Norma bilirubin in newborns, the limit level in the blood, a table, an analysis of the causes of increased, the effects as to reduce as eliminated from the body, treatment

At birth, the majority of children there is physiological jaundice, which normally should pass on their own without any consequences for health. bilirubin norm is strictly controlled in the hospital, which allows to identify possible deviations in the health of the newborn.

Medical surveillance and intervention is required in the case of preservation of unnatural yellowness of the skin of the child after 2-4 weeks after birth.

What is bilirubin?

The concept of bilirubin is most convenient to consider in relation to what is happening in the body metabolism. functioning of red blood cells last for about 4 months, after which they die and decompose.

One of the products of their decomposition is hemoglobin. In the decay of the last formed substance bilirubin, which when released into the cell membrane may disrupt their operation and acts as a toxin.

If bile pigment is formed in the blood, it can lead to a slow toxic poisoning. Chemical reactions occurring in the body, are necessary for the conversion of bilirubin and its excretion from the body in a natural process. If you violate the process of removing the pigment will affect the kidneys, gall bladder, intestinal microflora.

In the body of the fetus is not bile pigment, and fetal. After the birth of the hemoglobin breaks physiologically newborn, forming a decay product - bilirubin.

That's why the child content ratio is most often raised that particular time is the norm. baby bodies are not always able to cope with the large number of incoming pigment, in this case, a state of pathological jaundice.

Types of bilirubin and their role in the body of the baby

Processed and transmitted a series of chemical reactions, hemoglobin is represented by the body in the form of several fractions:

1. Bile pigment or indirect fraction. Such a composition is capable of penetrating cell membranes and readily soluble in water, hence the possibility of toxic effects. Bilirubin capable digested synthesized by enzymatic transformation. Entering into a close relationship with the proteins, which act as carriers, they get into the liver.
2. Free or direct fraction occurs due to the compound with glucuronic acid. Reacting the enzyme acquires the properties of solubility in water and delivery to the duodenum is due to fusion with bile. Further changes bilirubin states occur in the gastrointestinal tract. After separation of part of bilirubin in the blood is fed back and the remaining portion subjected to filtration in the kidneys. A certain amount of naturally derived from the urine, and the other part is converted and output from the stool, changing their color.
3. Total bilirubin index is obtained by summing the direct and the indirect type.

In the compound with fats indirect bilirubin becomes toxic and affects internal organs. Its accumulation in tissues occurs due to the impossibility of recycling in the body by enzymes.

bilirubin standards for days in the newborn: a table of upper and lower threshold indicators

Full normalization of the blood pigment should happen by the end of the first month of life. To determine the parameters of the newborn blood sample is taken and determined the ratio of direct and indirect bilirubin. In the diagnosis of the child's age is taken into account, since the rules will depend directly on this.

Norma bilirubin in newborns is given in the table below:

Age of the child	The amount of total bilirubin, mmol / l	The ratio of direct and indirect indicators%
first day	50-60	90 to 10
From 2 to 7 day	No more than 256	90 to 10
From 7 to 14 days	60-100	75 to 25
On day 21	8,5-20,5	75 to 25
1-2 months	8,5-20,5	75 to 25

For full-term and term-born children can be guided by the above parameters. For children born before the due date, bilirubin is more toxic, however the maximum rate should not exceed the level of 172 mmol / l on day 3-4 after birth.

In the course of the child's survey deviations can be detected, which requires identification of the causes of zheltushki.

Self-holding bilitesta will be a thorough examination of the child:

• In head and neck yellowness - pigment indicators are in the border 170 pmol / l.
• When changing the color of the upper body - up to 256 mmol / l.
• When yellowing of the abdomen - about 340 micromoles / liter.
• When yellowing legs hands - 430 pmol / l.

Neonates diagnosing pathology occurs when the pigment performance over 520 pmol / l. In this case, the rate of bilirubin is considered to be excessively increased and begins the defeat of the child's nervous system, it requires skilled care physician.

As the analysis of the newborn?

During the medical procedures necessary to take great care not to damage the delicate skin and tissue. To do this, a blood test should be taken only by an experienced health worker. The first measurements are taken immediately after birth by measuring parameters in cord blood.

The following measurements for full-term babies performed on the second day, and for damaged or not born in time - a day later with a permanent control of parameters every 24 hours.

The sequence of test rate of bilirubin:

1. The child is in a horizontal position, lying on his back.
2. With a special test device under evaluation indicators bilirubin. To measure activated the frontal part of the baby's head.

Yellowness of the frontal lobe of the head for convenience may be determined at the time of the child's sleep. The duration of the test takes about 30 seconds. During this time, the child does not have time to experience severe discomfort or pain.

Such a test is a special cell, by which the fixation of the skin color. Convenience is the ability to see the immediate results of the survey.

If a strong excess indicators physician may need a certain time required to fully decrypt the received measurements. In severe jaundice control tests it must be carried out before the reduction of bilirubin levels to normal values.

Why bilirubin level drops so strong?

Norma bilirubin in newborns is an important indicator that helps to focus on the level of health of the child. When the physiological jaundice serious threat to health does not arise, because the state is normalized independently.

When pathological problem seems to be spreading yellowness on the feet and hands of the child, below the navel, dark urine, change in the state of extreme excitement to the oppressed.

The main reasons for this phenomenon are:

• Complications during pregnancy.
• The disease diabetes mellitus.
• The use of groups of drugs prohibited during gestation.
• Having a baby prematurely.
• Hypoxia or fetal asphyxia.

Factors leading to the consequences in the form of higher rates in newborns can be divided into categories:

• erythrocyte decay occurs at an accelerated rate.
• Process disturbed liver function.
• Failures at the outflow of bile.

Reduced production of enzymes in the newborn child often leads to the fact that his liver is not able to fully cope with their functions. The phenomenon of the late jaundice may be due to the mother's breast milk, and it contained a large amount of estrogen.

Physiological causes increased levels of bilirubin

When the body of the child to adapt to the environmental conditions of its active restructuring begins. On the background adjustment is an active destruction of red blood cells that were necessary for the transfer of oxygen to the organs of the fetus.

To the alleged main cause of physiological jaundice include:

• Preterm pregnancy.
• Diseases of women during gestation.
• Pathological delivery and oxygen starvation.
• Receiving separate groups of medical preparations.

In most cases, the level of bilirubin is normalized independently to 4 weeks of life of the newborn child. Ongoing monitoring allows you to control the condition and timely notice of possible complications.

Pathological causes of jaundice

Under pathological conditions of bilirubin level is significantly exceeded.

The appearance of a high content of pigment can occur under the influence of factors:

• Problems in the child's liver.
• The influence of hormones.
• Rhesus-conflict.
• Defective work of the intestine.
• Diseases of genetic nature.
• Inability to full operation of the biliary tract.

Congenital jaundice pathological occurs due to gene mutations, in which the structure is broken red blood cells, acquired form is a consequence of different diseases, malfunction of the immune system, blood transfusion.

When the liver malfunctions entering the body of the child with the mother's milk fatty acid requires a lot of energy for processing. This state does not perform conversion liver direct bilirubin in indirect form that results in its accumulation and increased performance.

Stagnation of bile - a common cause of pathological jaundice. At the same time there is an increase in temperature, malfunction of the digestive system, changes in stool color and darkening of the urine.

Such a condition requires not only getting rid of the symptoms, but also to combat the causes of possible complications. The nervous system of the newborn child pigment becomes poison.

When treatment is necessary?

Ignoring high levels of bilirubin can not be tolerated. The main symptom is yellowing of the skin and whites of the eyes. The advice of a specialist should be treated if symptoms do not begin to take place after 2 weeks.

Indicators need to initiation of treatment and will be:

1. Start yellowing occurs on the lower limbs upwards.
2. With the color becomes more vivid and saturated over time.
3. Yellowness persists for more than 1 month.
4. Change the color to a green.
5. Changing the color of feces in the light.
6. Darkening or redness of the urine.
7. Bruising on the body of the child for no apparent reason.
8. Increased liver and spleen.
9. Sluggish behavior of the child.
10. The sharp deterioration in the newborn health.
11. There undulating disease manifestations: jumps from improvement to rapid deterioration.

The pathological nature of the disease may be accompanied by a sharp aggravation in the form of loss of sucking reflex onset seizures and extreme sleepiness. Co-occurrence of problems with the liver and spleen necessarily require the ultrasound examination, during which you should find out the reasons for the deviations in health status.

disease symptoms

Norma bilirubin in newborns - one of the main criteria for determining the level of health.

The appearance of these symptoms is a straight base to raise the suspicion of bilirubin:

• Change the color of the skin and whites of the eyes on a yellowish tint in the first days after birth.
• Changing the color of urine and feces.
• The weakening of the sucking reflex.
• Lethargy, drowsiness, restless or overly active behavior of the child.
• Detection Rh conflict which occurs between the mother and the newborn.
• There is a strong growth performance of daily - from 85 pmol / L.
• The lower parts of the body covered with yellow spots.
• Signs persist for more than 4 weeks.

Own body of the newborn in this case not be able to cope with the disease and would need skilled care physician.

Symptoms may become more acute and dangerous at the beginning of the toxic effects:

• The appearance of seizures.
• Reduction of reflexes.
• Temperature rise.
• Tics.
• lowering blood pressure.

The complex of the above symptoms are an indication for ultrasound survey, in which can be found hidden factors: enlargement of the liver and spleen in size.

How to Lower your rate: effective treatments

Norma bilirubin in infants allows the physician to quickly identify anomalies and disease development. After determining the form of the disease your doctor will be matched by a corresponding method. Each case is individual, so ignore the doctor's prescription or self-medication is not worth doing.

Physiological manifestation of jaundice does not require additional treatment in the case of a visible improvement over time. The most effective form of treatment of a pathological condition is considered to be the impact of light rays. Ultraviolet light destroys the accumulated material, and the procedure should be carried out for several hours a day.

If for any reason this kind of treatment has not been appointed, it is recommended that the administration of drugs to improve the condition of the newborn:

• Drugs with a content of L-carnitine. Medicines help to clean the affected liver from toxins.
• Hepel - a means to accelerate the outflow of bile and the normalization of the gallbladder, restores intestinal function.
• Sorbents for interrupting the circulation of the active substances harmful intestinal tract.
• Preparations choleretic action.

To neutralize the negative impact of toxic substances in low quantity of liquid consumed child possible with intravenous glucose reference. Exchange transfusion is shown only in severe cases. With timely proper treatment of the disease will be consequences and will not cause any violations of the child's health.

The main purpose of therapy is aimed at providing an antiviral effect, improvement choleretic function, antibiotic therapy and treatment in order to increase immunity.

What might be the consequences of high bilirubin?

Toxic effects, caused by the elevated levels of bilirubin in the body can lead to dangerous health consequences.

Their appearance is due to several factors:

1. Effects on breathing cycle upon penetration of the pigment into the blood.
2. With an increase in bilirubin levels to critical indicators of the collapse of the product can penetrate the natural barriers and affect the nervous system. The occurrence of toxic encephalopathy caused by exposure to neurons.

Among the complications of penetration of toxic pigment and the impact on the nervous system of the child threatening complications in the form of deafness, partial or complete paralysis, paresis and mental violation development. Defeat pigment can cause brain and nervous system and reduce albumin levels.

prevention

Preventive measures can not completely guarantee the absence of jaundice after birth.

General recommendations are summarized as follows:

• Completion of all scheduled examinations during pregnancy. The survey can be found a variety of infectious diseases, which should be promptly treated.
• In the absence of contraindications rodorazreshitelny process should occur naturally.
• If possible, breast feed your baby breast milk. Milk will not only help naturally reduce pigment performance, but also will promote a strong immune system.

At physiological type of jaundice as the main preventive measures to reduce the level of pigment is recommended:

• Moderate sunbathing. When a child is born in summer or spring is permitted to omit the hood on the stroller, which will affect the sun's rays on the skin of the child. During the walk, do not forget that the light enters the eyes of a child are best avoided.
• Feeding a baby on demand. Generated mother body colostrum promotes active excretion of feces child, simultaneously with which the body will deliver the toxic effects of bilirubin. The situation may be exacerbated by a loss of stool excretion process since harmful substances are absorbed into the bloodstream and penetrate back. Accumulating in the body of the child, will gradually emerge the risk of developing pathological form.

When you are in the nursing home or a planned visit to the pediatrician is not necessary to abandon the procedure for determining the level of bilirubin in the baby. This will allow the physician to navigate to a possible deviation from the established norms of bilirubin in newborns.

Treatment will depend on the detected form of the disease. In the absence of complications should ensure that the newborn child walks in the fresh air, take sun and air baths, to provide for the possibility of full breastfeeding.

Registration of the article: Vladimir the Great

Video of jaundice

Dr. Komarovsky tell about jaundice in newborns: