Rus Articles Journal

Jaundices of newborns

Certainly, practically all parents are very much disturbed by emergence of jaundice in their newborn baby. Whether this process is normal? Whether it is worth being afraid of it and whether it is necessary to take any measures?

Jaundice is called coloring of the integuments visible mucous and a skler of eyes in yellow color. It is a consequence and visible manifestation of increase in bilirubin level blood.

Jaundice develops when bilirubin level in blood exceeds 35 - 50 µmol/l at the full-term and 85 µmol/l at premature. Expressiveness of jaundice is defined not only concentration of bilirubin in blood, but also features of skin (initial coloring, a depth, a tone of capillaries and so forth) and therefore is not an objective indicator of level of bilirubin. Eye skler, the lower surface of language, the sky, face skin are the easiest painted over.

different types of jaundice can occur At kids of the first month of life: pairing (i.e. connected with the low connecting ability of a liver), hemolytic (caused by the increased destruction of erythrocytes - gemolizy), parenchymatous (connected with toxic or infectious defeat of cells of a liver) and obturatsionny (caused by a mechanical obstacle to bile outflow).

Physiological (tranzitorny) jaundice

Is a state by right belongs to so-called borderlines of newborns (the states which are found normal at most of newborns, but demanding fixed supervision as at adverse succession of events many characteristics of functions of an organism can be beyond normal belong to this group). Tranzitorny jaundice occurs at 60 - 70% of all newborns. In character this type of jaundice belongs to pairing. Reorganization of system of hemoglobin which takes place after the birth of the kid is the cornerstone of this process. The matter is that hemoglobin of a fruit differs from that at the adult: during pre-natal development in an organism F (HbF) hemoglobin (it connects oxygen better), in comparison with “usual“, adult A (HbA) hemoglobin prevails at the expense of what there is a transition of oxygen from maternal erythrocytes to fruit erythrocytes, Soon after appearance of the baby on light its organism begins to destroy intensively HbF to synthesize HbA. Naturally, process of disintegration of hemoglobin leads to formation of indirect bilirubin. As the connecting abilities of a liver at this age are small, concentration of bilirubin in blood begins to increase gradually. Usually the first displays of physiological jaundice can be observed by the end 2 - go, and is more often on 3 - 4 - y day of life. Intensity of yellow coloring can increase a little to 5 - 6 - go day. As a rule, process has a good-quality current, and everything comes to an end safely: by the outcome 1 - y weeks of life activity of hepatic enzymes increases, the level of bilirubin begins to decrease gradually, will not reach norm yet, and by the end 2 - y weeks symptoms of jaundice disappear. But if there are “the aggravating circumstances“ (prematurity, immaturity of a fruit, the postponed hypoxia and/or asphyxia, it is hereditary - the caused defects of fermental systems of a liver, application of some preparations which are forcing out bilirubin from communication with glyukuronovy acid - for example, vitamin K, nonsteroid anti-inflammatory preparations, sulfanylamides, a levomitsetin, tsefalosporin, oxytocin the newborn and mother), bilirubin level in blood can increase to dangerous figures. In this case jaundice from a physiological state becomes the state menacing. Respectively distinguish jaundice premature, medicamentous jaundice, jaundice of children with asphyxia etc.

What is bilirubin?
Bilirubin - the substance which is formed in an organism at disintegration of red blood cells - erythrocytes, to be exact - the hemoglobin which is contained in them. Grown old and served the erythrocytes collapse generally in a spleen, at the same time the bilirubin called indirect, or untied is formed. It is insoluble in water (therefore, it cannot be removed by kidneys) and therefore for transfer in the blood course contacts albumine - low-molecular protein of plasma of blood. But the most important - indirect bilirubin is fabric poison, most of all it is dangerous to the central nervous system, in particular, of a brain. Being connected with albumine, it reaches a liver where there is its transformation: it contacts the rest of glyukuronovy acid and turns into direct (connected) bilirubin. In this new state it is nontoxical for cages and body tissues, we will dissolve in water and can ekskretirovatsya (to be allocated) with kidneys. It is also allocated with bile and comes to intestines. When the rate of decay of erythrocytes advances the connecting ability of a liver, indirect bilirubin begins to collect in the blood course and causes coloring of skin, mucous and a skler of eyes in yellow color.

At the full-term newborns the critical level of bilirubin in blood - 324 µmol/l, at premature babies are 150 - 250 µmol/l. Such difference is connected with the fact that at premature kids permeability gematoenets - a falichesky barrier (natural the chemist is increased - a biological barrier between a gleam of blood vessels and tissue of a brain thanks to which many of the substances which are present at blood plasma do not get into cells of a brain) and unripe cells of a brain are more sensitive to any sort to adverse effects. Toxic defeat of subcrustal kernels of a brain indirect bilirubin is called a kernicterus, or bilirubinovy encephalopathy. Its symptoms are the expressed drowsiness or, on the contrary, shrill shout, spasms, decrease in a sosatelny reflex, sometimes a rigidnost (tension) of occipital muscles.

That is why doctors in maternity hospitals carefully trace bilirubin level in blood at all newborns. At emergence of jaundice by the newborn 2 - 3 times during stay in maternity hospital have to appoint this analysis to specify whether there is no increase in concentration of bilirubin of blood. Mother can take an interest whether took such analyses from the child. (Increases of level of bilirubin in blood) earlier widely applied intravenous transfusions of 5% solution of glucose (she is a predecessor of the glyukuronovy acid connecting bilirubin in a liver), ascorbic acid and phenobarbital (these preparations increase activity of hepatic enzymes), zhelchegonny means (they accelerate removal of bilirubin with bile), the adsorbents (an agar-agar, holestiramin) connecting bilirubin in intestines and interfering its return absorption to treatment of a giperbilirubinemiya. However today more and more researchers give preference to phototherapy as the most physiologic and effective method. When carrying out phototherapy skin of the kid is irradiated with special lamps. At influence of light of a certain wavelength bilirubin passes into the photoisomer (it is called lyumirubiny), which is deprived of toxic properties and we will well dissolve in water thanks to what without preliminary transformation in a liver it is removed with urine and bile. Procedures are carried out, as a rule, in maternity hospital. As the indication for purpose of phototherapy serves concentration of bilirubin in blood higher than 250 µmol/l for the full-term newborns and higher than 85 - 200 µmol/l for premature (depending on the weight of the kid).

of Tranzitornaya jaundice occurs at 60 - 70% of all newborns.
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To group of pairing possesses also jaundice at the children raised by breast milk (Ariyes`s syndrome). Still the reason of development of this state remains low-studied. Perhaps, in it maternal estrogen (female sex hormones) which are present at milk as they can force out bilirubin from communication with glyukuronovy acid “is guilty“. It is possible the matter is that the sum of all calories received per day at the unsteady lactation will be lower, than when feeding by mix (it is known that at relative malnutrition bilirubin can be exposed to the return absorption in intestines and again come to the blood course). Anyway, within the first week of life at the children raised by breast milk (including donor), development of tranzitorny jaundice, than at their age-mates transferred for any of several reasons to artificial nutrition is 3 times more often noted. But you should not be frightened this statistics: it is proved that early applying to a breast and the subsequent 8 - single feeding in general reduce the frequency of development and degree of a giperbilirubinemiya at newborns. Decrease in level of bilirubin by 85 µmol/l and more at the feeding termination by breast milk for 48 - 72 hours will be diagnostic criterion of this type of jaundice. The thicket for carrying out this test of the child is not transferred to artificial nutrition even on these by two there are three days, it is enough to offer it the decanted milk previously heated to temperature of 55 - 60 ° With and cooled to body temperature - 36 - 37 ° C. At such processing biological activity of estrogen and other substances of maternal milk which can compete for liver enzymes considerably decreases. Sometimes resort to this test to exclude other possible reasons of jaundice. The current of this state good-quality, cases of bilirubinovy encephalopathy against Ariyes`s syndrome is not described therefore treatment usually is not required, and children can quite be nursed. Hemolytic jaundice arises at the raised gemoliz (disintegration of erythrocytes). It can be one of displays of the hemolytic illness of newborns (HIN) developing at a Rhesus factor - positive children at a Rhesus factor - negative blood of mother. In such cases in an organism of mother antibodies against fruit erythrocytes which destroy them can be developed. In a clinical picture of a hemolytic illness - anemia (decrease in level of hemoglobin and erythrocytes), a giperbilirubinemiya, increase in a liver and spleen, in hard cases - puffiness of fabrics, a liquid congestion in body cavities, sharp decrease in a muscular tone, oppression of reflexes. Jaundice most often develops right after the birth or in the first days of life, bilirubin level quickly increases to the menacing figures. Most often apply operational methods to treatment of GBN. The zamenny blood transfusion (ZBT) first of all concerns to them, sometimes haemo sorption is also applied. At ZPK at the newborn the blood containing the increased level of bilirubin and the reduced quantity of uniform elements (cells) of blood gets, and blood of the donor is transfused to it. For one procedure make replacement up to 70% of volume of blood. Thus, it is possible to reduce concentration of bilirubin and to prevent damage of a brain, and also to restore necessary quantity of the erythrocytes transferring oxygen. Quite often repeated carrying out procedure is required if bilirubin level begins to reach critical figures again. Haemo sorption represents purification of blood of bilirubin, maternal antibodies and some other substances by their sedimentation in special installation. At not heavy current of GBN the treatment methods which are used at tranzitorny jaundice can be applied.

Besides, hemolytic jaundice can develop at the hereditary diseases which are followed by defects of a structure of membranes, either enzymes of erythrocytes, or hemoglobin molecules. Any of these reasons leads to the increased destruction of erythrocytes and as result, to growth of level of bilirubin. Jaundice is noted from the first days of life. The accompanying symptoms are anemia, increase in a spleen. The diagnosis is made on set of symptoms and the general blood test, additional researches sometimes are required.

Parenchymatous jaundice

Develops at defeat of cells of a liver by infectious or toxic agents that leads to decrease in their ability to connect bilirubin. In this row pre-natal infections are on the first place: a cytomegalovirus (it is the reason about 60% of all cases of long jaundice at babies), toxoplasmosis, listeriosis, a rubella, viral hepatitises. As a rule, the thought of a pre-natal infection arises at development of long jaundice (when its duration exceeds 2 - 3 weeks at the full-term newborns and 4 - 5 weeks at the kids who were born premature), and also in the presence of other symptoms (increase in a liver, spleen and peripheral lymph nodes, anemia (decrease in level of hemoglobin in blood), darkening of urine and decolouration a calla, inflammation signs in the general blood test (increase in quantity of leukocytes, increase of SOE), increase of level of hepatic enzymes in biochemical blood test. For statement of the diagnosis use serologichesky reactions (detection in blood of antibodies to viruses or bacteria), detection of RNA or DNA of the activator by PTsR method (polimerazny chain reaction - the method allowing “to recreate“ DNA or RNA by small fragments which are found in biological liquids or body tissues. After that the received RNA or DNA are investigated on a vidoprinadlezhnost (i.e. define a type of the activator).

of Obturatsionnaya jaundice

Arises in connection with gross violations of outflow of bile, obstruction (obstruction) of bilious ways. This jaundice develops at bile malformations - the removing channels (atresias, aplaziya), an intra hepatic hypoplasia, pre-natal cholelithiasis, sdavleniye of the bilious courses a tumor, bile condensation syndromes, etc. A characteristic sign of this type of jaundice is zheltovato - a greenish shade of skin, increase and consolidation of a liver, continuous or periodic decolouration a calla. Jaundice as a clinical symptom develops on 2 - 3 - y to week of life. Radiological methods, a biopsy are applied to diagnostics (research of a piece of fabric under a microscope, and also by means of various biochemical methods). Treatment most often surgical.

we tried to tell

In this article about some most frequent reasons of development of jaundice in newborns. We hope, it will allow you to avoid unnecessary disorders, and in cases when your fears are not groundless, quicker to orient and in time to show the kid to the expert.