Increased bilirubin in newborns: causes

Bilirubin is an intermediate product of certain reactions in the human body. It appears after the breakdown of hemoglobin in two parts: globin and gemma. The process occurs when red blood cells age.

Gemma particles are toxic, so the body wants to get rid of them. Thus, the particles are converted to bilirubin in order to be subsequently brought out.

A certain amount of bilirubin is normally found in the body of an adult, but in a newborn the level is significantly higher.

Elevated bilirubin levels may be:

  1. a symptom of jaundice
  2. a consequence of blockage of the bile ducts (for example, with a tumor),
  3. a consequence of a low-calorie diet.

Indirect, direct and total bilirubin

To determine the level of bilirubin in the blood, it is important to consider 3 indicators:

It is important to know the percentage of all three indicators.

Free or direct bilirubin is insoluble and is not excreted from the body. Indirect bilirubin is processed by liver enzymes; it leaves the body through feces and urine.

Most bilirubin is an indirect substance - 75% of the total. Direct in the body is 25%. But in newborns during the first month of life, these ratios may be different.

Translation into direct soluble bilirubin can occur in the liver under the influence of certain enzymes. The supply of "bad" bilirubin to the liver is performed by special proteins called serum albumin.

These proteins are quantitatively lacking in the body of a newborn. After the child’s enzymatic system ripens, the “bad” bilirubin is processed and excreted.

Thus, the rate of bilirubin in a newly born child is naturally overestimated, and remains at this level for about 2 to 4 weeks.

The problem is that not every jaundice in children is physiological. The process can transform into a pathological one very quickly if the level of bilirubin is above the acceptable threshold, or if there is a constant increase.

Pathological jaundice of children has such features:

  1. longer physiological
  2. requires urgent treatment
  3. Needs constant monitoring of bilirubin (every day).

Norms of bilirubin in newborns

So, as it became known, bilirubin in children is always high. In adults and children, it is normal in the range of 8.5 - 20.5 μmol / L. However, in a child who has just been born, the concentration of the substance can be even more than 205 μmol / L.

The level of bilirubin in the blood of a child who was recently born changes almost every day, gradually decreasing. The norm for a weekly baby is considered an indicator of 205 μmol / L, however, in premature infants this indicator is lower - 170 μmol / L).

In newborns, bilirubin rises 2-4 days after birth. In the absence of negative factors, within a month the level of the substance returns to normal. At the end of the first month of life, the level reaches the “adult” indicator.

There are cases that the concentration of a substance in the blood continues to increase. A high level poses a serious threat to the health of the child. If the indicators have become higher than 256 μmol / L (and in a premature baby - 172 μmol / L), then it is urgently necessary to hospitalize the child in order to lower the level of the substance under medical conditions.

Causes of increased bilirubin in a newborn

The obvious question arises: why do some children have physiological jaundice easily and without consequences, while other children suffer from a pathological type of jaundice, which requires surgical intervention?

In severe form, pathological jaundice occurs against the background of rapid growth of bilirubin (more than 85 μmol / l per day). In addition, pathological jaundice is different:

  1. The spread of yellowness below the navel of the child, as well as on the feet and palms,
  2. Oppression or extreme excitability of the child,
  3. Staining white, dark urine.

Factors developing childhood bilirubinemia may include:

  • severe pregnancy and complications,
  • maternal diseases, for example, diabetes,
  • the use of certain drugs while carrying a child,
  • prematurity of the child,
  • intrauterine hypoxia (lack of oxygen),
  • choking of the fetus (asphyxia).

In addition, the consequences of pathological jaundice in a child can be as follows:

  • liver infection
  • incompatibility by blood of mother and child,
  • obstructive jaundice
  • bowel obstruction,
  • various hormonal disorders
  • Gilbert's syndrome and other disorders in the work of the liver of the child,
  • erythrocyte deformation for genetic reasons.

A critical condition can be prevented if you notice the yellowing of the child in time.

The effects of high bilirubin in newborns

In general, a large amount of bilirubin negatively affects the health of the child. Abnormal concentration primarily affects the nervous system and brain.

The danger is that the substance accumulates and provokes serious intoxication, as a result of which nerve endings, brain cells die and other serious consequences can occur.

This may result in the following violations in the future:

  • mental disorders
  • hearing loss
  • mental underdevelopment
  • loss of vision
  • other deviations.

Therefore, the level of bilirubin in a child should be controlled by a doctor. If, during the examination, the pediatrician suspects the development of jaundice in a child, then he will immediately send him to study bilirubin and its fraction.

Urgent medical attention is required if a child with jaundice develops the following symptoms:

  1. drowsiness, apparent lethargy,
  2. decreased sucking reflex,
  3. tics, anxiety, convulsions,
  4. an increase in the size of the spleen and liver,
  5. lowering blood pressure.

Decreased bilirubin in the blood of a newborn

Treatment requires only pathological jaundice. The physiological variety of jaundice passes independently and is not dangerous to humans.

The most effective way to treat bilirubinemia is with light rays. But the method is being used less and less, and children are being treated with toxic drugs. Therefore, if the child is not prescribed light therapy, it may make sense to find out why.

It is important to be prepared for the fact that radiation will cause the child to lose hair or peel off the skin. No need to be scared, after the end of the treatment course, all unpleasant phenomena will pass on their own. It is necessary to more often apply the baby to the chest and treat his skin with moisturizers.

Phototherapy or quartzing gives the result only in the first days after the birth of the baby. If the jaundice is in a neglected form, then medication cannot be dispensed with.

It is imperative to always carefully study all the instructions for medications prescribed by your doctor. Many of them are not so harmless, and have serious side effects and contraindications. It is worth finding a doctor for your child, whom you can trust in these important issues.

In the treatment of bilirubinemia, breastfeeding, especially with colostrum, is of great help. It is necessary to breastfeed the baby, this contributes to the rapid elimination of toxins from his body, and protects against potential diseases.

Mothers recommend doctors to drink a lot of fluids, in particular a decoction of rose hips. The child needs to have long sunbathing. The pediatrician may prescribe additionally:

Instead of a conclusion

In any case, if your newborn baby has a physiological or pathological jaundice, there is no reason to panic. With the proposed hospitalization, it is better to agree and go with the child to the department, where he will be provided with timely and qualified medical care. Another plus of hospitalization after the maternity hospital is that the mother and the baby will undergo all the necessary examinations, as they say, without leaving the ward.

What is bilirubin?

Bilirubin - This is a pigment whose high concentration in the body can become a poison for the nervous system. This substance is the result of the breakdown of red blood cells.

Hemoglobin is released from red blood cells that have become obsolete, which immediately becomes toxic. Immunity begins to "attack the enemy" and destroys hemoglobin, releasing gems - compounds containing iron. Under the influence of enzymes, gems are transformed into bilirubin.

Need to distinguish straight and indirect bilirubin. Direct is excreted in the feces and urine, and indirectly first forms a compound with albumin and is transported to the liver, where it is fermented and becomes direct bilirubin, which easily leaves the body.

Bilirubin in the blood of a newborn is always elevated. The fact is that red blood cells saturated with fetal hemoglobin carry oxygen in the body of an unborn baby. After childbirth, it loses its functions and is destroyed, leaving behind a decay product - bilirubin.

A blood test is taken several times in the maternity hospital to determine the level of this pigment. Increased bilirubin in newborns indicates the occurrence of jaundice, and thus doctors control its course.

Jaundice with high bilirubin is dangerous both on its own and may indicate the development of any pathological condition in the crumbs.

What tests need to be passed?

  • Right after the baby’s first cry, doctors measure the level of pigment in cord blood. After two days, the full-term baby is tested again.
  • Premature babies check the amount of pigment in the blood a day after birth, and monitor it every 24 hours.
  • Children from the risk group (complex pregnancy, complex birth, pronounced yellowness of the sclera and skin) take blood from a wreath on the head.

This procedure is painless and safe for the child, although it is very scary for mothers. The fence is carried out with a special thin needle by the hands of an experienced nurse, this analysis helps to diagnose the development of dangerous complications in time, so you should not refuse it in the hospital.

  • Children who do not have vivid signs of jaundice are given a bloodless test - a bile test.

The analysis device is a photocell that captures the color of the skin on the forehead of the child and thus determines the amount of yellow pigment. The result can be seen instantly. The disadvantage of this test is that it does not show direct and indirect bilirubin, and these numbers are very important for diagnosis.

With jaundice, babies are given control tests throughout the entire treatment period, until the pigment level drops to normal.

Once again, an analysis of bilirubin in newborns is done already in the clinic, when undergoing medical examination at a month of age. Blood is taken from the wreaths on the head or on the handle, in different medical institutions in different ways.

Norms of bilirubin in children

Since the process of blood renewal is ongoing, a safe amount of pigment is always present in the body. The norm of bilirubin in a month-old baby falls in the range from 8.5 to 20.5 μmol / liter. But in the newly born baby and in the next few weeks, these figures are much higher. This situation is due to the decay of a large amount of fetal hemoglobin.

  1. Normal is the content of pigment in the blood from the umbilical cord:
  • 51-60 μmol / liter in children born on time,
  • 71.8–106 µmol / liter in premature infants.

This is the level of total bilirubin, which is the sum of the amount of bilirubin indirect and direct. In this case, indirect bilirubin should not be more than a quarter of the total level, and direct, respectively, should be less than 75%.

  1. 24 hours after birth, the normal level of pigment in babies born on time does not exceed 85 μmol / L.
  2. After 36 hours from birth, this figure rises to 150 μmol / L.
  3. After 48 hours, up to 180 μmol / L.
  4. 3-5 days after birth, bilirubin can reach its maximum: 256 μmol / L. If this boundary is exceeded, then doctors talk about the development of jaundice in a child.

Then the bilirubin level decreases.

  1. On the 6-7th day of a child’s life, it amounts to 145 μmol / l.
  2. On day 8–9, up to 110 μmol / L.
  3. On day 10–11, up to 80 μmol / L,
  4. On day 12–13, up to 45 μmol / L, etc.
  5. By the fourth week of life, crumbs of bilirubin reaches its normal value - up to 20.5 μmol / L.

Bilirubin norms table (indirect and direct)

12-24 hoursup to 85 36 hoursup to 150 48 hoursup to 180 3-5 daysup to 225 6-7 daysup to 145 8–9 daysup to 110 10-11 daysup to 80 12–13 daysup to 45 14 days

up to 20.5

The daily rate of bilirubin in a newborn is different in full-term and premature babies. 24 hours after birth, the average level of bilirubin in the “early” baby is 97.4–148.8 μmol / L. The indicator reaches its maximum value on the 5-6th day after birth. At a pigment level above 172 μmol / L, a baby is diagnosed with jaundice.

Why does the child have high bilirubin and what is the danger of this condition

When bilirubin is above the normal level (256 μmol / L in children born on time and 172 μmol / L in "hurried" babies), doctors talk about the development of jaundice. It is of two types. Physiological jaundice most often ends by the 4th week of a child’s life and does not have any consequences for his body.

However, children with this diagnosis need constant monitoring, since the disease can also flow into a more severe form. Pathological jaundice requires treatment, and in its absence brings significant harm to the health of the child.

If bilirubin is elevated in the blood of a newborn, the reasons may be as follows:

  • severe pregnancy
  • diabetes in the mother,
  • complicated birth
  • preterm pregnancy
  • lack of oxygen in the child during pregnancy or childbirth - for example, with the entanglement of the umbilical cord.

With pathological jaundice, bilirubin in the blood of children goes off scale. The reasons for this increase may be the same problems that lead to physiological jaundice. Also, an extremely high level of pigment may indicate:

  1. problems with the baby’s liver
  2. hormonal disorders
  3. rhesus conflict between mother and child,
  4. bowel obstruction,
  5. a genetic disease leading to the destruction of red blood cells,
  6. obstruction of the biliary tract.

Also, pathological jaundice can provoke drugs that the mother received during pregnancy and childbirth.

If a child finds this condition, the doctors treat not only the symptoms themselves, but also eliminate the cause of the disease.

Conditions that can cause pathological jaundice are in themselves very dangerous and sometimes fatal. But high bilirubin in newborns cannot be ignored. This pigment is poison for the baby’s nervous system. With its high level in the blood, bilirubin encephalopathy develops. Signs of this condition are:

  • enlarged liver and spleen,
  • pressure reduction
  • convulsive syndrome
  • the baby sleeps a lot or, conversely, is constantly in motion,
  • the child practically does not take the bottle and chest.

Untimely receipt of treatment (or a complete lack of help) with bilirubin encephalopathy can have the following consequences:

  1. hearing loss
  2. developmental delay,
  3. motor paralysis.

Sometimes bilirubin in crumbs rises due to mother's milk: the so-called "jaundice of breastfeeding" develops. Fatty acids are present in the milk that prevent the liver from converting indirect bilirubin into direct, and the toxin accumulates in the body. In this case, the children are transferred for two days to a mixture of food.

If bilirubin is reduced, then the child is left to breast-feed. Or it is possible to feed the baby with breast milk. To do this, express it in a bottle and warm to a temperature of 70 °, then cool and give to the child. More on how to express breast milk correctly >>>

When heated, fatty acids are destroyed, and milk does not harm the baby.

Medical help for elevated bilirubin

How to reduce bilirubin in a newborn? If physiological jaundice is diagnosed, no special measures are needed other than observation. Usually the disease recedes after a few weeks.

Sun baths will help to reduce bilirubin in a newborn faster. If you have a “spring” or “summer” child, then during walks you can push the hood of the stroller out, exposing the sun to the face and arms of the baby. Winter and autumn suns are harder to catch. But if it turned out to be a clear day, go out with the crumbs to the balcony, let the rays shine on the face of the baby.

The baby should not be in the sun for longer than 10 minutes. In this case, it is necessary to ensure that the sun does not fall into open eyes. In late spring and summer, do not keep your child in direct sunlight from 11 a.m. to 5 p.m.

Phototherapy is the most effective way to treat pathological jaundice. It can be carried out in the hospital if it has the necessary equipment. Otherwise, the mother and baby are transferred to the children's hospital. The baby is placed under a special blue lamp.

With the help of light, bilirubin passes into lumirubin, which quickly leaves the body. You need to lie under the lamp for a total of 96 hours, with breaks for feeding.

On the eyes of the kids they put on a special bandage or pull on a hat, as the light of the lamps is harmful to eyesight. The procedure is painless and effective, but it can also have unpleasant side effects: drying and peeling of the skin, liquefied stool, which will disappear after completion of therapy.

In especially severe cases, children are given droppers and even receive a blood transfusion. An excellent prophylaxis of jaundice is the feeding of mother's milk. It is very important to put the baby to the chest as quickly as possible. How to do this, read the article: Breastfeeding: WHO recommendations.

On-demand feeding also helps reduce the amount of harmful pigment. Colostrum provokes the elimination of meconium from the body of the newborn, with which a large amount of bilirubin comes out. More on demand feeding >>>

One of the bad tips that mommy can hear is to drink the baby with jaundice. Neither sweet water, nor a rosehip decoction will lower the level of bilirubin. Better often put crumbs on the chest and follow the recommendations of your doctor.

What does it mean?

Bilirubin is a bile pigment that is a product of the breakdown of red blood cells. Its increased concentrations badly affect the nervous system of the crumbs and can cause the development of bilirubin encephalopathy in the newborn.

Increased bilirubin in newborns occurs as a result of the destruction of obsolete red blood cells, which, after their breakdown, release hemoglobin into the serum.

The protein compound of iron under the influence of enzymatic complexes turns into bilirubin, which in large quantities becomes a real poison for the nerve structures of a small organism.

In newborn babies, bilirubin in the blood is always in an elevated state. Why it happens? The fact is that before the birth, red blood cells with fetal hemoglobin circulate in the fetal blood. After the baby is born, this compound loses its functionality and is subject to decomposition, as a result of which a lot of bilirubin is formed in the blood.

It should also distinguish between direct and indirect bilirubin. An indirect fraction of a substance that circulates in the blood and poisons the nervous system is dangerous to the baby’s health. Immediately after birth, doctors determine bilirubin in all full-term babies by taking an analysis from the umbilical vein. Preterm infants are tested one day after birth.

For children in the first days of life, the following indicators are considered normal:

  • in full-term newborns - 51-60 μmol / l,
  • in premature babies - 71.8-106 micromol / l.

These indicators relate to the total amount of bilirubin. In healthy infants, indirect bilirubin should not exceed ¼ of the total amount of this compound in the blood.

During the first five days from birth, bilirubin in the blood of a newborn continues to grow. But doctors talk about pathology only if on the fifth day it rises to 256 μmol / L or more.

Over the next ten days, bilirubin normally decreases and on the 14th day of life is usually not more than 45 μmol / L, and after 28 days it completely returns to normal and does not exceed 20.5 μmol / L.

Possible reasons for the increase

If bilirubin is sharply increased on 3-4 days, then doctors talk about the development of jaundice in a newborn, this pathological condition can be of two types:

  • physiological jaundice, which independently passes by the 4th week of the baby’s life and does not pose a threat to his health,
  • pathological jaundice, which without treatment can cause serious harm to the child’s body.

Among the main causes of increased bilirubin in infants are:

  • mismatch of blood type in the child and mother,
  • premature birth of a baby,
  • complicated birth and severe pregnancy,
  • diabetes in a pregnant woman,
  • hereditary predisposition to hyperbilirubinemia in the first days of life,
  • infectious processes on the part of the mother and fetus,
  • liver diseases and problems with normal outflow of bile,
  • the presence of hemorrhages in the body of the child,
  • diseases of the endocrine organs,
  • child hypoxia during fetal development and directly during childbirth.

In addition, pathological jaundice often occurs as a result of taking drugs to stimulate childbirth.

What happens in the baby’s body

The fact that a few days after being outside the womb of the mother, bilirubin in newborns begins to increase is explained by the physiological peculiarity of the rebuilding of the body. The following processes are characteristic of this period:

  • as a large amount of hemoglobin is unnecessary, it begins the decay process,
  • deforming, red bodies release bilirubin - a special pigment that participated in the formation of an iron-containing protein - hemoglobin and in an abnormally large volume is thrown into the blood,
  • the accumulation of bile pigment in the bloodstream increases,
  • the dermis and sclera are painted in the tone of the pigment - yellow mustard.

At the beginning of life outside the womb, the baby’s liver is simply not able to cope with a high bilirubin level, since its functionality is not yet fully operational. This condition is considered transient (transient, temporary), and corresponds to the norms of the physiological development of the child. Such jaundice is called physiological and does not require special treatment.

Like jaundice of breastfeeding. After childbirth, the concentration in the milk of hormones that lower the activity of liver enzymes is high, and with natural feeding they penetrate the baby's body, causing jaundice. With an increase in the amount of milk in the chest, everything returns to normal, and the baby recovers.

Important! Do not rush to interrupt breastfeeding, which for a child can subsequently become a panacea. However, in order to dispel doubts and make sure that the liver pathology did not become the cause of yellowing of the skin, you can transfer the baby to artificial feeding for several days. If during this time the color of the skin normalizes, it is recommended to resume breastfeeding without delay.

Jaundice in a newborn

With an increase in bilirubin, the skin and sclera of the eyes turn yellow in the newborn. In this case, pediatricians diagnose jaundice. It can be of two forms:

Physiological, which is inherent in many children after birth. Its main reasons are described above. She is not dangerous. The course of a woman’s pregnancy, the presence of some infectious diseases, TORCH infections, and diabetes mellitus can also provoke this phenomenon.

Pathological, in which there is high bilirubin in the newborn, the causes and consequences of this syndrome can be serious, they are associated with the development of some pathologies.

The following conditions and pathologies usually lead to pathological jaundice:

  • The infection in the liver, its inflammation,
  • Bowel obstruction,
  • Red blood cell inherited disease
  • Incompatibility of blood groups in a child and mother,
  • Mechanical damage to the bile ducts,
  • Hormonal disorder,
  • Liver function disorder,
  • Gilbert's syndrome.

Provocative factors

In fact, there are many reasons why a child has elevated bilirubin. They also include:

  1. Congenital malformations
  2. The liver is not fully developed
  3. The rapid death of red blood cells,
  4. Violation of the outflow of bile,
  5. Prematurity
  6. Fetal hypoxia,
  7. The use of drugs
  8. Aries syndrome
  9. Premature birth
  10. Hemorrhages in the body of a small person,
  11. Infection of the body,
  12. Digestion pathology,
  13. Endocrine disorder,
  14. The use of drugs to stimulate labor.

What is dangerous for a newborn?

The consequences of high bilirubin in newborns arise only in case of untimely diagnosis of a pathological condition or the refusal of parents to treat it.

At elevated concentrations of bilirubin, encephalopathy occurs, which is clinically manifested by a number of symptoms:

  • a sharp increase in the spleen and liver in the child,
  • the appearance of convulsive readiness and spasms directly,
  • anxiety of the baby or, conversely, pathological drowsiness, when the baby is constantly sleeping,
  • lowering blood pressure,
  • the refusal of the baby from the bottle or chest, sluggish sucking.

Bilirubin encephalopathy is dangerous for the development of persistent disorders in the health of infants, among which:

  • nuclear jaundice, which is manifested by serious and irreversible changes in the central nervous system,
  • hearing loss or complete loss of analyzer function,
  • partial or complete paralysis,
  • convulsive syndrome
  • child lag in mental and physical development.

Symptoms of bilirubin encephalopathy cannot be ignored. This pathological condition needs immediate and qualified treatment.

Parenchymal and obstructive jaundice

Such a pathology appears due to the ingestion of toxins or infection in the liver, so hepatocytes cannot bilirubin. Typically, this phenomenon is observed when the expectant mother has TORCH infections, for example, cytomegalovirus, toxoplasma, etc.

In this case, jaundice will be accompanied by the following symptoms:

  • Swollen lymph nodes
  • Discoloration of urine and feces,
  • Anemia,
  • An increase in the size of the spleen, liver.

To identify the pathogen, the PCR method is used.

Obstructive jaundice occurs if a child has high bilirubin for 1-2 months, this is due to a disorder of the outflow of bile, obstruction of the ducts.

The causes of this pathology can be:

  1. Hepatic hypoplasia,
  2. Cholelithiasis,
  3. Neoplasm,
  4. Thickening of bile
  5. Atresia or aplasia.

The skin will acquire a greenish tint. Diagnosis is carried out using a biopsy, radiography. The surgical method of therapy is used.

What to do if the baby has bilirubin in the blood?

When diagnosing physiological jaundice in a newborn, doctors prescribe him an observation without special therapeutic measures.

To speed up the process of removing bilirubin from the body, these babies are credited with sunbathing. Well, if the baby was born in the spring and summer, then he can simply be put in a stroller in the sun.

To eliminate jaundice, 10 minutes a day walking with the baby in the sun is enough, during which you need to make sure that the sun's rays always fall on the face and arms of the crumbs. It is important to make sure that the sun does not fall into the newborn’s eyes.

In winter and autumn, it is enough on a sunny day to go out with the child to the balcony, let the rays shine on his face. The most effective way to treat pathological jaundice is phototherapy, which is carried out by a newborn in a hospital.

Treatment can be offered by doctors within the walls of the maternity hospital if the facility has the appropriate apparatus.

In the absence of equipment for phototherapy, the mother and the child are transferred to the children's hospital to obtain the necessary complex of therapeutic measures. In the hospital, the baby is placed under a special blue lamp.

Under such conditions, the newborn should stay up to four days with interruptions in feeding. Under the influence of blue rays, indirect bilirubin in the blood serum is transformed into lumirubin, which is able to leave the body of the crumbs very quickly without causing any harm to it.

During the treatment procedure, the eyes of the sick newborn should be covered with a special dressing, as the light of the lamp is very dangerous for eyesight. The procedure for such a treatment is completely painless.

Negative reactions of therapy do not carry a threat to the normal functioning of the infant and pass independently after discontinuation of treatment.

In severe cases of pathological jaundice, pediatricians may recommend droppers or transfusion of donated blood.

What is the norm of bilirubin in a newborn

Bilirubin in the blood is represented by two fractions:

  • Indirect (free), which is formed as a result of the fact that the decay rate of red blood cells is higher than the ability of the liver to bilirubin. Free bilirubin is a substance that typically dissolves only in lipids (fats). Due to the inability to dissolve in water, the pigment is very toxic, accumulates in the bloodstream, causing a characteristic staining, and can interfere with the normal functioning of cells, freely penetrating into them.
  • Direct (bound) bilirubin is formed directly in the liver. After biochemical interaction with organic acids, uronic groups and liver enzymes that reduce the pigment's toxicity, it becomes soluble in water and is easily excreted from the body along with bile and urine.

The indicators of the two fractions add up to the total concentration of bilirubin in the blood, while the direct concentration is no more than 25% of the total volume.

In order for free bilirubin to become bound and soluble, some proteins that the newborns lack are necessary to transfer it to the liver. As a result, the rate of bilirubin in the blood rises, physiological jaundice occurs.

The table shows the rates of bilirubin in infants (table of bilirubin in newborns by day)

Jaundice develops in newborns if bilirubin is higher than 50 μmol / L and is expressed, in addition to the concentration of pigment in the blood, by changes in the skin condition of infants: initial color, tone of capillaries, and the vastness of the pigment distribution zone.

To assess the intensity of changes in indicators, the Cramer scale is used, according to which you can assess the severity of the child's condition:

  • The head area (eye sclera, face, sky, tongue from below) turns yellow - 100 μmol / l.
  • Yellowness falls to the upper body area above the navel - 150 μmol / l.
  • The area below the navel is added, including the buttocks and hips - 200 μmol / L.
  • The upper and lower extremities are painted in a pigment - 250 μmol / l.
  • The skin changes color throughout the body, including the fingers and toes, palms and feet - over 250mkmol / l.

The higher the indicator, the more serious is the reason to assume that the child has jaundice of various types and severity and such complications as gallbladder dyskinesia.

For full-term infants, the concentration of bilirubin in the bloodstream is above normal and to the limit of 250 μmol / L, for premature babies - 200. Infants who were born prematurely have more risks of being in the group diagnosed with jaundice underdevelopment of body systems and increased sensitivity to adverse conditions.

Indirect bilirubin toxins can cause damage to the deep structures of the anterior part of the brain, which are responsible for motor activity and coordination, and cause bilirubin encephalopathy (nuclear jaundice). This condition provokes:

  • increased drowsiness or extreme agitation,
  • decreased sucking reflex,
  • increased muscle tone in the neck.

Important! Parents should know that off-scale indicators negatively affect the functioning of the brain and biliary organs. If the skin of the newborn has sharply turned yellow-brown, you need to seek medical help immediately. Only a decrease in bilirubin levels will help to avoid toxic poisoning with bile pigment.

In the absence of pathology within 2-3 weeks from the moment of birth, the level of direct bilirubin gradually decreases and returns to normal, it is during this period that the physiological jaundice of the baby disappears completely and never returns.

Complications and consequences

Increased bilirubin in newborns acts as a poison. Since typical blood albumin does not have the ability to completely neutralize it, it begins to penetrate the central nervous system, including the brain. When it enters the brain, encephalopathy develops.

The child will show the following symptoms:

  • Impaired sucking reflex,
  • Lowering blood pressure
  • Seizure development
  • Long cry
  • An increase in the size of the spleen and liver.

If therapy is started untimely or completely absent, after six months the baby’s hearing will decrease, mental development will slow down, and paralysis may occur. Therefore, it is necessary to undergo an examination with him to establish the causes of this phenomenon and undergo appropriate therapy.

But there may be diarrhea after such treatment, as well as husking of the skin.

Related videos

On the treatment and consequences of increased bilirubin in the blood of a newborn in a video clip:

WHO experts for the prevention of jaundice recommend early application of the baby to the mother’s breast and feeding her mother's milk. Applying a newborn to the breast on demand and the use of colostrum, which helps to quickly remove meconium, and with it bilirubin from the baby's body, also contribute to reducing harmful pigment.

Causes and consequences of high bilirubin in newborns

More than half of full-term babies and ¾ premature infants suffer from jaundice in the first days. The risk group also includes:

  • twins
  • children whose mothers have diabetes.

In order to timely recognize the pathology in the newborn, blood is immediately taken from the umbilical cord for analysis at the time of birth and again, on the third day of life. This allows doctors to keep the situation under control and, if necessary, take emergency measures to preserve the health and life of the baby.

If, even after 2-3 weeks, signs of jaundice continue to manifest actively, doctors may suspect pathological jaundice, as a result of an increased concentration of bilirubin in the blood. The causes of this condition can be:

  • Hemolytic disease of the newborn. This serious illness occurs against the background of Rhesus - conflict between mother and child. Manifested by congenital internal edema of the subcutaneous tissue, enlarged spleen and liver, damage to the central nervous system.
  • Genetic failure. In this case, one of the conditions can be observed in a newborn: a defect in the formation of liver enzymes (Gilbert’s syndrome), decreased enzyme activity (Krigler-Najar syndrome) and a deficiency of necessary enzymes (Lucey-Driscola syndrome). With timely treatment, full compensation is possible, provided that there is no severe damage to the brain nuclei.
  • Damage to the liver by dangerous infections while the baby is in the womb. Toxic agents and viruses reduce the ability to bilirubin and provoke parenchymal jaundice. This condition is characterized by prolonged jaundice, an increase in lymph nodes, darkening of urine and lightening of feces, a change in the biochemical analysis of blood.
  • Blockage (obstruction) of the bile duct, which happens due to intrauterine gallstone disease, the presence in the body of a tumor that compresses the bile ducts, bile condensation syndrome. This type of jaundice is called obstructive. The problem is solved by surgery.

Watching the baby and knowing the signs of jaundice, mothers will be able to recognize a pathological or safe course of the disease and seek medical help in time. Only in this case it will be possible to avoid such serious complications as:

  • acute intoxication of the body,
  • albuminemia, when albumin levels decrease and do not allow plasma to fully transport vitamins and nutrients,
  • deafness, mental retardation, convulsions due to the penetration of bilirubin into the brain,
  • uncontrolled involuntary motor reflexes,
  • leg cramps.

Very rarely, but still there are cases when the most undesirable and very dangerous complication arises - nuclear jaundice, which symptomatically passes from one phase to another:

  • Braking. The baby becomes lethargic, practically unable to suckle, all of his reflexes are depressed.
  • Irritation. The child is in hypertonicity, wringing his back, twisting, screaming heart-rendingly.
  • Imaginary recovery. At first glance, the stage is favorable, when it seems to everyone that everything is behind and the disease has completely passed the child. However, this is only a temporary lull during which you need to pay special attention to the child, try not to miss a single symptom.
  • Complication. Bilirubin attacks the brain, affecting the nucleus, affecting the nervous system, causing serious disorders in the body, can result in cerebral palsy.

For the diagnosis of complicated jaundice, biochemical, radiological methods are used, as well as a biopsy.

Important! From a timely diagnosis and correctly selected medical tactics depends on how severe the consequences of jaundice will be for health.

How to reduce bilirubin in a newborn

Since jaundice is not an independent disease, a decrease in bilirubin will be symptomatic, it is important to eliminate the underlying disease, then its content in the body normalizes. And for this, the doctor must make an accurate diagnosis, and only then eliminate the cause of increased bilirubin. This is the easiest and most effective way to reduce the concentration of pigment in the blood.

In addition to the main methods of therapy, the following measures are used:

  • Phytotherapy,
  • Blood transfusion,
  • Taking medications
  • The use of droppers.

Often, with an increase in bilirubin in the blood of a child, herbal medicine is used. In this case, the baby is put in a crib, an ultraviolet lamp is installed above it. In this case, it is necessary to cover the eyes of the child with a bandage so that the rays of light do not fall into them.

When using this method, the child's body can lose fluid. Therefore, infusion therapy is then carried out, the purpose of which is to normalize the water-salt balance. In this case, the child is injected with a dropper glucose solution, soda and membrane stabilizers, as well as drugs that can improve microcirculation. You can’t do this at home, only a doctor should do the treatment.

Further, the doctor prescribes the child an enterosorbent, for example, Smecta. This is necessary so that the pigment does not enter the bloodstream through the duodenum. If all these methods are ineffective, a blood transfusion is prescribed.

But sometimes breast milk can, on the contrary, provoke the appearance of jaundice. This phenomenon is not dangerous, it disappears on its own in three weeks. This type of jaundice is observed only in those who are breast-fed. This is due to the fact that in milk there is a special substance that provokes the blocking of enzymes to break down bilirubin.

The reasons for this phenomenon have not been studied at present, but it is quite common. In some cases, such a jaundice smoothly becomes physiological. To know such a pathology is very simple. It is enough on the third day of feeding to stop giving breasts for two days, replacing it with a mixture. If the skin begins to lighten, then this is not a cause for concern, such a syndrome will soon pass.

Treatment of increased bilirubin in the hospital and home remedies

Doctors at the hospital must take control of the bilirubin in the blood of newborns. In order to get a complete systemic picture of the pigment concentration, they prescribe biochemical blood tests throughout the entire stay of the baby in the hospital (2-3 times) and monitor the tendency to increase or decrease the level of bilirubin.

Moms can keep this topic under control and ask the doctor if such a test was taken from the child and what the results of the laboratory study are.

It is this approach that allows timely detection of jaundice and prescribe measures appropriate for the condition of the child to treat this ailment.

Important! If the child has mild symptoms of jaundice, is active and well sucks, no treatment is required! With continued breastfeeding, after a week, the skin, mucous membranes and sclera are fully normalized.

Experienced specialists, as a rule, accurately determine the severity of the disease and all kinds of risks, unlike the advice of friends and general information on the Internet

In this case, young mothers should be patient, and if the child needs to stay under the supervision of a doctor for some time, do not give up, do not take responsibility, and do not jeopardize the life and health of their child.

After carrying out all the necessary studies - visual and laboratory specialist makes an appointment and gives recommendations.


The causes of high bilirubin in a newborn are different. It is necessary to take care of the baby's health even before he is born. Therefore, the expectant mother is recommended to monitor what she eats, the diet should be balanced and contain only natural products rich in useful elements. A woman’s diet and regimen will affect the health of her child.

Doctors recommend avoiding stressful situations and emotional stresses, not using strong power loads, normalizing sleep and wakefulness, labor and rest. Sleep is an important component of good health not only for the mother, but also for her child, who has not even been born.

After the birth of the baby, it is important to feed him well and correctly. After all, bile pigment is excreted from the body with urine and feces. It is necessary to offer the breast to the baby often enough. If he uses artificial mixtures, you need to choose only high-quality products that must be adapted to the body of the child that was recently born.

Following such simple recommendations, a woman will not be wondering about how to reduce bilirubin in a child after his birth, since he will be born healthy.

In fact, there are many reasons for increasing bilirubin levels in children. But to independently reduce it is strictly prohibited, since there is a risk of developing dangerous consequences.

Photolamp Treatment

Phototherapy is considered the main and effective method of treating jaundice in newborns. The therapeutic result gives a feature of light waves of a certain length to act on bilirubin. The child is freed from clothes and a special lamp is sent to his body. Bilirubin molecules during the absorption of light radiation are converted into a soluble substance - lumirubin, which is harmless to the child's body, since it is completely non-toxic and easily excreted from the body with urine and bile.

For this procedure, in addition to lamps, special glasses, a blindfold, mattresses and blankets are provided. The manipulation is completely painless and comfortable, does not require emotional stress - for its implementation, the baby does not need to part with his mother. In addition, in maternity hospitals, the use of special lamps in joint wards is practiced, where the mother can independently monitor the condition of the child.

Long-term herbal medicine brings good results, and the baby can be exposed to light from several hours to several days during one session. In between procedures, it is necessary to take time to feed the child, care for him and rest.

Important! The more milk mom has, the lower the concentration of enzymes that prevent the liver from coping with high levels of bilirubin.

If the number of procedures during the stay in the hospital is not enough and the level of dangerous pigment in the blood rises, the baby is weaned from the mother and proceed to more intensive treatment.

Drug therapy

For a full and comprehensive treatment, doctors prescribe drugs that help babies overcome the complications of jaundice:

  • Elkar. The active substance of the drug is a special amino acid L-carnitine, which is responsible for the normalization of energy metabolism. Due to the stimulation of lipid metabolism, the content of bilirubin in tissues, bloodstream and organs can be minimized. This increases the functional ability of the liver - it neutralizes bilirubin, reduces its toxic effect, which gives hope for a favorable prognosis.

For infants, this medication is available in drops and solution for injection with a 20% content of the main substance. If intravenous and intramuscular injections are recommended to be carried out in a hospital, in order to make it easier to monitor the infant's reaction to the drug, then after discharge at home, the child can be given drops on his own. The main thing is to follow the doctor's recommendations and act strictly according to the instructions.

  • Ursofalk. The drug of a new generation, which is designed to eliminate the symptoms and signs of a diseased liver, has a wide spectrum of action, helping the liver to activate its functional capabilities. Due to this stimulation, the body begins to bilirubin more actively, neutralize it and remove it from the body. Doctors really appreciate the ability of this medicine to relieve toxic stress, reduce the likelihood of brain damage and prevent such a complication of the disease as nuclear jaundice.

The drug for newborns is available in the form of a suspension - a medicinal suspension, which tastes good and is easily dosed. A single dosage and course of treatment is calculated by the pediatrician after analyzing the condition of the child and comparing the risks of possible complications of jaundice and adverse reactions of the fragile body to a strong medication.In this regard, parents need to know that there are restrictions on taking the drug for those children who have serious pathologies of the biliary tract and kidneys.

  • Hofitol. A homeopathic remedy of plant origin with a pronounced choleretic effect. This drug protects and supports the liver, restores its cells, promotes the acquisition of a soluble form by hemoglobin, improves metabolism, and cures gall bladder diseases.

Despite the lack of synthetic components, the drug is given to newborns with great care because of the high probability of developing an allergic reaction, up to Quincke's edema. With the approval of the pediatrician, the drug, produced in the form of drops, must be diluted with boiled water to mitigate the unpleasant taste. As a rule, 3 days is enough for a course of liver support and restoration of the body.

  • Enterosgel. Represents a drug that does not affect the level of bilirubin in the bloodstream. Being a sorbent, it helps to cleanse the body of toxins, helping the liver and kidneys. Treating food poisoning with this drug will also be effective. At the same time, its constituent components do not negatively affect the intestinal microflora balance. It can be given from birth and are not afraid of allergic manifestations, it is not absorbed into the blood. The daily dosage is determined by the pediatrician, as well as the duration of the course. These indicators are individual and depend on the severity of the disease.

Drug therapy for newborns with jaundice may include: interferon, vitamins, glucose, hormonal drugs - a large arsenal of tools to restore a child’s health and create a favorable prognosis for recovery.

Home treatment

Once at home, young mothers can independently recover the child after jaundice by folk remedies, following the recommendations:

  • It is useful to give the baby an infusion of mint leaves, which is prepared as follows - a measured spoon of dry raw material is brewed with a glass of boiling water. After cooling completely, the infusion is ready for use. 1 teaspoon after a meal is enough for a baby.
  • Bathtubs with calendula flowers will help lower bilirubin levels. The newborn is placed in the bath, where water of a comfortable temperature, mixed with a glass of infusion, is poured. After a 5-10 minute procedure, the child needs to be wiped without washing the solution from the body.
  • Air baths. It is very beneficial for babies to stay in the fresh air, which enriches the blood with oxygen and strengthens the immune system. If there is an active sun at this time of the year, this is just luck, because the sun's rays accelerate the decay of bilirubin.
  • Emotionally positive attitude. The psychological balance of the mother is an essential factor for the speedy recovery of the child.

Thus, a person who has just been born has to overcome many tests related to adaptation to the outside world. The task of the mother and the pediatrician is to create all conditions so that the child with the least stress passes this period without complications and consequences.

Watch the video: What is Jaundice in Newborns? (February 2020).