A few words to understand:

Red blood cells are produced continuously in the bone marrow. They then pass in the blood and, after a life of 120 days, will die in the spleen. The normal destruction provides in the release of free bilirubin. This free bilirubin is toxic from a certain rate to the brain. Free bilirubin blood enters the liver where biochemical processes will transform it into a conjugated bilirubin, which is not toxic and which is one of the components of bile. This pigment is at the origin of the staining of feces and urine. Jaundice (jaundice) reflects the excess of bilirubin in blood, combined or free, as it has been transformed in the liver. The richness of blood bilirubin tint the skin and mucous membranes in yellow by transparency.

Where come from this excess of bilirubin?

In infants, the number of red blood cells is higher than in adults and there is a hyper-destruction of these cells. This number of destroyed red blood cells may exceed an immature liver enzyme opportunities. This results in an excess of bilirubin which translates “physiological” said simple jaundice. This is by far the most common case.

newborns

For the baby, in addition to the normal destruction, there are diseases that cause premature destruction of red blood cells. This is the case of fetomaternal blood incompatibilities (ABO and rhesus systems). Red blood cells are destroyed in large numbers; the liver is overwhelmed and cannot metabolize all this free bilirubin is happening and which increases the blood level. Family hemolytic disease may be at birth by intense jaundice.

In other cases, it is the liver is sick. It cannot transform the bilirubin is because it is infected (hepatitis) or because the enzymes are deficient or inhibited (drugs, etc.).

Finally, hemolytic may be normal, the liver can function properly but an obstacle to the flow of bile causes retention of conjugated bilirubin. It passes in the blood and its high rate determines said jaundice “homeostatic”. In this case, the stools are discoloured.

What is the consequence of this jaundice?

The occurrence of jaundice in a baby poses two problems:

in his case because so banal physiological jaundice is good prognosis, so cholestatic jaundice is a medical emergency. That its gravity immediate because from a certain rate of free bilirubin in the blood, it becomes toxic to the brain and can cause a serious neurological disease: nuclear jaundice. The prognosis is bad because the child keep the major neurological sequelae (profound deafness, abnormal movement disorders tone etc.). Monitoring of the hearing must be carried out after a significant jaundice. Physiological jaundice of the newborn is very common. It is only 24 to 48 hours after the birth.

The child is yellow but it has no other abnormal signs. The size of the liver tenderness is normal. The spleen is not increased volume. Stool and urine are normally colored. This jaundice disappears within 3 weeks.

Certain circumstances intensify it: anoxia, acidosis, resumption of hecatomb, hypoglycemia, administration of certain drugs etc.

Infants fed breast milk is sometimes a physiological jaundice that extends beyond the usual limits. This “mother’s milk jaundice” is due to the presence in the milk of some women of a substance that would inhibit the metabolism of bilirubin in the liver. These infants are yellow as long as breastfeeding. This type of jaundice poses no risk and should in no way stop breastfeeding.

The treatment of physiological jaundice is intended to prevent the bilirubin levels become too high rate because of the possible risk of kernicterus. Monitoring is done by asking on the baby’s skin a small electronic reader (“flash”) that provides an indication of the level of bilirubin in the blood. For high value, a control is done by a simple blood test. From a level of bilirubin from 130 to 150 mg/l (220-250 µmol/l), infants at term is exposed, naked in incubator, to the action of a “blue” light or neon lights (phototherapy) rays. Prematurely is benefiting from this measure for rates lower. The eyes are protected from rays by a headband. The temperature and the State of hydration of the newborn are monitored to avoid heat stroke. Phototherapy is interrupted after a few days when the rate of free bilirubin descends below dangerous levels. When this therapeutic measure is not enough, other treatments are undertaken in specialized unit.

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A few words to understand: Red blood cells are produced continuously in the bone marrow. They then pass in the blood and, after a life of 120 days, will die in the spleen. The normal destruction provides in the release of free bilirubin. This free bilirubin is toxic from a...