- Norma bilirubin in neonates: tell about the test results?
first blood in the baby taken from the umbilical cord immediately after birth.They do it mainly in order to determine the concentration of bilirubin in his body.What is so important to this investigation, and what is the rate of bilirubin in the newborn?
What is it?
Bilirubin - a pigment yellow-green color, which is formed by the breakdown of hemoglobin.When the red blood cells become obsolete the term, they are destroyed in the spleen.Their protein part is converted to bilirubin, which is called the free (or indirect).This product does not dissolve in water and therefore can not be displayed by the kidneys.But most importantly, it is dangerous for the body, as it causes the death of nerve cells.
Neutralization of free bilirubin in the liver under the influence of its enzymes.It is converted to a soluble protein (express or implied) form and in this form is transported in the bile.
If the rate of decomposition of red blood cells exceeds the "working capacity" of the liver, the unconjugated bilirubin accumulates in the blood and into the tissue.With a high concentration of pigment jaundice.
the first day of life the rate of bilirubin levels in newborns is 10 to 60 mmol / l.By the third or fourth day, this figure increases dramatically.In full-term infants are considered acceptable values to 200 mmol / l, and preterm - no more than 175 mmol / l.The amount of direct bilirubin when it should not exceed 25% of the total.Within 2-4 weeks concentration of the yellow pigment in the blood of newborn gradually decreases and becomes equal to 8,5-20 micromoles / liter.
Such sharp changes of parameters are explained in children age immaturity of the liver and the physiological processes that occur in their bodies.The fact that immediately after the birth of their replacement is a mass of old (fetal) hemoglobin with a new - "adult".As a result, large quantities of free pigment that simply do not have time to be disposed of.After 7-10 days of hemoglobin update is completed, the excess bilirubin is excreted in the urine and feces and indicators are stable.
Jaundice physiological and pathological
If the level of bilirubin in the blood of a full-term baby more than 95-100 mmol / l, then he developed jaundice.Premature babies a similar condition is observed at values of 75-85 mmol / l, which is associated with a lesser thickness have subcutaneous fat.
The higher the bilirubin, the more intense yellow colored skin, mucous membranes and eye sclera baby.The vast majority of infants jaundice is a physiological, that is normal.It occurs on the second and fourth day after birth, strengthened on the fifth and sixth passes completely by the tenth day.If the pigment thus continues to remain within the norms of the above, no remedial measures are not assigned to a doctor.
When exceeding the critical concentration (200 mmol / l) shows a two-day baby phototherapy and intravenous glucose Glucose: The energy source .
Physiologic jaundice is diagnosed in 50-70% of newborns.In this special care is necessary to provide not more than 3% of them.
In rare cases (0.3-1%) excess levels of bilirubin indicates pathology.Among the most common:
- Hemolytic disease of the newborn (HDN)
This condition is caused by the incompatibility of blood between mother and baby.Conflict develops when the blood of women has a negative Rh and fetal blood - positive.Another option - a woman's blood group I, and the child - II or III (an illness milder and sometimes not even diagnosed).Maternal antibodies cause massive loss of red blood cells of the fetus.Jaundice occurs in a child in the first hours after birth.Along anemia.In severe in children diagnosed cardio-pulmonary insufficiency.Treatment for hemolytic disease is a blood transfusion.
- jaundice from breast milk
due to high levels of estrogen in the breast milk.This begins as a physiological jaundice for 3-4 days, but persists for much longer - for 9-10 weeks.Peak rise of bilirubin (up to 250 mmol / L) is recorded in the 6-14-day life of the baby.The therapy consists in the transition to artificial feeding.The mixture is allowed no more than 1-2 weeks, and then again transferred to the child breast milk.
Jaundice is prolonged (approximately 20 weeks) and is accompanied by lethargy, dry skin, swelling.To confirm the diagnosis in a child taking tests for thyroid hormones Tests for thyroid hormones - screening for diseases .
Jaundice occurs at birth and lasts for 2 weeks.Your child has dark urine staining, poor appetite, frequent vomiting, low blood pressure Blood pressure - dangerous if his swing? .On US doctor diagnose an enlarged liver.
- Congenital malformation of the biliary tract
may occur in children whose mothers had been ill with hepatitis.Bile ducts the baby partially or completely fused, which leads to a violation of the outflow of bile.Part of it gets into the blood, jaundice.Other signals pathology are discolored stools, hypertension, dark urine.Treatment - surgical.
- Gilbert's syndrome
hereditary disease caused by a defect "bilirubin" gene.Free bilirubin these children badly inactivated by the liver, so jaundice occurs periodically in their lifetime.The disease is four times more common in boys recorded.Pathology is considered non-hazardous.Treatment is prescribed only during exacerbations.
- Lyutseya-Driscoll Syndrome
utero or mother's milk in the baby's blood get substances that interfere with the binding of bilirubin in the liver.The nature of this phenomenon is not completely clear.It is believed that the development of specific compounds in the mother's body caused by genetic mutations.Severe jaundice in these kids develop in the first days of life.Bilirubin up to 400 mmol / l.For the treatment used phototherapy Phototherapy - restores vitality and blood transfusion.Newborn transferred to artificial feeding.