The situation when bilirubin in the blood of newborns exceeds normative indicators is not uncommon. Most often, this phenomenon passes on its own. However, too high rates require additional treatment, as they can lead to significant complications. Therefore, high bilirubin should be taken very carefully.
The concept of bilirubin
Bilirubin is a product resulting from the breakdown of red blood cells. If the cycle of their existence has already ended, they turn into toxic hemoglobin, from which the formation of the dye occurs.
In medical practice, it is customary to distinguish two types (fractions) of this substance: direct and indirect. Indirect bilirubin is initially formed. It is slightly soluble and difficult to remove from the body. Therefore, first bilirubin is converted into a straight line, which enters the liver, then into the gall bladder and is excreted through the intestine.
The human body makes every effort to get rid of this substance. However, the baby’s liver is initially unable to cope with such a load. That is why in the first days of life it is so important to monitor whether the norm of bilirubin in the blood is observed in newborns. The table that contains the threshold values of the indicator is designed to help do this.
Causes of Elevated Bilirubin
They pose a threat to the health of the child in situations where the value obtained during the analysis differs from the norm of bilirubin in newborns by day. A table that allows you to compare these two indicators was developed during a long study. His goal was to identify the causes that cause this phenomenon. The main ones are:
- deviations in the rate of fetal development;
- treatment of pregnant women with toxic drugs, as well as their use during childbirth;
- refusal of breastfeeding;
- Too much weight loss in the first days of life.
Children born to women with a negative Rhesus factor are also at risk. They often show excess when comparing: the result of the analysis for bilirubin is the norm in the newborn (table).
Norm
In a recently born child, not all organs are working at full capacity. Therefore, the fetal hemoglobin formed during the decay process does not have time to quickly contact albumin. As a result, bilirubin levels increase.
In this case, the amount of substance in the blood first increases, then it begins to decrease. In a normal situation, around the fourth day of life, children have minimal bilirubin. The norm in a newborn (the table below contains its values) varies significantly with age.
The rate of total bilirubin according to the reference Ingerleib M.| Child age | The normal value of the indicator, μmol / l |
| First day | less than 34 |
| 1-2 days | 24-149 |
| 3-5 days | 26-205 |
| 5 days-60 years | 5-21 |
There is another table that summarizes data on the normal level of bilirubin in the distribution by fractions.
| Child age | The value of bilirubin, μmol / l |
| General | Connected | Free |
| Newborns | 23.09 | 8.72 | 14.37 |
| Second day | 54.22 | 8.72 | 45.50 |
| Fourth day | 90.14 | 7.87 | 82.27 |
| Sixth day | 69.10 | 7.72 | 63.28 |
| Ninth day | 53.02 | 8.72 | 44.30 |
| Month | 11.12 | 2,57 | 8.55 |
During the birth of a baby, the threshold value of the substance content can reach 51 μmol / L. Subsequently, it gradually increases, and reaches a maximum on 3-4 days of life. In children born on time, the level of bilirubin should not be higher than 256 μmol / l, in premature babies - 171.
Physiological jaundice
Often there is a physiological jaundice in newborns. The norm of bilirubin (the table confirms this) increases in the first days of life, however, the amount of the substance should independently decrease by the age of a crescent.
Doctors distinguish a number of signs that allow us to talk about the presence of physiological jaundice in a child:
- manifests itself on the second day of life;
- the rate of bilirubin in the blood is exceeded slightly;
- yellowing of the skin is noted on the face and body above the navel.
Despite everything, the condition of the child remains absolutely normal, physical activity remains. The level of bilirubin should be continuously monitored by a pediatrician so that physiological jaundice does not develop into pathological. Normally, at the age of one week, a decrease in the amount of the substance should begin. At about 3 weeks in children who were born on time, and by the month in premature infants, bilirubin in the body normalizes.
Pathological jaundice
Very quickly, physiological jaundice can turn into pathological. Severe forms are accompanied by a significant increase in the level of bilirubin: almost 90 μmol / l every 24 hours. In addition, newborns may initially have a very high value: more than 250 μmol / l.
That is, in a similar situation, the amount of substance in the blood is much higher than the norm of bilirubin in newborns. A monthly table helps to compare these indicators and identify the problem in time. But there are other signs of pathological jaundice:
- yellowing of the body surface below the navel;
- orange color of the palms, as well as feet;
- dark urine and too light feces.
The disease is usually protracted and occurs in waves. In addition, the general condition of the child may be impaired: depression is observed, as well as excessive excitement.
Types and causes of pathological jaundice
There is a wide variety of types of pathological jaundice. They stand out depending on the causes of the appearance.
1. Hemolytic manifests itself in a conflict of the Rh factor in the baby and mother, as well as genetic diseases.
2. Parenchymal jaundice occurs when the liver is damaged by congenital forms of hepatitis, cytomegaloviruses, toxins.
3. The conjugation type is manifested in case of impaired functioning of the enzyme system, as well as bilirubin binding.
4. Mechanical jaundice occurs when the outflow of bile is disturbed with anomalies of the gallbladder, as well as the hepatic ducts.
Determination of bilirubin level
To assess the level of staining substance in the blood, a special analysis is used. The sample is usually taken on an empty stomach. But for children, such a requirement is rarely presented, in extreme cases, it is recommended not to feed the baby 4 hours before blood sampling. In newborns, samples are taken from the heel in a special small vacuum tube.
For the purpose of a complete analysis of the situation, the content of all bilirubin fractions in the blood is determined. This helps to establish not only the type of jaundice, but also the reasons for its transition to the pathological stage.
After receiving the results of the analysis, they are compared with the norm of bilirubin in newborns. The monthly table contains threshold values. If the amount of coloring matter significantly exceeds them, the situation without fail requires treatment.
Possible consequences
High concentration in the blood negatively affects the health of the baby. In particular, this refers to the situation when the norm of bilirubin in newborns is not restored (2 months). The table makes it clear that by this age the value should correspond to what happens in an adult healthy person.
First of all, high bilirubin is dangerous for the brain, as well as the nervous system of the child. The danger is that the coloring matter can accumulate here. Such a situation can lead to severe intoxication of the body and, as a result, the death of brain cells and nerve endings. Subsequently, this can lead to problems with hearing and vision, mental disorders, dementia and other problems.
All this leads to the fact that the pediatrician continuously monitors the possible presence of jaundice in the child. At the slightest suspicion, a blood test is done, on the basis of which it becomes clear whether the values of the pair "detected bilirubin is the norm in a newborn" match. The table at the same time helps doctors make the right conclusion.
It is important for parents to know that there are several symptoms, the manifestation of which in a child with jaundice should be an occasion for urgent medical attention. These include:
- lethargy and drowsiness;
- decreased sucking reflex;
- cramps, tics, restless behavior;
- an increase in the size of the spleen and liver;
- lowering blood pressure.
Ways to lower bilirubin levels
It is important to understand that physiological jaundice does not require treatment. It must go on its own. However, treatment cannot be dispensed with if the rate of bilirubin is significantly exceeded (normal in a newborn). The table allows not only specialists, but also parents to understand the need for medical intervention.
The fight against high bilirubin should begin with the help of light exposure. It is carried out in a special cuvette with the obligatory use of goggles. This method is recognized as the most harmless, but at the same time quite effective and fast. Side effects of this procedure can be diarrhea and peeling of the skin. In case of termination of treatment, the negative consequences from it very quickly disappear.
However, you should know that phototherapy is effective only with physiological jaundice. If, over time, the level of the substance is higher than the value in the line “The norm of bilirubin in newborns is 1 month” (the table is presented above), it will not be possible to do without drug treatment.
Many do not consider jaundice in newborns to be a serious enough problem. But it is worth knowing and understanding that this is far from true in all cases. Without proper attention and treatment, the problem can have serious consequences.