The norm of bilirubin in newborns

In the first days of a newborn's life, the icteric color of the skin and visible mucous membranes may appear-a physiological jaundice of the newborn appears. It is due to the fact that in the first days of life fetal hemoglobin of the blood dissolves, replacing the usual, and the product of the decomposition of hemoglobin is bilirubin. During the breakdown of hemoglobin, indirect bilirubin is formed, which binds to the protein in the liver and is converted to direct bilirubin. Indirect bilirubin is insoluble, it is not secreted with urine, direct soluble, it is excreted with bile.

The norm of bilirubin in the blood of a newborn

The norm of direct bilirubin contains no more than 25% of total bilirubin. In the decay of fetal hemoglobin, the level of direct bilirubin increases, which does not have time to bind with albumin. Its maximum level is on day 3 of life, after which it decreases for 1-2 weeks. During this period, physiological jaundice appears and disappears, which, unlike the pathological one, passes without a trace and does not require treatment.

1. When the baby is born in the umbilical cord blood, the level of bilirubin in newborns is normal up to 51 μmol / l.
2. On the first day of life, the increase in the level of bilirubin should not be higher than 5.1 μmol / l per hour. At the same time, maximum increase in the level of bilirubin in the full-grown children is up to 256 μmol / L up to 3-4 days of life, in preterm infants - not more than 171 μmol / l.
3. The average level of bilirubin in the first days of life usually does not exceed 103-137 μmol / l, and the increase is due to indirect bilirubin.

When physiological jaundice does not change the general condition of the baby, the color of urine and feces, as well as the size of the liver and spleen, the skin has an orange tint, and jaundice disappears without treatment at the 2-3 week of life. Degrees of physiological jaundice:

• 1 degree (icteric color of the face and neck only);
• 2 degree (icteric color of the upper half of the body to the navel);
• 3 degree (icteric complexion of the face, trunk and upper parts of the arms and legs);
• 4 degree (complete body coloring in icteric color, including feet and brushes).

The causes of increased bilirubin in newborns

In addition to physiological jaundice, there is also pathological jaundice in newborns, in which there will also be a high bilirubin and yellow color of the skin and mucous membranes. Types of pathological jaundice:

1. Hemolytic. Because of the collapse of red blood cells in the conflict over the blood group or the Rh factor between mother and child, genetic diseases - microspherocytosis, sickle cell anemia.
2. Parenchymal - due to liver damage with congenital hepatitis, cytomegalovirus, toxins.
3. Conjugation - in the case of abnormalities in the enzyme system and the binding of direct bilirubin.
4. Mechanical - in cases of violations of the outflow of bile due to obturation of the gallbladder or liver ducts with their congenital anomalies, for example, atresia.

At high concentrations of bilirubin in the blood (more than 324 μmol / l), it penetrates the blood-brain barrier and acts like a toxin on the brain of a newborn (nuclear jaundice). This causes toxic encephalopathy with a decrease in all reflexes, apathy, convulsions and even the death of a child. Complications of nuclear jaundice can become paralysis and paresis, mental retardation and deafness.

Treatment of an increased level of bilirubin in newborns

Physiological jaundice does not usually require treatment, with pronounced coloring of the skin can use phototherapy, in which sunlight speeds up the binding of bilirubin. With pathological jaundice, in addition to phototherapy, the doctor usually prescribes detoxification therapy and even exchange blood transfusion.