Bilirubin in neonates: rate and limit, table
Bilirubin is a compound formed in the body as a result of destruction of red blood cells. With increasing concentration develops hyperbilirubinemia. This article tells about the features of development and the characteristic manifestations of this disorders among newborn children.
Causes of hyperbilirubinemia in newborns
Bilirubin, as a rule, determine the children on day 3 after birth. For what it’s doing? It is known that the level of total bilirubin is a summary measure of the number of its direct and indirect fraction. Because the metabolism of bilirubin is in the liver, which in newborns is still functionally immature, registered quite a significant increase in the number of indirect bilirubin. In most cases, this process is physiological and seen in 60 – 70% of newborns. The condition is not violated, however, there is yellowness of the skin and sclera (the so-called transient jaundice).
The basis for the development of this condition is that after birth the fetal hemoglobin (he provided the transport of oxygen from blood cells of the mother to fetal red blood cells), begins to rapidly disintegrate and be replaced on HbA («adult» form of hemoglobin). Because the liver is not able to fully convert indirect to direct faction faction, the excess bilirubin accumulates in the body and provokes a peculiar yellowness. In this state the body of the child in norm, and the usual color of the skin restores itself during the week (maximum 20 days).
If jaundice increases, and General condition of the child worsens, you should immediately consult a doctor because of hyperbilirubinemia in this case, it may be pathological in nature and negatively affect the Central nervous system of the child, leading to serious complications.
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What is the normal bilirubin is characteristic of a newborn baby? This figure varies considerably and in just a few days can change dramatically. For a better understanding of such pattern is supplied the following table of normal bilirubin at 1 month of life:
The maximum number of bilirubin in µmol/l
After birth (1 – 2 day)
The first 3 – 7 days
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14 – 21 days
The limit of bilirubin for children who are born prematurely is somewhat different. So, 1 week after birth, the level of the compounds for them should not exceed 175 µmol/L. Big difference in performance stems from the fact that in prematurity there is a poor blood-brain barrier and are more immature nerve cells of the brain. This contributes to greater sensitivity of the CNS to various substances in the blood (and also to the indirect bilirubin, which has a toxic effect).
What is pathological jaundice?
This pathology is manifested in newborns at the background of certain diseases or disorders in the body that require medical intervention. It can develop when damage to the hepatic cells, in the presence of certain infections or when exposed to toxic substances. In first place among the causal factors are intrauterine infections. So, prolonged jaundice, which lasts 1.5 – 2 months, the most frequently observed in the infection of the child is still in utero with cytomegalovirus, Toxoplasma, hepatitis or rubella. This condition is often accompanied by enlargement of the liver and lymph nodes, and anemia. The newborn may experience discoloration of the stool and darker urine.
In case of serious disruption of bile flow (e.g. obstruction or complete blockage of the biliary tract) the kids also there is too much bilirubin. This mainly happens in the presence of malformations of the bile-excretory ducts, with their compression by the tumor and the syndrome of thickening of bile or intrahepatic hypoplasia. For newborns with obstructive jaundice such a specific characteristic yellowish-green skin, enlarged liver and discoloration of feces.
How to donate blood for newborns to determine the amount of bilirubin?
Adults all biochemical analyses are recommended to take on an empty stomach for more accurate results. Blood bilirubin babies taken away at any time because of unacceptable deprivation of the child.
For laboratory studies you need 3 – 5 ml of venous blood. Where do you get the blood? Typically, the fence is carried out from the veins on the head, because here they are localized in the most superficial and accessible for puncture. The results were evaluated depending on the duration of life of the child and the presence of comorbidities. Have a month old baby concentration of bilirubin comes to normal development of physiological jaundice. In other cases, the bilirubin level remains high.
It is worth noting that infants can perform blood sampling from the heel. The resulting biomaterial used not only to determine the concentration of bilirubin, but also to identify individual genetic diseases (congenital hypothyroidism, phenylketonuria, cystic fibrosis, galactosemia, adrenogenital syndrome).
Sometimes bilirubin is determined using a special apparatus that does not require blood sampling. Is baby skin just put a sensor and instantly get the results, but a similar methodology for the identification of hyperbilirubinemia should be regarded only as a screening test.
What should be treatment plan when identifying hyperbilirubinemia?
Before the treatment determine the etiology of pathological conditions and eliminate the causal factor that stimulates the growth of bilirubin. In addition to laboratory examination may conduct an abdominal ultrasound. The main methods of treatment of hyperbilirubinemia:
- Phototherapy is considered one of the most effective methods of eliminating physiological jaundice. The time of exposure of the child is determined by the physician because the excessive length of session possible burns, dehydration, hemolysis and fever.
- Bilirubin in neonates can be reduced with the help of infusion therapy with the use of solutions of electrolytes and glucose.
- Drug therapy includes the administration of inducers of microsomal liver enzymes (eg, phenobarbital), chelators, Ursofalk (with cholestasis), fat-soluble vitamins.
- In the presence of jaundice resolve the question about surgical intervention.
Treatment should begin immediately if the baby is showing signs bilirubinemia encephalopathy (this splenomegaly, hypotension, increased sleepiness, seizures, reduction of the sucking reflex). To improve the condition of the child in this case is usually carried out exchange transfusion. In the absence of timely treatment of the child register hearing loss, developmental delays, possible paralysis and even death.