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Icterícia no babyê (neonatal): what é, causes and treatment

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Icterícia no babyê (neonatal): what é, causes and treatment
Icterícia no babyê (neonatal): what é, causes and treatment
Anonim

Jaundice in the baby, also known as neonatal jaundice or neonatal hyperbilirubinemia, occurs when there is an increase in the concentration of bilirubin in the baby's blood, resulting in more yellow skin, eyes and mucous membranes.

Neonatal jaundice is considered normal during the first week of life due to the liver's inability to metabolize and eliminate bilirubin, as it is still underdeveloped. However, in some cases the accumulation of bilirubin can be caused by diseases, and it is important that an investigation is carried out so that the cause of jaundice can be identified and the most appropriate treatment can be initiated, which is usually done through phototherapy.

Bilirubin is a yellow pigment that is produced by the breakdown of blood cells in the body, then taken up by the liver where it is bound to proteins and eliminated along with bile by the intestine. Therefore, alterations in any of these phases can cause the elevation of this pigment in the blood, resulting in hyperbilirubinemia. Learn more about bilirubin.

Cause of neonatal jaundice

Most cases of neonatal jaundice are physiological, occurring after 24 to 36 hours of birth due to the fact that the baby's liver is poorly developed, which may present difficulties in transforming and eliminating bilirubin. However, it is possible that the change in bilirubin levels is due to other causes, the main ones being:

  • Increased destruction of blood cells: is a serious cause of jaundice, which happens due to blood disorders such as sickle cell anemia, spherocytosis or hemolytic anemia, which can be caused by incompatibility of the baby's blood with that of the mother, this situation being known as erythroblastosis fetalis;
  • Breast milk jaundice: occurs in babies who are exclusively breastfed, usually after about 10 days of birth, as a consequence of the increase in hormones or substances in the blood that increase the reabsorption of bilirubin in the intestine and make its elimination difficult, although its causes are not yet fully understood;
  • Liver diseases: usually hereditary diseases, such as Crigler-Najjar syndrome, Gilber syndrome and Gaucher disease, for example;
  • Congenital diseases: such as congenital hypothyroidism;
  • Infections: which can be acquired during pregnancy, such as rubella, as they can interfere with bilirubin metabolism.

It is important that the baby remains under observation when signs of bilirubin accumulation are noticed, even if the cause is physiological, as it is possible that bilirubin levels are monitored regularly, preventing complications for the baby, as very high levels of bilirubin in the blood can be toxic.See more about neonatal hyperbilirubinemia.

How the diagnosis is made

The initial diagnosis of jaundice is made by the pediatrician through a physical examination, in which a yellowish coloration of the face, trunk and feet is observed. In addition, blood tests are performed, such as heel prick test, blood count, maternal and newborn blood typing and glucose-6-phosphate dosage, in addition to direct and indirect total bilirubin dosage.

In this way, through the tests requested by the doctor, it is possible to confirm jaundice and identify the cause, which is important so that the most appropriate treatment is initiated.

Treatment for neonatal jaundice

Treatment for neonatal jaundice should be done regardless of the cause, as it is important that bilirubin levels in the blood are controlled, as it is possible to prevent brain damage, for example, which is one of the consequences of bilirubin toxicity.

Phototherapy treatment

Phototherapy is the main treatment for jaundice in the baby and is done by placing the baby in a small crib where he is completely naked, wearing only a diaper, being exposed to light with a suitable wavelength for the absorption of the bilirubin. During exposure, a protective mask is placed on the baby to protect the eyes.

According to the severity of jaundice, age and weight of the baby, exposure may be more or less prolonged and the device used may vary. Learn more about phototherapy.

Other forms of treatment

Breastfeeding the baby is a great way to complement the treatment, as it reduces the reabsorption of bilirubin in the intestine.

In the most serious cases of jaundice, such as those with an infectious, congenital or genetic cause, the treatment is specific according to the cause, guided by the pediatrician, during hospitalization, which may involve the use of antibiotics, corticosteroids, hormone therapy or, in cases of very high bilirubin, exchange transfusion, which helps to remove bilirubin from the blood more quickly.

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