Jaundice (hyperbilirubinemia) in newborns

What is jaundice in newborns?

Jaundice is a disease in which the newborn skin turns yellow and the whites of the eyes. This is due to the fact that there is a lot of bilirubin (C32H36O6N4) in the blood of the child, this phenomenon is also called hyperbilirubinemia.

Bilirubin

Bilirubin is a substance produced by the decomposition of old red blood cells and hemoglobin, a protein in red blood cells that carry oxygen from the lungs to the rest of the body. Bilirubin is excreted from the body through the digestive system, as part of the bile coming from the liver.

Our body constantly produces new blood cells and destroys the old ones. Usually the amount of bilirubin in the human body is very low. The content of bilirubin in the blood, exceeding the norm, causes yellowing of the skin and eyes (jaundice). Blockage of the bile duct or certain medical diseases, for example, liver disease, can lead to the fact that the level of bilirubin rises to an unhealthy level.

Usually, newborns have a high content of bilirubin in the blood. In most cases, after a few days, the baby’s system will be able to better excrete bilirubin from the body. Nevertheless, the child may need medical help if yellowing intensifies on the third day after birth, or does not decrease after the fifth birthday.

Bilirubin is a substance that is produced when old red blood cells are destroyed in the body.

Red blood cells (erythrocytes)

Red blood cells, or erythrocytes, pass through the body, transferring oxygen to body tissues and organs, and at the same time removing waste from the body. These blood corpuscles form the major part of the circulatory system.

As red blood cells pass through the lungs, oxygen molecules from the lungs attach hemoglobin, a protein in the red blood cells containing iron. Then oxygen enters the body tissues and organs, and hemoglobin combines with carbon dioxide and other gaseous waste. Waste products are transported and withdrawn as the circulation of blood continues.

One drop of blood contains millions of red blood cells. Red blood cells are constantly produced in the bone marrow to replace old, gradually dying bodies. The average life cycle of red blood cells is approximately 120 days.

A significant decrease in the number of red blood cells causes anemia or rapid breathing.

Usually jaundice is not a problem. But in some cases too much bilirubin can lead to brain damage (nuclear jaundice or bilirubin encephalopathy).

Nuclear jaundice or bilirubin encephalopathy

Nuclear jaundice or bilirubin encephalopathy is a very rare type of brain damage that occurs in newborns with severe jaundice. This occurs when a substance contained in the blood and called bilirubin accumulates in a very large amount and penetrates into the brain tissue.

Nuclear jaundice or bilirubin encephalopathy can lead to hearing loss, development of mental retardation, and also to bieheveristic problems.

The development of bilirubin encephalopathy can be prevented if the treatment of jaundice begins on time, which does not go away when it would seem that it should have already passed. Jaundice of medium severity – when a small amount of bilirubin accumulates in the body – a common occurrence among newborns.

The main symptoms of the disease – a yellowish tinge on the skin of the child and sometimes in front of eyes. Usually peak jaundice occurs on the 5th day after birth. Most often, jaundice passes by itself, when the baby is fed every 2-3 hours. But both doctors and parents should closely monitor the child, who suffers from jaundice.

Children exposed to the risk of developing a serious case of jaundice will have a blood test to measure the level of bilirubin in the blood. Doctors start treatment in those children whose blood levels of bilirubin are higher than normal.

The moderate and moderate cases of jaundice can easily be cured with the help of special light irradiation, which is called light therapy. Usually, children are treated with light therapy in a hospital. In some cases, children suffering from jaundice can be treated at home using the lamps provided by the doctor. If bilirubin reaches a level at which there is a suspicion of the development of bilirubin encephalopathy, the child may receive a blood transfusion.

As soon as bilirubin encephalopathy symptoms appear, brain damage has already occurred. A child with bilirubin encephalopathy has increased drowsiness and apathy. This means that the child is very difficult to wake up and difficult to keep awake. Also, it should be borne in mind that newborns sleep very much. Drowsiness in newborns can easily be confused with the normal behavior of the newborn. It seems that the child is not fully awake. The child will also be poorly eating, will not respond to touch or do not flinch from sudden movements.

A child suffering from bilirubin encephalopathy usually cries very loudly, and the crying itself sounds very strange. The child has a low muscle tone. It may seem that the child is “flexible” or weak. Sometimes this flexibility dramatically changes the tightness of the muscles and their tension. At such times a child can arch his back and neck.

The heat that appears against this and other symptoms is also a sign of bilirubin encephalopathy. A child who develops signs of bilirubin encephalopathy needs urgent medical treatment to prevent further development of brain damage.

This can lead to hearing loss, the development of mental retardation, as well as to bieheveristic problems.

In healthy children, there are almost always signs of jaundice after 2 to 4 days after birth. Usually the child’s well-being improves, and the symptoms go through a week or two without causing complications.

In children who are breastfed, jaundice of moderate severity can last up to 10-14 days. In some children who are breastfed, jaundice can pass, and then manifest again. Jaundice can continue throughout the period of feeding. Usually this is not a problem until the child receives enough milk and while he is fed regularly.

The doctor will probably ask you to check the child’s health at home to make sure that jaundice passes. After 5 days after birth, an additional examination of the child will be carried out. Contact the doctor if the yellow color increases after the child is three days old.

What causes jaundice in newborns?

Jaundice develops due to the fact that the body produces more bilirubin, than the body can process. Bilirubin is produced when old red blood cells are destroyed in the body. Bilirubin comes out of the body through urine and stool. During pregnancy, your body removes bilirubin from the body of the baby through the placenta. After birth, the child must independently get rid of bilirubin.

Newborns who are breastfed can suffer from dehydration if there are too large gaps between feedings. The lack of sufficient milk in the body complicates the process of removing waste from the body of the child, for example, bilirubin withdrawal. Also, some substances that are part of breast milk, can change the way bilirubin is removed from the body.

In rare cases, too much bilirubin can trigger the development of infection, problems with the child’s digestive system, as well as problems with the blood of the child and mother (Rh-incompatibility).

Rh-incompatibility

People who do not have Rh factor on the surface of their blood cells are Rh-negative and suffer from Rh-incompatibility with blood, which is Rh-positive. This incompatibility means that when you come into contact with Rh-positive blood, the immune system of people with Rh-negative blood produces antibodies for the destruction of Rh-positive blood cells.

Pregnancy and blood transfusion are the two most common cases in which a person with Rh-negative blood can be affected by Rh-positive blood.

A woman with Rh-negative blood that is exposed to at least one Rh factor (usually from a previous pregnancy), the immune system reaction can cause serious problems during a future pregnancy if the fetus has Rh positive blood. The immune system produces Rh-antibodies, which penetrate the placenta and attack the fetal blood. This can be avoided if the mother is injected with antibodies called RhoGAM.

People who need a blood transfusion, check the Rh factor and select only compatible blood.

The child may develop some of the above problems if jaundice manifests less than a day after birth.

What are the symptoms?

When jaundice in newborns, the skin and the whites of the eyes may turn yellow. You can see yellowing 1-4 days after birth. First, the symptoms appear on the child’s face and on the chest. Children who have a very high bilirubin level can cry loudly. Passivity and irritability may appear in them.

How is jaundice diagnosed in newborns?

The child’s doctor will conduct a physical examination and ask you a number of questions.

The doctor can ask questions about:

  • Your general health, especially during pregnancy.
  • Was the child born before the due date (premature) or as expected.
  • The problems that arose in the process of birth.
  • The child’s weight at birth, as well as whether the child has gained or lost weight after birth.
  • Timetable for feeding the baby, as well as on how often the child goes to the toilet.
  • Your blood group and whether you and the child have problems with Rh-incompatibility.
  • Family health problems that can lead to the development of jaundice.

They can conduct a blood test to detect bilirubin, this is necessary in order to determine whether there is a need for treatment of the child.

Can conduct additional tests if the doctor believes that the health problem is caused by a large amount of bilirubin in the blood.

What are the ways of treatment?

In most cases, there is no need, because usually jaundice passes by itself. If you are breastfeeding, you can fight jaundice by feeding the baby 8-12 times a day.

Sometimes children suffering from jaundice are exposed to fluorescence irradiation. This is called open light therapy.

When light therapy in a hospital, a light box and / or an optical fiber cover directs fluorescent light on a child suffering from jaundice. The child is treated in a closed cradle (incubator), while the light is absorbed into the skin. Light converts bilirubin into another form and the body more easily removes this substance through a stool or urine.

The baby is undressed to grab a large area of ​​skin, which is exposed to light. Eyes at the same time covered to protect them from exposure to bright light.

When treated at home, a fiber optic blanket or bandage can be used alone.

The skin absorbs light. As a result, bilirubin changes and the body more easily removes this substance through a stool or urine. Treatment is easily used in hospitals. But sometimes children are treated at home.

If jaundice occurs due to health problems, the child may need another treatment.

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