What are the main risks of jaundice in newborns? What are the treatments for the disease are the most effective? How phototherapy can help in the treatment of jaundice
Jaundice is called yellow or ikterichnoststaining visible mucous membranes and skin due to the accumulation of bilirubin in the blood. Neonates staining occurs when the level of total bilirubin 70 umol / L, and for nedonoshennyh- 50 mmol / l.
More common physiological jaundice in infants developing during the first 3 days after birth. Doctors attribute this condition to the border, which do not require treatment.
Danger is a state of the toxic effect of free (not bound) bilirubin in the organs of the central nervous system.
These children are likely to develop kernicterus,or bilirubin encephalopathy. It is found only in newborns and can lead to serious consequences: cerebral palsy and mental retardation.
Classification of diseases
In the neonatal period there are several types of jaundice:
1. Indirect or unconjugated hyperbilirubinemia. More than 85% of total bilirubin account for indirect;
2. Conjugated or direct hyperbilirubinemia, when the share of direct bilirubin accounting for 15% or more of the level of total bilirubin; conjugation jaundice in newborns can indicate hereditary diseases;
3. Hemolytic jaundice;
4. Parenhimtoznaya jaundice;
5. Mechanical (obstructive) jaundice.
Physiological jaundice in the neonatal periodcalled transient, occurs in 60% of full-term healthy infants at 2-3 days. At the same time the level of bilirubin in premature infants up to 85-103 mmol / l and in term - 51-60 mmol / l.
Accepted to share the development of jaundice in the phases:
1. In the first five days after birth, grows relatively fast fraction of direct bilirubin in the blood;
2. In the second phase, there is a moderate decrease in unbound bilirubin up to 50 mmol / l during the 11-14 days of newborn life.
Rarely second phase can last up to a month. This is due to the functional maturity of the child and the type of feeding (jaundice lasts longer breastfeeding).
Staining skin covers baby comes naturally: in turn painted face, neck, body and limbs.
The disappearance of jaundice staining observed inreverse: the limbs, torso, neck and face. Several factors contribute to the prolongation of jaundice: lack of breast milk from the mother, or, conversely, sometimes jaundice associated with the impact of mother's milk to the baby's body.
Causes of disease
Causes of Jaundice in newborns are different:
1. The birth was a big release of red blood cells;
2. Initially, a high amount of fetal hemoglobin in neonatal blood;
3. The rapid decay of fetal hemoglobin after birth;
4. Lack of liver enzymes which are involved in the conjugation of indirect bilirubin fraction;
5. Wrong mode of infant feeding.
Physiological jaundice in newborns has its own characteristics:
1. It appears externally after 48 hours (2 days) after birth;
2. The level of bilirubin does not reach critical values, which can cause the development of bilirubin encephalopathy;
3. The general condition of the newborn remains satisfactory.
Children fed breast milk of mother, the highest level of bilirubin is observed in 4-5 hours, as in the early days they receive less liquid due to transient lactation.
Premature babies severity of jaundiceIt depends primarily on the maturity of the child and the pathologies of the mother during pregnancy, rather than the weight of the newborn. The frequency of jaundice is higher among children who had birth trauma in children of multiple births and mothers with diabetes.
Treatment of jaundice in newborns
The main method of treatment of physiological jaundiceremains frequent feeding, breastfeeding on demand, sometimes you have to wake up these children to feed. Nursing mothers recommended to establish a drinking regime. Of no little importance given to nutrition and rest mother.
The child is receiving breast milk, notit is recommended to give any of his substitutes, as it is believed that the mother's milk can provide all the needs of the child and contribute to an early normalization of bilirubin level.
If the general condition of the child becomesunsatisfactory, jaundice increases, it is recommended to determine the level of bilirubin. If jaundice developed after 8 days of life newborn or lasts longer than 2 weeks, you should establish the true cause of this condition.
hyperbilirubinemia Treatment has its own principles:
1. The first step is to eliminate the causes of increased levels of toxic bilirubin;
2. Measures should be taken to prevent the further growth of toxic levels of bilirubin;
3. Apply methods that promote rapid excretion of excess bilirubin from the blood.
Such methods include phototherapy and exchange transfusion, which shows a newborn, who is set Rhesus-conflict or incompatibility blood group with the mother.
The final decision on the application of this methodtaken after studying the detailed history, obtain blood test results on the presence and level of antibodies, broadly, the presence of clinical signs of bilirubin rise at a rate 17 mol / l / hr, and bilirubin pokazateyahi below 110 umol / l in cord blood.
Phototherapy is used in jaundice innewborn for the past 30 years. When done correctly, this method can not be held for an adverse effects. In the world is a major method of phototherapy in the treatment of this condition in the newborn.
Based on the method of transition fat-soluble formbilirubin, which is toxic to the brain, in a water-soluble non-toxic form, which readily leaves the body. This process takes place under the influence of UV rays.
The larger effect is achieved by increasing the illuminated area of the baby's body. Therefore, these children are usually completely stripped, but to save the Heat are in the incubator.
Under the influence of bilirubin light breaks down into non-toxic fraction. The main of them is lyumirubin. Within 12 hours, he completely leaves the body of the child with feces and urine.
Sometimes during phototherapy in a newbornnotes loose stools, peeling skin, excessive sleepiness. After the termination of this procedure, the above-described phenomena are without a trace.
The action of the blue part of the spectrum of the light wave is toxic, so the child close their eyes special glasses and genitals dark cloth.
To the greatest exposure affected area of the body of the child, it should be every 2 hours change the position.
While stored indications for phototherapy, itshould be carried out at regular intervals. The most appropriate regime for the majority of neonatal phototherapy is the alternation and feeding breaks.
Continuous phototherapy regimen is recommended if there is a critical bilirubin level or intensive growth.
The average duration of treatment is from 1 to 3 days.
The treatment effect is assessed not only byexternal data about skin coloring, but also on laboratory parameters. Newborn bilirubin levels need to be monitored with a blood test 2-3 times a day. During the first 12-24 hours from the start of phototherapy sessions at the child in the body there is a stabilization level of indirect bilirubin.
This method has contraindications: liver disease and obstructive jaundice.
Currently, there is an alternative phototherapy -fiber optic method. The baby swaddled in a blanket containing a fiber optic layer. That it has a direct effect on the skin. The advantage of this method is the possibility of free feeding of the child, it can be worn on the hands.
It is worth remembering that the fiber treatment gives a slightly smaller effect than conventional phototherapy in term infants.
The most effective is a combination of both methods.
After a child, and the mother will be discharged fromhospital, mothers recommend walking with a toddler under indirect sunlight, frequent breastfeeds (on request). It should be remembered that maladentsa located in the phototherapy should wake up for the next feeding.