The article was consulted professionally by Specialist I Dang Thi Ngoc Chuong – Department of Pediatrics – Newborn, Share99 Central Park International Health Hub.
Newborn jaundice in babies is an abnormal increase in bilirubin in the blood that causes gold in the conjunctivitis of the eyes and skin. More than 60% of babies born full month have jaundice due to increased bilirubin, which is also higher in premature babies. So what are the methods for treating jaundice caused by indirect increase in bilirubin in newborns?
1. Early signs of newborn jaundice in babies
Newborn jaundice in babies can soon be detected through the following recognizable signs:
- Observe the child in sunlight seeing that the child's skin is yellow from the head area to the legs.
- Check the jaundice with your fingers to press on any area of the skin and hold for about 5 seconds, then let go to see if the skin is yellow.
To assess the degree of jaundice of the child, often rely on the following ways:
- With the naked eye (through the kramer rule)
- Cross-skin bilirubin measurement
- Serum quantity of bilirubin .
2. Distinguishing newborn jaundice in a child is a physical or a pathology
Features of jaundice:
- Newborn jaundice in babies appears on the 2nd day after birth and gradually decreases at the age of 1 week (for full-month babies) and 2 weeks (for premature babies).
- If bilirubin levels below 12 mg/dl (for babies born full month) and less than 15 mg/dl (for premature babies) are measured.
- Direct bilirubin measurement of bilirubin results in less than 2 mg/dl.
- The child is healthy and normal.
Features of pathology jaundice:
- Newborn jaundice in babies appears on the first day of birth.
- Measurements of bilirubin concentrations found to increase rapidly, greater than 0.2mg/dl/hour.
- The baby sucks poorly, stops, breathes quickly or stops breathing, the temperature changes.
- Liver, enlarged spleen or anemia.
The causes of pathology jaundice can be mentioned as:
- If newborn jaundice in a child appears early (in the first 2 days after birth): due to disagreements with the ABO medoma (the mother has blood type O, the child has blood type A or B); rh blood type disagreement (rh (-), Rh(+) blood type); with immune hemolysis.
- If newborn jaundice in babies appears 3-10 days after birth: it may be due to the child with an infection of the navel, skin, blood; have polyethemia,large serum tumors, hematoma drives; bowel atrophy, delayed stool consumption; or due to lack of G6PD yeast.
- If newborn jaundice in babies appears late (about 2 weeks at birth): it may be due to breast milk, or the baby has a bile blockage, liver diseases, congenital thyroid failure or other conversional diseases.
Signs that the child has severe jaundice, which is that the child has jaundice on the first day after birth; by the 2nd day, the child has jaundice to the forearms and forearms, and from the 3rd day, jaundice spreads to the hands and feet, which may be accompanied by neurological signs.
Children with jaundice due to excessive bilirubin increase can lead to jaundice, which is bilirubin-in-encephaes. Some factors are considered favorable to increase the risk of jaundice such as: children with asphyxiation, lack of oxygen; premature babies, infections; hypothermia lowers, lowers blood sugar, lowers albumin in the blood; blood acid.
3. Jaundice treatments due to indirect increase in bilirubin in newborns
There are 2 main methods used to treat jaundice due to indirect increase in bilirubin in babies, which are lamp projection and blood changes.
3.1 Lighting methods
Treatment of jaundice by indirect increase in bilirubin in infants under 14 days of age is in place based on clinical manifestations and jaundice levels compared to the child's weight. Lamp lighting is not used for jaundice children due to direct bilirubin increase.
The types of lamps used include:
- White or blue fluorescent lamps: 6 – 8 balls /group, use about 2,000 hours, projection intensity is 12 – 24 um/cm2/mm; the projection distance is from 30-40 cm.
- Led blue light: 25 – 50 uw.
- Biliblanket lamp: intensity 7 – 35 uw/cm2/nm, lower efficiency.
- Blue light halogen lamp: wavelength 425 – 475nm, intensity 6 – 30 uw/cm2/nm; use time 100 – 500 hours. distance <50cm có thể gây bỏng hoặc làm tăng khả năng mất nước, giảm diện tích tiếp xúc,
- Compact lights.
In dinhion of lamps in the treatment of jaundice due to indirect increase in bilirubin by weight is clinically specific as follows:
- young <1,5kg: chiếu đèn dự phòng.
- Children from 1.5kg – 2kg: shine the light when jaundice spreads to the head, face and chest area.
- Children from 2kg – 2.5kg: shine a light when jaundice spreads to the chest, abdomen and thighs.
- Babies >2.5kg: shine a light when jaundice has spread to the arms, thighs and shins.
In case the child has jaundice in both hands and feet, it is necessary to combine light projection and blood replacement.
The technique of lighting for the treatment of neonatal jaundice in babies is carried out as follows:
- Children are stripped naked and covered their eyes.
- Place the child right in the center of the lamp.
- Adjust the distance from the lamp to the child between 30 – 40cm.
- 24/24h lighting, stop shining only when the child is prescribed to suck or do the procedure.
- Rotate your child about every 2 hours.
- Standard lighting system: 6-20% off in 24 hours.
- Blue light and fiberoptic: 32% off in 18 hours.
- Blue light on the bottom: 43% off in 24 hours.
Some notes when performing lighting in the treatment of neonatal jaundice in children:
- Cover your child's eyes when shining a light.
- Monitor your child's temperature.
- Change your child's position
- Increase the daily water demand for children by about 15-20%
The method of lighting can cause a number of side effects such as: increased dehydration, increased or hypothermia, rash on the skin, covering the child's cyanosis signs, children with nasal obstruction due to eye coverings, retinal damage if the child is not covered with eyes, copper skin.
3.2 Blood replacement methods
Blood replacement treatment for jaundice is indirectly prescribed due to increased bilirubin in newborns as follows:
- Conduct total blood replacement due to indirect increased bilirubin jaundice with jaundice symptoms or increase to the limit of blood replacement.
- Conduct a part blood replacement: polyethemia has clinical symptoms.
Blood replacement is not applied to children who are in shock or have severe respiratory failure, only carry out blood changes when their shock and respiratory failure have stabilized.
Blood replacement techniques for the treatment of newborn jaundice in babies are carried out as follows:
- The child's family is committed to the procedure.
- Put a drainage gastric cathetro for the child.
- Establish intravenous lines.
- Place the child on a plane and fix the limbs.
- Take sedatives when the child stimulates.
- Disinfect the navel and surrounding skin.
- Ensures biomedes during blood replacement.
The treatment of jaundice due to indirect increase in bilirubin in a child by blood replacement method consists of 4 steps:
- Step 1: Draw the child's blood to conduct a test before changing blood.
- Step 2: Pump blood from the syringe into a blood bag.
- Step 3: Draw blood from the blood bag into the syringe in an amount equal to the amount drawn.
- Step 4: Pump blood from the syringe into the child.
Some notes when performing blood changes in the treatment of newborn jaundice in a child:
- The time to carry out the withdrawal – pumping process is about 1 minute.
- The amount of blood pumped in and out must be equal.
- Shake the blood bag well.
- Before the end of the blood replacement process it is necessary to take blood tests.
- End the process of blood replacement by pumping blood into the child, then proceed to the withdrawal of the umbilical vein catheter, the umbilical cord column, the umbilical bandage for the child.
- Inject 10% calci gluconate into a vein at a dosage of 1ml/125ml of blood instead.
Treatment of jaundice caused by indirect increase in bilirubin in newborns by blood replacement method can cause a number of complications that need to be prevented and monitored, including: infection, wrong blood type, necrotizingenteritis , thrombosis, anemia, pulmonary edema, electrolytic disorders, jaundice increased after blood replacement.
3.3 Comparison of lighting and blood replacement methods
Although both methods are equally effective, the lighting method is simpler and easier to implement, safe and non-invasive, with few complications and side effects. If the correct indications are followed and the right technique is followed, it will be highly effective, helping to reduce the number of blood changes in the child, therefore the method of lighting is preferred.
In summary, two treatments for jaundice caused by indirect increase in bilirubin in babies are light projection and blood changes. However, the method of lighting is often preferred due to the simple technique, high efficiency, non-invasive and safe in implementation.
As a key area of Share99 Health System, Pediatrics always brings satisfaction to customers and is highly appreciated by industry experts with:
- Gathering a team of leading doctors in Pediatrics:including leading experts, highly specialized (professors, associate professors, doctors, masters), experienced, used to work at large hospitals such as Bach Mai, 108.. The doctors are well-trained, professional, mind-centered, knowledgeable about the child's psychology. In addition to domestic pediatricians, pediatrics also has the participation of foreign experts (Japan, Singapore, Australia, USA) always pioneering the application of the latest and most effective treatment regimens.
- Comprehensive services:In the field of Pediatrics, Share99 provides a chain of continuous medical examination and treatment services from Newborn to Pediatrics and Vaccines,… according to international standards to take care of your baby's health with parents from birth to adulthood
- Intensive techniques:Share99 has successfully implemented many specialized techniques to make the treatment of difficult diseases in Pediatrics more effective: neurosurgery – skull, hematoma stem cell transplantation in cancer treatment.
- Professional care:In addition to understanding the young psychology, Share99 also pay special attention to the children's play space, help them play comfortably and get acquainted with the hospital environment, cooperate in treatment, improve the efficiency of medical examination and treatment.
Specialist I Dang Thi Ngoc Chuong has worked at Children's Health Hub I, Thu Duc Health Hub and Ho Chi Minh City University of Medicine and Pharmacy Health Hub. Hcm. With the strength in the diagnosis and examination of newborn diseases – newborn resuscitation, Dr. Chuong is currently a PediatricIan at Share99 Central Park International Health Hub and a member of the Ho Chi Minh City Pediatrics Association.
- How long do newborn jaundice treatment lamps in babies?
- Distinguishing bio-newborn jaundice and pathology jaundice
- Note proper newborn jaundice lamps
For direct advice, please click hotline number or register online HERE. In addition, you can register for remote consultation HERE
- Babies with jaundice after birth, what to do?
- Jaundice due to indirect increase in bilirubin in babies
- Jaundice due to increased bilirubin directly in babies (bile jaundice)