Description of neonatal jaundice
Neonatal jaundice is very common in newborns. It occurs in about 50% of all newborns and can be expressed to varying degrees. The cause is a breakdown of a large number of red blood cells (erythrocytes). While the fetus still within the mother’s womb, there is around it completely different environment than after delivery. The fetus gets oxygen from the mother’s blood through the placenta and the blood contains less oxygen than the blood circulating in the arteries of each of us. It is therefore referred to evolved during the relative lack of oxygen (hypoxia). Its organism is however adapted by several mechanisms.
Firstly, the red blood cells contain a different type of red blood pigment (hemoglobin) than blood cells already born children and adults. It’s called. “Fetal hemoglobin”. With this type of hemoglobin can transmit blood cells and releasing oxygen in a medium having a smaller oxygen content.
Secondly, the fetus of RBCs more. The blood of an adult contains about 5 million red blood cells per mm3 of blood. Blood contains many fetal and 8 million per mm3 of blood. Immediately after birth, but the baby begins to breathe and his body will be supplied with oxygen from the lungs. His blood suddenly becomes more oxygenated and fetal hemoglobin and an excess of red blood cells containing it, will be useless. Therefore, they begin to disintegrate in a large amount, and up to 2 to 3 months of age, their quantity decreases. At this time they can even reach such a low quantity that in adult humans was considered anemia. The disintegration of erythrocytes released into the blood hemoglobin, which is then metabolized to the yellow pigment bilirubin blood. Bilirubin is further processed by the liver and excreted in the bile. It goes to the stool, which is dyed dark. However, since the newborn liver is not yet mature and fully functional insufficient so a large amount to degrade bilirubin and its level in blood increases. Thus, the accumulated bilirubin is then deposited in tissues and we can be seen as yellow skin or mucous membranes, very good observable to the eye sclera. In a healthy physiological neonatal bilirubin levels do not exceed the limit. Jaundice occurs early as the second day after birth and culminates third-fourth day. In complicated neonatal conditions (low birth weight, prematurity, infection, lack of oxygen to the fetus before or after birth), jaundice may occur earlier (the first day) and take a long time.
The concept of neonatal jaundice is sometimes called earmarks separately. Hemolytic disease of the newborn (fetal erythroblastosis), which is a more severe type of neonatal jaundice: In the event of a disagreement blood groups of mothers and infants, bilirubin can reach very high values.The most common and most serious disagreement known. “Rh factor” when the mother is Rh-negative and Rh-positive fetus. In this case, during pregnancy, especially during childbirth may enter the blood of a child receive maternal antibodies against blood cells, fetal (risk especially in the case that in the previous pregnancy already mother immunized with Rh-positive fetus) occurs their massive decay and release large amounts of bilirubin. Threatens deposition of bilirubin into the brain tissue, which can cause irreversible brain damage and threaten the child and the life.Fortunately, it follows the dramatic progress of an extremely rare and doctors know how to deal with it (see treatment).
As we can see, neonatal jaundice has a completely different cause than infectious hepatitis A, B or C, which are caused by viral hepatitis. Although at first glance shows like infectious types (yellow color) should not be mistaken for them because it is a completely different disease.
Risk factors for neonatal jaundice
The risk of neonatal jaundice is higher in newborns with low birth weight and preterm infants, as well as those who are suffering from infections or newborns who suffered during birth hypoxia (lack of oxygen). In these cases, sometimes jaundice started sooner and lasts longer.
A major risk factor is a mismatch in blood groups of mother and child, the most serious is Rh incompatibility, which are at risk of serious forms of jaundice and nervous system damage.
Symptoms of neonatal jaundice
The most obvious symptom is yellowing of the skin and whites of the eyes, but that routine neonatal jaundice in healthy child may not even be noticeable. Often in mild forms the skin slightly grayish. Generally better yellow coloration observed in daylight with artificial lighting is not so obvious.
Prevention of neonatal jaundice
The mother should as soon as possible after delivery to start regularly and properly breastfeed.A sufficient amount of food in the form of a breast milk substitute or enhance the child amount defecation and with it leaves more of bilirubin, which gets into the bile from the liver. This may contribute to its rapid elimination from the body and thus prevent the development of jaundice.
Furthermore, prevention of infection and preterm labor plays an important role in the eventual development of jaundice.
When Rh incompatibility of mother and child is Rh-negative mother postpartum Rh-positive child apply so called. “Anti-D antibodies”, which inhibit the mother’s antibodies to red blood cells Rh-positive child and the subsequent birth, they will protect any further Rh- positive sibling before the onset of severe jaundice (hemolytic disease).
The treatment of neonatal jaundice
Physiologic jaundice requires treatment, it is recommended that only frequent, unrestrictedbreastfeeding mothers and newborns should be the most exposed to daylight (but not direct sun), which if falls on the skin, accelerates the disintegration of bilirubin in the blood.
While severe forms used phototherapy (light therapy). Use the blue light of a specific frequency, which shines on the greatest part of the body exposed newborns. The blue light breaks down bilirubin circulating in the blood vessels in the skin, producing water-soluble components, which are then excreted in the urine.
Bilirubin levels also affects the degree of hydration, the treatment therefore pay attention to the administration of a sufficient amount of fluids, whether only breast milk or drip infusion.
If bilirubin levels phototherapy fail to keep within acceptable limits, performs so-called. “Exchange transfusion”. The procedure consists in the gradual replacement of the blood of children with high blood bilirubin for free bilirubin. It is most frequently through the umbilical vein and the exceptional performance must be repeated after a few hours.
Auxiliary importance of administration of blood protein albumin, which partially binds to bilirubin in the blood, thus preventing its transfer to the brain.
How can a mother help
Mother can help a lighter and faster course by letting a child fall as much daylight, which accelerates the disintegration of bilirubin water-soluble substances. These are then excreted from the body and urine. Daylight is not meant to direct sunlight. Baby skin after birth is very sensitive and direct sunlight, it could be hurt. It is therefore advisable to put the crib with the baby as much as possible to the window, preferably on the side facing away from the sun as much as possible to expose him, but only to the extent to ensure the thermal comfort of the child. It must therefore be careful not to neprochladlo.
Mother also may help treat a responsible attitude to breastfeeding the child, because the child is drinking more often, the better. First, it is for him the energy and nutrient and the child’s body will then be loads better deal, but also will accelerate the departure of meconium and after stool, with which the body goes and bilirubin.
Complications of neonatal jaundice
Said RH-incompatibility was previously the most common cause of the extremely high bilirubin levels that are child serious danger. Since the newborn is not yet fully developed barrier between blood and brain, bilirubin passes into the brain tissue, especially in the area called the basal ganglia, settles there and may cause irreversible brain damage or death of the child. This complication called core jaundice. Nowadays her but no longer, thanks to the monitoring of the child and the mother before and after childbirth and effective prevention (the additional administration of anti D antibodies mother) and treatment.
Other names: Jaundice in newborns, Icterus neonatorum, icterus neonatus, neonatal hyperbilirubinemia, icterus neonatorum gravis, hemolytic disease of the newborn, fetal erythroblastosis
