Why do newborns turn yellow?
The fetus has more red blood cells than it needs after birth, and they contain special fetal hemoglobin. After childbirth, excess cells begin to break down and a lot of bilirubin is formed. At the same time, the newborn’s liver is not yet working at full capacity, and part of the bilirubin is absorbed back from the intestines. As a result, it temporarily accumulates in the blood and stains the skin.
- Increased breakdown of red blood cells in the first days of life
- Immaturity of liver enzyme systems that process bilirubin
- Enhanced reabsorption of bilirubin from the intestine, especially with infrequent stools
- In premature babies, all these mechanisms are more pronounced, so their jaundice is brighter and lasts longer
Physiological jaundice: what does the norm look like?
- Appears no earlier than 24–36 hours of life, usually on days 2–3
- Reaches a maximum at about 3–5 days
- Gradually fades and completely disappears by 2 weeks in full-term infants and by 3 weeks in premature infants
- The baby is active, sucks well, and wakes up during feedings.
- Weight gain is normal, urination is sufficient, stool is normal yellow-mustard color
- The coloring does not reach the palms and feet
- The abdomen is soft, the liver and spleen are not enlarged
When is jaundice dangerous?
Pathological jaundice differs from physiological jaundice in the time of appearance, rate of increase, duration and accompanying symptoms. There are many reasons for it, and each requires its own solution.
- Hemolytic disease of the newborn with incompatibility according to the Rh factor or blood group - jaundice appears on the first day and increases rapidly
- Hereditary characteristics of red blood cells and enzymes
- Cephalohematoma and extensive hemorrhages - absorbable blood provides additional bilirubin
- Infections, including intrauterine and sepsis
- Congenital hypothyroidism
- Biliary atresia and other bile outflow disorders - here direct bilirubin increases, stools become discolored, and urine darkens
- Hereditary metabolic diseases
Jaundice and breastfeeding
Here two different conditions are confused, and the confusion leads to unnecessary breastfeeding.
- Underfeeding jaundice appears in the first week: the baby receives little milk, has fewer bowel movements, and bilirubin is reabsorbed and accumulates. The solution is not to stop feeding, but to establish it: breastfeed more often, evaluate breast latch and weight gain
- Breast milk jaundice appears later, usually at 2–3 weeks, but can last up to 8–12 weeks. The child is active, gaining weight well, and has normal-colored stools.
- The sufficiency of feeding is assessed by objective signs: the number of urinations, the nature of the stool, weight dynamics
In most cases, it is not necessary to stop breastfeeding due to jaundice. On the contrary, frequent feedings - 8-12 times a day - accelerate the excretion of bilirubin because they stimulate stool. The decision to temporarily suspend is made by the doctor in rare situations and always while maintaining lactation.
Survey
- Чрескожная билирубинометрия — быстрое измерение прибором на коже, без укола; используется для скрининга.
- Биохимический анализ крови: общий билирубин и обязательно его фракции — прямой и непрямой. Именно повышение прямого билирубина указывает на проблемы с оттоком желчи.
- Группа крови и резус-фактор матери и ребёнка, проба Кумбса при подозрении на гемолитическую болезнь.
- Общий анализ крови с ретикулоцитами — оценка распада эритроцитов и анемии.
- УЗИ органов брюшной полости при затяжной желтухе и повышении прямого билирубина.
- Гормоны щитовидной железы, обследование на инфекции и другие анализы — по показаниям.
Treatment: what works and what doesn't
The main and most effective method is phototherapy. Under the influence of light of a certain wavelength, bilirubin in the skin is converted into a form that is excreted in urine and bile, bypassing processing in the liver.
- Phototherapy is carried out in a special installation; the baby is under a lamp with eye protection, while feeding continues
- Frequent feedings are the most important part of treatment: they ensure regular stool, which removes bilirubin
- Treatment of the main cause of pathological jaundice: infection, hypothyroidism, hemolytic disease
- Exchange blood transfusion is a rare measure in case of critically high bilirubin and the threat of brain damage
- Surgical treatment for biliary atresia - as early as possible
What should not be done: give the child additional water or glucose solution - bilirubin does not dissolve in water and is not excreted with it, and water displaces milk and increases jaundice; placing the child in direct sunlight or keeping it near a window is ineffective if bilirubin levels are high and is dangerous due to burns and hypothermia; give herbal decoctions and any medications without a doctor’s prescription. The danger of high bilirubin is that in free form it penetrates the brain and damages its structures - this condition is called bilirubin encephalopathy, and it is to prevent it that phototherapy is carried out without waiting for symptoms to appear.
