Jaundice in infants

Jaundice in infants

Jaundice is a common condition in babies, most often occurring very soon after birth and especially if babies are born prematurely. Jaundice is a condition caused by the liver and consists of yellowing of the skin, sclerotia and mucous membranes due to the accumulation of bilirubin in the blood.

How does jaundice manifest?

There are two types of bilirubin: free or "unconjugated" bilirubin, produced during the destruction of red blood cells, insoluble in water and non-urinating, transforms into the liver, by binding to albumin, to the so-called "conjugated" bilirubin, water soluble and excreted in the urine.

For this reason, two major types of jaundice are distinguished, according to the type of bilirubin:
The first is related to an excessive destruction of red blood cells (hemolytic anemia) or to a hereditary enzyme deficiency of liver cells (Gilbert's syndrome);

The second is manifested during liver and biliary tract diseases (viral or toxic hepatitis, bacterial infection, cirrhosis, yellow fever, malignant tumor, infected lithiasis).

When jaundice appears in babies

Newborn jaundice usually occurs after approximately 24 hours after birth. In the case of healthy newborns, nourished with breast milk, the skin color changes to yellow about 2-4 days after birth. Jaundice disappears or decreases in intensity by itself, without treatment and without follow-up in 1-2 weeks.

In the case of newborns breast-fed, a mild jaundice may be sustained 10-14 days after birth or may recur during breastfeeding. As long as the baby receives enough milk and is fed frequently (8-10 or more times within 24 hours), jaundice is not a problem.

Physiological jaundice it is specific to all children (some are low intensity and goes unnoticed) beginning after the first day of life, because the baby's organs are not yet able to effectively remove excess bilirubin.

The intensity of jaundice increases after the first day from birth until day 3-4 of life.

The effects of jaundice on newborns

Rarely large amounts of bilirubin accumulate in the blood and cause brain damage, the situation being known as nuclear jaundice. These injuries can be followed by hearing loss, mental retardation and behavioral disorders.

During pregnancy, the mother's body removes bilirubin from the fetus through the placenta. After birth, the newborn must remove bilirubin from the blood alone.

The jaundice caused by breast milk causes the increased circulating level of bilirubin, which occurs around days 10-14 of life. The mechanism by which some components of breast milk affect the elimination of bilirubin by the newborn is not known.

Treatment of jaundice in infants

The most used method of therapy is phototherapy. It uses fluorescent light that intensifies the transformation of bilirubin into a form that the body can eliminate at a faster rate.

Standard phototherapy is usually applied in the hospital. In the case of children who are no longer suffering from other diseases, there is a method of treatment at home that uses a device made of optical fibers, in the form of beds. These "beds" reduce the level of bilirubin slower than standard phototherapy, which is why they are used only for the treatment of mild forms of jaundice.

Children who have dangerously high levels of bilirubin in their blood need treatment.

The opinions of the specialists

"The persistence of jaundice after 3 weeks of life requires medical investigations, as it may be the sign of pathological conditions. The causes of hyperbilirubinemia unconjugated at this age are multiple:

• the physiological jaundice of the prolonged newborn (premature, low birth weight, dehydration);

• haemolytic anemia: by congenital red blood cell defects (red blood cells), by acquired red blood cell defects, by Rh or ABO group immunostaining, drugs administered to the pregnant mother, infections;

• polycythemia (too large number of red blood cells in the blood): in placental hypertransfusion (passage of blood from mother to fetus or late binding of the umbilical cord);

• endocrine diseases (maternal diabetes, neonatal thyroxytosis), hematomas in resorption, metabolic diseases (galactosemia);

• bilirubin conjugation defects that may occur in congenital diseases (Crigler-Najjar Syndrome, Gilbert Syndrome) or may be due to the inhibition of the enzyme responsible for conjugation by certain drugs administered to the mother during pregnancy or birth or by certain substances present in milk. breast (progesterone);

• intestinal obstruction.

The results of the analyzes must be interpreted in context: they must be correlated with a careful anamnesis (to retain gestational age at birth - if it was premature birth, birth weight, age of onset of jaundice, treatments administered to the mother during pregnancy or birth and may be revealed eventually certain inherited defects) with the results of a general clinical examination, with the other analyzes performed, which even if within normal limits are important to exclude some causes; also, further investigations are likely to be needed in order to be able to diagnose certainty.

It is not good to neglect jaundice in infants, because increased unconjugated bilirubin can cross the blood-brain barrier to the brain, sometimes leading to severe disease with severe neurological consequences. "

Alina Pop-Began
ATI specialist doctor

What moms say about baby jaundice

A mother tells that she has a four and a half month old girl and that she has had the problem of prolonged jaundice. The girl had jaundice for up to a month and a half, when she fainted.

To another mom, the doctor recommended blood tests, followed by Fenobarbital, which is too harsh for infants. The parents refused this treatment and went to another doctor, who told them that there was no need to be alarmed, and the jaundice passed after a month.

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