yawning.

Then the classic manifestations of the so-called “nuclear” jaundice appear:

increased muscle tone,
protrusion of a large fontanel,
convulsive twitching,
the baby screams monotonously,
eye rolling,
breathing problems until it stops.

Fortunately, the pathological form of jaundice is rare. Such jaundice is diagnosed in only 5 out of 100 newborns. Parents should carefully monitor the condition of their baby in the first days of his life so as not to delay treatment.

Why does physiological jaundice occur?

Since the newborn’s liver is still immature, in the first days of his life it does not have time to process all the bilirubin that is formed, so the pigment partially enters the blood. It stains the mucous membranes and skin yellow. When the child's liver grows a little, it will more thoroughly process the bilirubin that enters it.

As a rule, the liver begins to function fully by the 5th-6th day of a baby’s life. From this moment on, physiological jaundice gradually fades away and there is no reason for concern.

In some children, liver function improves faster, in others slower. What determines the rate of bilirubin excretion? A child has every chance of being “yellow-skinned” for a couple of weeks if:

Norm of bilirubin for a newborn

How much bilirubin is in the blood is determined by a biochemical analysis. If the bilirubin level is above 58 µmol/l, then noticeable jaundice of the skin appears. With physiological jaundice it is never higher than 204 µmol/l.

The upper limits of normal bilirubin content in a baby’s blood can be found in the table:

Breast milk jaundice

There is an opinion that bilirubin levels increase during breastfeeding.

For this reason, breastfeeding is stopped when signs of jaundice are detected in the baby, but modern research has confirmed the fact that breastfeeding is an important measure in the treatment of jaundice in a newborn.

Most of the yellow pigment is excreted from the baby's body in feces. Breast milk has a mild laxative effect, which helps eliminate bilirubin and prevents the development of jaundice.

A slight yellowing of the baby’s skin during breastfeeding should not bother parents, but you still need to consult a doctor

There is no evidence that breast milk jaundice causes any harm to the baby. If a baby who is only breastfed has a slight jaundiced skin tint, this is not scary and should not worry parents.

Treatment of jaundice

The main and main medicine is maternal colostrum, which has a laxative effect and helps remove bilirubin from the newborn’s blood.
Phototherapy is often prescribed.
After exposure to a special lamp, bilirubin is eliminated from the child’s body after 10-11 hours.
The sun's rays are also an excellent treatment.
When walking with your child in warm weather, leave him naked for a while in the lacy shade of trees. At home, it is advisable to place the baby's crib closer to the window.
If the child has pronounced jaundice, more intensive treatment is necessary.
Doctors usually prescribe activated carbon or Smecta internally. Activated carbon absorbs bilirubin, and Smecta stops its circulation between the liver and intestines.

Attention! All information on the site is provided for informational purposes only and is for informational purposes only. For all questions regarding the diagnosis and treatment of diseases, you must consult a doctor for an in-person consultation.

Features of the disease

Komarovsky emphasizes that the processes of excretion of red blood cells in newborns are imperfect. In this regard, the problem of disposal of excess bilirubin becomes especially acute. In combination with aggravating factors (endocrine disorders, the presence of infections, etc.), the time frame for the formation of liver enzyme systems in a newborn increases.

Jaundice is a physiologically natural process. It usually occurs on the 3rd day and goes away by the second week of the baby’s life. However, not all forms of jaundice are so harmless. In some cases, a newborn requires immediate medical attention, in the absence of which the child may experience problems with the central nervous system.

Depending on the type of bilirubin metabolism, there are:

hemolytic jaundice - increased breakdown of red blood cells does not allow liver cells to utilize bilirubin,
hepatic – inflammatory processes in the liver impair its functioning,
subhepatic - a violation of the outflow of bile complicates the disposal of bilirubin.

Newborns sometimes develop breastfeeding jaundice. Yellowness of the skin occurs immediately after drinking breast milk.

What Komarovsky says

Jaundice in a mild form, in which it is more common in newborns, does not require serious treatment in the absence of aggravating factors. However, Komarovsky considers the following procedures useful to help get rid of hyperbilirubinemia:

Phototherapy is a safe and effective treatment method.
Photoisomerization of bilirubin is carried out using blue lamps. Phototherapy is carried out continuously except during feeding periods. A protective fabric is placed over the child's eyes and genitals to block light from entering. During phototherapeutic procedures, the newborn’s water balance should be monitored.
infusion therapy – helps normalize water balance,
the use of enterosorbents - act as an additional method of treatment.
Helps cleanse the liver, prevent the circulation of bilirubin in the liver,
blood transfusion - used in rare cases when other treatments are not effective.

Komarovsky notes that the risk of complications due to infantile jaundice in newborns is quite small. However, in the presence of aggravating factors and with progressive hyperbilirubinemia, the development of anemia, the appearance of seizures, and damage to the nervous system cannot be ruled out. With jaundice, an enlargement of the spleen and liver is observed.

Children who have had jaundice may lag behind their peers in development and have neurological problems. Such manifestations are quite rare and occur, as a rule, in the presence of congenital disorders and pathological changes in internal organs. Under normal conditions, newborns get rid of jaundice within 7-10 days.

Types of jaundice in newborns

First of all, mothers should know that there are 2 types of jaundice in newborns: physiological and pathological. Let's try to learn as much as possible about each type of jaundice.

Where does pathological jaundice come from?

Most often, this terrible phenomenon happens for the following reasons:

Incompatibility of the blood of mother and fetus according to the Rh factor (hemolytic disease of newborns). Currently, it is extremely rare, since all women with negative Rhesus disease receive special preventive treatment from the 28th week of pregnancy.
Congenital diseases or underdevelopment of the baby's liver.
Genetic or hereditary abnormalities.
Congenital pathologies of the circulatory system or intestines of a newborn.
Inappropriate antibiotic therapy.
Severe pregnancy of the mother, toxicosis, threat of miscarriage.
Mechanical disturbance of the outflow of bile: blockage of the bile ducts by a tumor, narrowing of the bile ducts or their underdevelopment.

Where does pathological jaundice come from?

Most often, this terrible phenomenon happens for the following reasons:

Incompatibility of the blood of mother and fetus according to the Rh factor (hemolytic disease of newborns). Currently, it is extremely rare, since all women with negative Rhesus disease receive special preventive treatment from the 28th week of pregnancy.
Congenital diseases or underdevelopment of the baby's liver.
Genetic or hereditary abnormalities.
Congenital pathologies of the circulatory system or intestines of a newborn.
Inappropriate antibiotic therapy.
Severe pregnancy of the mother, toxicosis, threat of miscarriage.
Mechanical disturbance of the outflow of bile: blockage of the bile ducts by a tumor, narrowing of the bile ducts or their underdevelopment.

Norm of bilirubin for a newborn

The upper limits of normal bilirubin content in a baby’s blood can be found in the table:

Age	Bilirubin level, µmol/l
Newborn	50 – 60
24 hours	118
48 hours	152
72 hours	186
45 days	204 (prematures – 170)
14 – 20 days	20

Breast milk jaundice

If the yellowness of a baby’s skin due to breastfeeding does not go away even in the third week after birth, then doctors talk about “breast milk jaundice.” It is believed that the presence of mother's milk in the baby's body increases the bilirubin content in his liver. In this case, the bloom of jaundice occurs on days 11–23 of life. This condition goes away very slowly; in many of these babies, the jaundice completely disappears by the third month, only sometimes by the second. In such cases, a thorough examination of the child to identify more serious causes of jaundice is recommended.

There is an opinion that bilirubin levels increase during breastfeeding. For this reason, breastfeeding is stopped when signs of jaundice are detected in the baby, but modern research has confirmed the fact that breastfeeding is an important measure in the treatment of jaundice in a newborn. Most of the yellow pigment is excreted from the baby's body in feces. Breast milk has a mild laxative effect, which helps eliminate bilirubin and prevents the development of jaundice.

Indeed, a jaundiced skin tint often appears in breastfed infants. However, there is a high likelihood of developing breast milk jaundice in those babies who began to breastfeed late or too rarely and too little, due to a lack of milk from the mother.

A slight yellowing of the baby’s skin during breastfeeding should not bother parents, but you still need to consult a doctor

There is no evidence that breast milk jaundice causes any harm to the baby. If a baby who is only breastfed has a slight jaundiced skin tint, this is not scary and should not worry parents.

When will my baby's jaundice go away?

Neonatal jaundice is not a disease, but a syndrome that manifests itself in the neonatal period.

The syndrome can be physiological or pathological in nature, most often it manifests itself in the first days of a child’s life (sometimes later).

With jaundice, the child's skin, mucous membranes, and sclera of the eyes acquire a yellow tint. This is due to an increase in bilirubin levels and a slowdown in its elimination from the body.

Physiological jaundice normally occurs even in healthy children in 25–50%. The danger of jaundice is that when bilirubin levels are high, it acts on the brain as a neurotoxic poison; in severe cases, this can cause bilirubin encephalopathy (also called kernicterus).

The diagnosis of jaundice in newborns is made on the basis of assessing the degree of yellowness of the skin according to the Cramer scale; the level of concentration of bilirubin, red blood cells, hemoglobin, and liver enzymes is also taken into account.

Causes of hyperbilirubinemia in newborns

One of the main reasons for hyperbilirubinemia is that in a newborn baby, in most cases, the liver is neither physiologically nor functionally mature enough to fully remove bilirubin from the body. At the time of birth, most of the child’s organs and systems are immature.

For example, colic in a baby appears due to the immaturity of the gastrointestinal tract, but goes away by 4–6 months, when the intestines complete their formation and adaptation to the new environment.

After birth, organs and organ systems continue to “ripen” and complete their formation during the first few months of the child’s life.

Another reason for hyperbilirubinemia is that after birth, the baby breaks down a large number of red blood cells, which supplied him with oxygen in utero. This increases the concentration of bilirubin in the blood. Due to the immaturity of liver enzyme systems, bilirubin is poorly excreted; enzyme systems mature only by 3 - 3.5 months.

Bilirubin concentration also increases due to increased reabsorption of bilirubin in the intestine. The natural colonization of intestinal microflora, which occurs immediately after birth, slows down the absorption of bilirubin and its natural excretion.

Physiological jaundice appears in many babies (almost half of babies); it goes away on its own without any treatment by the time the child is one month old (usually by the end of 3 weeks).

Pediatricians consider the main causes of jaundice in newborns to be:

multiple pregnancy and premature birth;
treating a woman with certain medications during pregnancy and using drugs that stimulate labor;
iodine deficiency in the body, maternal diabetes and other diseases.

It is customary to distinguish pathological jaundice from physiological jaundice, which requires special medical treatment and monitoring.

The causes of pathological jaundice are considered to be:

incompatibility of the blood of mother and child by group or Rh factor;
uncontrolled treatment of a newborn child with antibiotics;
liver dysfunction, problems associated with hormone synthesis;
genetic diseases;
blockage of the bile ducts.

With pathological jaundice, there is high bilirubin in the blood, which needs a rapid and forced reduction due to the risk of bilirubin encephalopathy. Pathological jaundice is treated in a hospital in the neonatal pathology department.

It is important to quickly establish and eliminate its cause, and carefully monitor the decrease in bilirubin levels.

The difference between physiological jaundice and pathological

Bilirubin appears in the blood due to the breakdown of red blood cells. In an adult, they break down throughout life, so there is a constant concentration of bilirubin in the blood of an adult; normally it is 17.1 µmol/l. Bilirubin enters the liver, which removes it.

Normally, at the birth of a child, bilirubin in his blood is 51 - 60 µmol/l; on days 2 - 5 it rises to a level of 205 µmol/l, but should not exceed this figure. By the end of 3 weeks, bilirubin decreases and is usually 8.5 - 20.5 µmol/l. Jaundice is considered a condition in which the bilirubin level on the 2nd – 5th day of a child’s life exceeds 256 µmol/l.

Yellowness of the skin in an adult appears when the bilirubin concentration is over 34 µmol/l, and in a newborn – at a concentration of 70 – 120 µmol/l. Bilirubin is considered especially dangerous for premature babies suffering from intratubal hypoxia and hypoglycemia.

Physiological jaundice differs from pathological jaundice in that it does not manifest itself symptomatically (except for yellowness of the skin and mucous membranes); with pathological jaundice, the following may additionally occur: anemia, enlargement of the liver, spleen, and disturbances in the behavioral reactions of the newborn.

Features of physiological jaundice

Jaundice of a physiological nature appears in infants on the 2nd – 5th day of life. The skin becomes yellowish, sometimes it mistakenly seems that the child simply has dark skin, but at the same time the sclera of the eyes turn yellow, and the yellowness spreads to the child’s chest and arms.

A distinctive feature of physiological jaundice is the absence of yellowness on the baby’s tummy, legs and feet. Against the background of such manifestations, the child feels normal, eats actively, is awake, and goes to the toilet. Feces and urine do not change their color.

In the blood, bilirubin is increased to 256 µmol/l.

If a newborn child has signs of physiological jaundice, but with normal development in the neonatal period, a natural decrease in the level of bilirubin in the blood is observed every day. Signs of jaundice disappear completely in 2–3 weeks, less often by the end of the month.

Features of pathological jaundice

Pathological jaundice occurs in 7% (7 out of 100 babies born). This is a dangerous condition, so it is important to promptly distinguish it from a physiological process.

With pathological jaundice, the manifestations of the syndrome may differ:

yellowish color of the skin and mucous membranes appears within a few hours after birth and rapidly increases;
high bilirubin in the blood – over 256 µmol/l;
the child’s behavior is unusual: he eats poorly, sleeps a lot, is lethargic or, on the contrary, hyperactive, constantly cries;
There is darkening of the urine and lightening of the stool.

With pathological jaundice, there is a rapid increase in bilirubin (85 µmol/l per day or more), a wave-like course of the process with fluctuations in bilirubin, and the appearance of jaundice not on the first day, but on the 14th day of life (the end of the second week).

Bilirubin encephalopathy is an extreme manifestation of pathological jaundice in the newborn.

It manifests itself as convulsions, decreased blood pressure, and a monotonous cry of the child; he must be rescued, as he may fall into a coma.

Such jaundice appears more often in premature infants, whose brain, due to morpho-functional immaturity, is not able to resist the neurotoxic effect of bilirubin.

Pathological jaundice can be: conjugative (due to immaturity of the liver), hemolytic (associated with the death of red blood cells due to damage by viruses, bacteria, toxic effects), parenchymal (liver cells are affected) and obstructive (there are problems with the gallbladder, ducts).

Causes of prolonged jaundice

Sometimes a month passes and the jaundice does not disappear. This is not a very good sign, which the baby’s parents should definitely pay attention to. The main signs of prolonged jaundice are:

presence of anemia;
problems with the bile ducts (fusion, blockage);
insufficient synthesis of thyroid hormone;
galactosemia, polycythemia;
jaundice due to breastfeeding.

If by the end of the month the jaundice has not gone away, and the pediatrician has not paid attention to it, you should immediately consult a doctor to rule out pathology.

Breastfeeding jaundice (pregnane jaundice) is a special type of prolonged jaundice, which is caused by the fact that a woman's breast milk sometimes contains an excess of the hormonal metabolic product pregnanediol. The pathogenesis of this process has not been fully studied by medicine.

Pregnanediol slows down the natural removal of bilirubin from the newborn's body. If breastfeeding is continued, the concentration of bilirubin in the blood will not increase, it will decrease, but very slowly. In this case, the baby will feel normal.

Pregnane jaundice can last up to 3 or even 6 weeks. The diagnostic test for this jaundice is to try to stop breastfeeding, after which the bilirubin immediately begins to decrease.

If feeding is resumed, bilirubin begins to rise due to a slowdown in its excretion.

Doctors do not have a clear opinion regarding this type of jaundice. Some demand to stop breastfeeding, believing that high bilirubin additionally burdens the baby’s liver, while others, on the contrary, believe that you need to continue breastfeeding.

It must be remembered that lactation begins in the first months after birth and if it is stopped, the milk may disappear; it will be very difficult to resume breastfeeding after 3 months have passed and the child’s liver enzyme systems have matured. For this purpose, it is recommended to express milk, warm it to 70 degrees and feed the baby.

At this temperature, pregnanediol in milk is destroyed and does not inhibit the excretion of bilirubin from the baby’s body.

Treatment of jaundice

Jaundice is treated mainly inpatiently. In rare cases, when the bilirubin level is not very high, treatment at home is possible, but subject to daily monitoring of its level in the blood.

The main treatment for jaundice is phototherapy. The child spends most of the day “sunbathing” under a special blue lamp, which destroys bilirubin through a photoisomerization reaction.

In this case, bilirubin is converted into lumirubin, which has no toxic effect on the body. For home treatment, a photo lamp is rented. A light-proof bandage is put on the child's eyes, and the genitals are also covered from rays.

The baby is irradiated around the clock with breaks for feeding and hygiene procedures. Your child will have a blood test every day to monitor the rate at which bilirubin levels are decreasing. When phototherapy is carried out correctly, bilirubin decreases very quickly.

Usually, by the end of the week, the child and mother are already discharged from the hospital. Phototherapy is completed by prescribing diuretics and choleretic drugs.

During phototherapy, the child actively loses fluid, so he needs to be fed frequently, on demand. If there are significant disturbances in water balance, it is necessary to additionally prescribe infusion therapy (glucose).

Also, a child with jaundice is prescribed liver enzyme inducers, which increase the activity of liver cells and accelerate their maturation; enterosorbents that accelerate the excretion of bilirubin. To stimulate metabolism, a complex of vitamins and microelements is prescribed.

In severe cases, when bilirubin levels are high, the child is prescribed a donor blood transfusion to prevent the development of bilirubin enphephalopathy, thus the body quickly gets rid of bilirubin.

Conclusion

Jaundice can appear in a baby against the background of various pathologies: anemia, polycythemia, Gilbert and Crigler-Najjar syndromes, pyloric stenosis, excessive intake of hormonal drugs, and many other problems. It is important to promptly diagnose newborn jaundice and differentiate physiological from pathological.

Sometimes the process of removing bilirubin is delayed even with physiological jaundice. This is due to the fact that the development path of each child is individual; the processes of “ripening” of the body in a new environment occur at different speeds.

Sometimes the cause of the protracted nature of jaundice is a combination of several factors, for example, pregnane jaundice, caused by breastfeeding, is added to physiological jaundice. It is important to identify the reason why physiological jaundice does not go away in due time. Knowing the problem helps to adequately correct it.

In most cases, jaundice is physiological; many newborns have its manifestations. Therefore, such jaundice can be considered a variant of normal child development.

Source: https://32dgp.ru/kogda-u-malyisha-projdet-mladencheskaya-zheltuxa.html

Treatment of jaundice

Treatment of a pathological process that can cause serious consequences should be carried out in a hospital under strict medical supervision. Physiological yellowness in most cases can go away on its own without treatment. With a pronounced degree of physiological jaundice, you can help the child with the following measures:

The main and main medicine is maternal colostrum, which has a laxative effect and helps remove bilirubin from the newborn’s blood.
Phototherapy is often prescribed. After exposure to a special lamp, bilirubin is eliminated from the child’s body after 10-11 hours.
The sun's rays are also an excellent treatment. When walking with your child in warm weather, leave him naked for a while in the lacy shade of trees. At home, it is advisable to place the baby's crib closer to the window.
If the child has pronounced jaundice, more intensive treatment is necessary. Doctors usually prescribe activated charcoal or Smecta internally (more details in the article: how to take Smecta while breastfeeding?). Activated carbon absorbs bilirubin, and Smecta stops its circulation between the liver and intestines.

In conclusion, it can be noted that jaundice in newborns is quite common and in the vast majority of cases goes away spontaneously. Pediatric doctor Evgeniy Komarovsky believes that the main thing is to monitor the symptoms. Let's listen to what Komarovsky says about this phenomenon in the next video.

A beautiful and long-awaited baby who was born suddenly turned yellow. On the third day after giving birth, just in time for the discharge that the whole family was waiting for, the baby acquired an unusual orange color, once and for all ending the mother’s dreams of a beautiful photo shoot with the newborn. Joyful thoughts were replaced by anxiety - what kind of jaundice is this and why is it dangerous? These questions are answered by the famous pediatrician, TV presenter and author of books and articles on children's health, respected by millions of mothers, Evgeniy Komarovsky.

Prevention

The expectant mother should be involved in the prevention of jaundice even while carrying the baby and after his birth. To do this, it is enough to follow the following rules.

Adequate nutrition for the mother during pregnancy.
Her refusal of bad habits.
Prevention and treatment of any diseases.
Refusal of vitamin K injections to newborns, which are practiced in maternity hospitals.
Sunbathing.
Frequent breastfeeding.
Drinking plenty of fluids for a nursing mother.
Cutting the umbilical cord in the second hour after birth, when the pulsation at the base of the navel stops. This will allow blood circulation to normalize.

By preventing jaundice, you can prevent the disease so that nothing overshadows the baby’s first days. If you have any additional questions about this phenomenon, it is better to find out all the information from your pediatrician in advance.

Controversial issue. Doctors are still arguing about how the timing of cord cutting affects the manifestations of jaundice. There is no scientific evidence about the direct relationship between these two facts.

What's happened?

Jaundice in newborns is a fairly common phenomenon; it is observed in 50-60% of full-term and 80% of premature babies. You shouldn't treat it like a disease. The child’s skin turns yellow for completely physiological reasons. Fetal hemoglobin in the baby's blood (which was natural for him during pregnancy) changes to normal human hemoglobin A. The baby adapts to the environment. Its enzyme system is immature, like its liver. It is this organ that is responsible for the excretion of bilirubin, which is formed in all people during the breakdown of red blood cells. These blood cells are constantly renewed, hence the need to “recycle” aging cells.

The enzyme system is improving quite quickly. As the liver begins to work at full capacity, receiving the necessary enzymes, bilirubin begins to leave the body, the skin brightens, first acquiring a peach tint, and then returning to its normal color. Usually this process is completely completed by the 7-10th day of life, so after discharge in 4-5 days, less often in a week, the jaundice should completely disappear. Prolonged neonatal jaundice can be observed in premature babies, but doctors try to treat and monitor them in a hospital setting.

Symptoms

Depending on the type of disease, the symptoms of jaundice may vary. If they do not go beyond the norm and indicate only the physiological form of the disease, there is no need to sound the alarm. After 3 weeks everything will end happily. But if alarming signs of a more serious pathology are added to them, you need to inform your doctor about this - and as quickly as possible.

Signs of physiological jaundice

The skin and whites of the eyes acquire a yellow, almost orange tint;
minor stool disturbances.

Symptoms of pathological jaundice

More intense yellow skin color;
pinpoint hemorrhages, bruises;
wave-like course of the disease: the skin color periodically recovers to pink, and then returns to icteric;
the child is lethargic and lethargic, refuses food;
increased muscle tone;
monotonous or strong high-pitched crying;
dark urine;
discolored stool;
convulsions;
slow heart rate;
stupor or coma.

Clinical picture of specific pathologies

Lethargy, refusal to eat, monotonous cry, throwing back of the head, convulsions, attenuation of the sucking reflex - symptoms of kernicterus;
persistence of yellowness of the skin after 3 weeks, dark urine and discolored feces indicate serious pathologies of the bile ducts;
if the skin and sclera turn yellow immediately after birth, the child is lethargic and sleepy, and diagnosis reveals an enlarged spleen and liver - this is hemolytic jaundice;
the skin acquires a yellow tint with a greenish tint 2-3 weeks after birth, the stool is abnormally light, the liver is compacted, the spleen is enlarged - symptoms of a mechanical type of disease.

The faster parents recognize a dangerous type of jaundice in a newborn, the faster doctors will prescribe treatment and be able to help. Very often, precious time is lost, and complications that affect the child’s entire subsequent life cannot be avoided. To prevent this from happening, mandatory diagnosis of the disease is necessary.

Distinguish jaundice from hepatitis!
With hepatitis, the newborn's temperature rises, and the skin turns yellow suddenly and unexpectedly.

How to treat?

Since the process is natural, Evgeniy Komarovsky advises mothers to calm down and not bother themselves with questions about the treatment of neonatal jaundice. Modern medicine does not use special medications for these purposes. It is believed that the most effective way to somewhat speed up the process of normalizing a child’s skin color is phototherapy. To do this, use a “blue” lamp, which illuminates the child’s skin. As a result, the pigment bilirubin, under the influence of rays, breaks down into substances that the newborn’s body is quite capable of excreting with urine and feces.

Komarovsky advises using regular “white” lamps at home if there are no LED lamps, since any bright light neutralizes the toxicity of bilirubin.

Another effective cure for jaundice was created by nature itself - mother’s breast milk. It contains natural substances to enhance the child's immune defense. Therefore, the sooner the baby is put to the breast, the more often he is fed breast milk, the faster and easier his body will cope with physiological jaundice. Feeding such children is a special story. As a rule, babies with increased bilirubin are more sleepy and may skip feedings. It is important to ensure that the baby eats on time, wake him up if necessary, but in no case overfeed him.

Pathological situations

A condition in which a child, after birth, begins a massive breakdown of red blood cells, which are not only outdated and in need of replacement, but also completely healthy, is considered abnormal. The bilirubin level in this case is very high, and we are no longer talking about functional jaundice. Doctors talk about hemolytic disease of the newborn (HDN). This pathology can develop in children whose blood type and Rh factor are different from their mother’s. If an immunological conflict occurs, the mother's immunity produces specific antibodies against the fetal blood cells.

Such jaundice develops already in the first hours after the baby is born. As a result, severe anemia is observed in the newborn, his liver, central nervous system, and brain suffer. Doctors closely monitor bilirubin levels. When certain critical levels of this pigment in the blood are reached, a replacement blood transfusion is prescribed. Sometimes several such procedures are required to reduce the toxic effects of bilirubin on the body and all its systems. In the case of rapid and severe hemolytic disease, death can occur.

Another pathological jaundice characteristic of children is associated with biliary atresia. This is a congenital pathology in which these pathways are not formed or formed incorrectly due to some genetic error. This disease is very rare; according to official medical statistics, one out of 15 thousand children born is susceptible to it. This condition is eliminated surgically; the operation is very complex and high-tech, but it gives the child a chance for a further normal life.

There are other reasons for the appearance of jaundice that is abnormal for a newborn:

Overdose of vitamin K. The drug "Vikasol" (a synthetic analogue of vitamin K) is used during childbirth to prevent or eliminate severe bleeding in a woman. If there is an error in dosing or an urgent need for a large amount of the drug for a woman, an overdose may occur in the baby.
Diabetic fetopathy. A condition in which the baby’s liver and its enzyme system are not sufficiently developed due to the fact that the fetus suffered during pregnancy due to the mother’s diabetes.
Genetic (hereditary) liver malformations. These are some types of genetic syndromes in which structural genetic errors have arisen at the level of organ formation in the fetus.
Intrauterine infections. Some infectious diseases that the mother suffered during pregnancy can cause pathologies in the development of the fetal liver.

Yellowing of newborn babies: why does this happen, how dangerous it is for the baby

Every mother dreams of her child being healthy. Unfortunately, this wish is not always fulfilled in the very first days of a newborn’s life.

After birth, children often begin to show different reactions to life outside the womb. One of them may be yellowness of the skin. Many parents are afraid of such changes.

Not everyone knows how dangerous they are and why the skin color takes on an unnatural shade.

Jaundice in a newborn baby

Norm of bilirubin for a newborn

A fairly pressing problem in newborns is increased bilirubin. According to statistics, in the first 7-10 days of life, almost half of babies show signs of jaundice. The norm and limit of bilirubin in infants are generally accepted values.

The norm for children born on time is considered to be 256 µmol/l. Indicators of 324 µmol/l are considered critical. For premature babies, a figure of 171 µmol/l is considered normal, and 250 µmol/l is considered critical.

When indicators exceed the norm, specialists usually insist on drug treatment. Otherwise, the situation may take an unexpected turn; the lack of therapy can provoke the development of serious complications and pathologies of a chronic nature.

Note! If the indicators are significantly exceeded, urgent hospitalization and drug treatment on an individual basis are required.

Mechanism of development of jaundice

Why does a newborn baby hiccup and spit up after feeding?

Elevated bilirubin levels in newborns are associated with the destruction of fetal hemoglobin. It is released in large quantities into the bloodstream as the baby passes through the birth canal. The launch of the bilirubin conjugation system normally occurs within a period of several hours to several days after the baby is born.

Jaundice syndrome in newborns can occur with infections or hemolytic disease. If we talk about physiological jaundice, then, from a medical point of view, this situation is considered not as a syndrome or an independent disease, but as a period of adaptation of the child to new conditions.

Treatment of jaundice in newborns using a lamp

Characteristics and types of jaundice

Why does a child scratch his eyes and nose with his hands, possible reasons

Neonatal jaundice is a condition in which a baby's skin turns yellow due to the conversion of fetal hemoglobin to normal hemoglobin. In this case, this manifestation refers to passing states.

According to statistics, physiological jaundice appears on the 2-3rd day of life, the maximum severity is observed on the fourth day. Completely disappears by the eighth day.

Depending on the pathogenesis, taking into account the root causes of the pathology, there are three main types of jaundice:

Hemolytic - develops as a result of the formation of a large amount of bilirubin, which the liver cannot process and remove from the body. Most often it develops in children as a result of a conflict with the mother's immunity.
Parenchymal - appears due to damage to liver tissue during hepatitis infection.
Mechanical – the causes of this type of jaundice are cholelithiasis, cancer of the pancreas or gall bladder.

As for jaundice, which occurs in newborns, they come in the following types:

Carotene – associated with the child’s diet. It develops if, during breastfeeding, the mother’s diet contains a lot of carrots, tangerines or pumpkins.
Conjugation - the development of this type of jaundice is based on a violation of the excretion of indirect bilirubin or the impossibility of its interaction with glucuronic acid in the liver.
Pregnane – develops in newborns if the mother’s milk contains the hormone prenandiol, which the body has nowhere to put. It promotes yellowing of the skin by blocking the excretion of bilirubin.

Yellowness in a newborn does not always require treatment; some types go away on their own. If any deviations occur, you should contact your doctor immediately.

If jaundice in a newborn does not go away

Why do newborns have yellow whites of their eyes?

Not all young mothers have an idea about jaundice and, when symptoms appear, they wonder why the baby turns yellow after childbirth. At the same time, even greater excitement is brewing when the jaundice of the newborn does not go away.

Note! Long-term exposure to bilirubin on a child’s body is extremely undesirable, as it can cause complications in the heart, liver, gastrointestinal tract, nervous system and brain.

If a newborn’s jaundice does not go away for more than three weeks, then it is necessary to seek help from a pediatrician. He will conduct all the necessary research and identify the cause of this condition in order to draw conclusions and select the correct treatment.

Treatment of jaundice in a newborn using ultraviolet light

Consequences and possible complications

When a newborn turns yellow after birth, this condition rarely leads to serious complications. Some infants become drowsy, moody or passive during this period. In rare cases, children may lose their appetite. Physiological jaundice passes quickly and does not harm the baby.

Pathological jaundice can result in negative consequences. It is highly toxic and has a detrimental effect on vital systems of the body.

The most dangerous complication is bilirubin encephalopathy, which can lead to metabolic disorders.

As a result, hearing loss, deafness, movement disorders, cerebral palsy, vegetative-vascular dystonia, and mental retardation can develop.

Prevention of jaundice in newborns

It is very important for parents to know not only why the newborn turns yellow, but also how and why to prevent the occurrence of such a condition. There are no specific measures to prevent jaundice. There are measures that will help prevent the occurrence and development of intrauterine infections, prematurity and reduce the risk of developing hemolytic disease of the newborn.

Advice. According to experts, to prevent a child from becoming yellow after birth, the expectant mother must lead a healthy lifestyle, give up bad habits and eat well. Breastfeeding is very important.

Treatment of pathological jaundice

Pathological jaundice does not go away in 7-8 days; it is usually protracted. Each type of jaundice requires mandatory additional examination to find the true cause, after which adequate treatment is prescribed - conservative or surgical.

Quite often, when treating pathological types of jaundice, children are prescribed such a serious drug as Phenobarbital. Evgeny Komarovsky says that there is nothing unusual about this; this drug actually has the ability to activate enzymes that accelerate the binding of bilirubin in the liver. However, nowhere in the world is this medication used to treat young children, since the side effects that Phenobarbital has on the child’s nervous system are so destructive that its other properties lose relevance. Modern medicine has established for certain that the use of Phenobarbital at an early age always leads to a decrease in intelligence and learning ability at an older age.

Advice from Dr. Komarovsky

With physiological (normal) jaundice in a newborn, he must be given water to drink. Glucose is very useful for the baby.

The presence of physiological jaundice in a newborn is not a contraindication to hepatitis vaccination. There is no point in refusing vaccination just because the baby is yellow, says Evgeniy Komarovsky. With pathological jaundice, the risk of getting hepatitis increases significantly, and therefore Komarovsky considers vaccination even more necessary and useful.

You can see more details about the jaundice of newborns in the following video.

Description
Norm of bilirubin
Doctor Komarovsky
Phototherapy
How many days does it take?

medical reviewer, psychosomatics specialist, mother of 4 children

A sharp yellowing of a baby’s skin on days 3-5 of life is a common occurrence. More than half of all newborns experience this physiological symptom. Mom should not be afraid, because this is a natural process of development of the baby’s body. It is enough to wait a few days until the jaundice in the newborn should go away. At the same time, you should not leave the child unattended so as not to miss a possible pathology.

Physiological jaundice

The famous doctor Evgeniy Komarovsky has repeatedly reassured parents in his speeches who are worried about when jaundice should go away in newborns. As the doctor explains, characteristic symptoms appear due to the normal process of adaptation of the baby to new living conditions.

Jaundice in newborns

When unused cells are destroyed, bilirubin is released. It is this substance that colors the skin yellow. Usually it is processed by liver enzymes and then excreted in the urine, coloring it in its usual shades. Jaundice in an adult is a symptom of a dangerous pathology, signaling that the organs are not functioning as they should. But with a newborn everything is different.

In the first days of life, the baby’s body quickly gets used to new living and nutritional conditions. The child’s liver is not yet able to work at full capacity, not having time to process all the bilirubin that is released during the natural replacement of blood. But after a few days, the body accumulates a sufficient amount of enzymes, and the jaundice goes away on its own.

Why does physiological jaundice occur?

During intrauterine life, the baby's tissues were supplied with oxygen by red blood cells (erythrocytes), but after birth the baby breathes on his own and now red blood cells with hemoglobin are no longer needed. They are destroyed and in the process of their destruction bilirubin is produced, which turns the skin of the newborn yellow (we recommend reading: bilirubin in newborns: what is it?). Bilirubin is excreted in feces and urine.

The baby’s body is just learning to function correctly and does not yet know how to fully cope with all its responsibilities. Jaundice in a newborn is a natural phenomenon that occurs as a result of insufficient liver function. Since the newborn’s liver is still immature, in the first days of his life it does not have time to process all the bilirubin that is formed, so the pigment partially enters the blood. It stains the mucous membranes and skin yellow. When the child's liver grows a little, it will more thoroughly process the bilirubin that enters it. As a rule, the liver begins to function fully by the 5th-6th day of a baby’s life. From this moment on, physiological jaundice gradually fades away and there is no reason for concern.

How to speed up the process

According to Dr. Komarovsky, treatment for jaundice in newborns is normally not required, and it is enough to wait until it goes away on its own. Mom shouldn't worry too much about this. But if you want to help your baby’s body, you can use simple tips:

Milk. Breastfeeding slows down the primary processing of bilirubin, prolonging jaundice. This occurs due to the composition of breast milk. But at the same time, it is the enzymes that it contains that accelerate the process of normalizing liver function. If you do not stop breastfeeding, the baby will return to its usual color much faster. Therefore, it is important to ensure that the baby does not forget to eat regularly due to the drowsiness that accompanies jaundice.
Walks. No pills or medications are needed to treat jaundice. Regular sunlight helps destroy bilirubin. Therefore, the baby needs to be taken for walks regularly. If the weather permits, it is advisable to spend as much time as possible outdoors.
Lamp. If the weather outside is inclement, then you should not expose your baby to the risk of catching a cold. At home, you can help your baby’s body if he sleeps under a lamp. Light in the blue spectrum works best. But in the absence of special devices, any bright lighting is sufficient. Just don’t forget to protect your baby’s eyes by wearing a blindfold or a hat.

Diagnostics

Determining what type of syndrome a newborn has - not so critical physiological or pathologically dangerous - can only be determined through laboratory testing. In the laboratory, doctors are required to carry out a number of checks:

General blood tests and bilirubin levels;
Coombs test for hemolysis;
Ultrasound examination of the abdominal cavity.

Consultations with specialists such as endocrinologists and surgeons will also be required.

For reference, here are the average bilirubin levels in newborns:

Age up to 24 hours – less than 34;
Age 1-2 days – 25-150;
From 3 to 5 days – bilirubin level 26-205.

This standard indicator is usually divided into direct (bound) and indirect (free). So, normally, the level of direct bilirubin should not exceed 25 percent of the total value, and indirect bilirubin should not be less than 75 percent of the same value.

The diagnosis and, accordingly, the prescribed treatment procedures and therapies depend on what the laboratory indicators are.

In any case, the Coombs test is performed immediately after birth, taking blood from the umbilical cord.

When to Raise the Alarm

There are conditions when the lemon color of the skin and mucous membranes is not a sign of normal liver development, but a signal of serious disturbances in the functioning of the baby’s body. In this case, it is important to draw the doctor’s attention to the symptoms in a timely manner, especially if the mother decided not to visit the maternity hospital:

Time. Normally, jaundice develops only 3-5 days after birth. Pathological conditions manifest themselves almost immediately. It is also worth paying the attention of a specialist to the child’s health if the skin has not returned to its standard color even by the third week of life.
Urine and feces With natural jaundice, the baby's stool retains its natural shades. But if there are disturbances in the functioning of the body, the urine becomes much darker in color. Feces, on the contrary, become discolored.
Behavior. Normally, despite the lemon tint of the skin, the baby will behave as usual. Maybe you'll sleep a little longer. But with pathologies of internal organs, the baby’s restlessness will be noticeable. A nervous child will lose his appetite and be lethargic.
Analyzes. Having taken a newborn's blood for examination, a doctor can immediately tell whether there are any disturbances in natural development. Normally, the baby’s hemoglobin level does not fall. The body gradually replaces some cells with others, maintaining the natural concentration of substances in the blood. But with pathology, anemia will be immediately noticeable due to the massive death of red blood cells.
Inspection. In case of pathology, the doctor will also be able to determine problems in the baby’s body without laboratory tests. The baby's liver and spleen will enlarge. The expansion of the veins on the anterior abdominal wall will also be noticeable. Bruises may spontaneously appear on the skin.

Each child's body is unique. Only a specialist can say exactly when jaundice should go away in a newborn, and how to treat a possible pathology. To keep your baby healthy, you should not try to do anything on your own without prior consultation.

Causes and consequences of pathologies

Malfunctions in the body of a newborn can be caused by many reasons. Some are quite harmless. Others may even require surgery:

How does jaundice appear?

Milk jaundice. If the mother puts her baby to the breast late, or she produces little milk, the development of symptoms may last. In this case, the baby remains yellow sometimes for 2-3 months. This is not dangerous. In this case, it is extremely important not to stop breastfeeding.
Overdose of vitamin K. This substance is responsible for blood clotting and is prescribed to mothers before childbirth to avoid severe bleeding. But if the dosage is not observed, the baby may receive an excessive amount of vitamin K through the placenta. In general, there is nothing dangerous about this. The problem will go away on its own with minimal medical help.
Mother's illnesses. Diabetes mellitus in the mother can lead to a slowdown in the development of the baby's body. Viral infections, parasites and other health problems during pregnancy can cause similar problems. These conditions can be corrected if the doctor starts appropriate therapy in time.
Developmental defects. If the process of formation of the baby’s internal organs has been disrupted, this may affect the duration and nature of the jaundice. This is usually how the body signals defects in the liver, bile ducts or urinary ducts, which may require surgical intervention.
Rhesus conflict. This is a problem only for women with negative Rh factor. If the baby is positive, then his blood will be perceived by the mother’s body as an infection. Accordingly, her immune cells will begin to destroy the baby’s red blood cells. A blood transfusion can save the life of a newborn.
Injuries. Damage to internal organs and internal hemorrhages can cause increased levels of bilirubin in the blood. The degree of danger of the baby’s condition and treatment methods can only be determined by a specialist after a complete examination of the child’s body.

Given the variety of possible causes of the development of pathological jaundice, treatment methods in individual situations vary. But more often than not, mom shouldn't worry too much. At this age, most pathologies can be corrected, ensuring the possibility of further normal development of the baby.

At-risk groups

Even during pregnancy, doctors include in the risk group special categories of women whose children at birth have a high chance of having jaundice. These include:

age less than 18 and more than 40 years;
early abortions, miscarriages;
previous premature birth;
smoking, alcoholism, drug addiction during pregnancy;
diabetes mellitus during pregnancy;
negative Rh factor;
intrauterine infections;
jaundice in previous children.

Women who are at risk are under the constant supervision of a doctor throughout their pregnancy and undergo additional tests. And yet, it is impossible to 100% prevent jaundice in a newborn, even if you constantly take care to prevent the disease. It is very important to recognize it in time by characteristic signs that will help distinguish one type of jaundice from another.

A truism. If a woman leads a healthy lifestyle during pregnancy, she reduces the risk of jaundice in her baby.