Jaundice Syndrome in the Newborn Period

Jaundice is a visual manifestation of increased levels of bilirubin in the blood. In full-term newborns it appears at a bilirubin level of 85 µmol/l; in premature infants - more than 120 µmol/l.

Causes of indirect hyperbilirubinemia:

1. Immune hemolysis (P 55), non-immune (P 58)
2. Conjugation disorders (P 59)
3. Impaired albumin-binding ability of blood (P 59.8)
4. Increased enterohepatic circulation (P 58.5, P76)

Degrees of visualization of jaundice according to the Cramer scale:

1. I degree – jaundice of the face and neck (80 µmol/l)
2. II degree – up to the level of the navel (150 µml/l)
3. III degree – up to the level of the knees (200 µmol/l)
4. IV degree – jaundice of the face, torso, extremities except palms and soles (300 µmol/l)
5. V degree - all yellow (400 µmol/l)

The Cramer score cannot be used if the child is receiving phototherapy. In premature and hypotrophic children, the degree of visualization of hyperbilirubinemia is less pronounced.

Examination:

Required:

1. bilirubin, fractions
2. blood type, Rh factor of mother and child
3. complete blood count + reticulocytes + normoblasts

Additional:

1. Coombs test (if hemolytic disease of the newborn is suspected) to detect immune antibodies
2. AST, ALT (if hepatitis is suspected)

Care:

1. optimal temperature regime (child hypothermia leads to a decrease in glucuronyl transferase activity)

Feeding:

1. continue breastfeeding (hemolytic disease of the newborn is not a contraindication). If the child’s condition is serious, feeding expressed breast milk from a syringe, cup, etc.
2. if a newborn is scheduled for an exchange blood transfusion (RTB), the child does not feed during the preparation period for it
3. If the suspected diagnosis is breastfeeding jaundice, more frequent breastfeeding is required.

Therapeutic tactics for indirect hyperb