2023-04-15 15:00:00
Last Thursday (13), influencers Viih Tube and Eliezer shared the first records of the birth of the daughter, Lua, eldest of the couple. In the midst of the photos, they told a little about the diagnosis that the little had at birth: neonatal jaundice.
“She needed a light bath because of jaundice. My heart ached, because it’s not easy, but we did it and we were discharged later”, wrote the first-time mom, in Instagram stories.
According to the SBP (Brazilian Society of Pediatrics), the condition occurs in approximately 60% of newborns and in 80% of late premature babies (34 to 36 weeks and 6 days).
“Jaundice is the name given to the yellowish color of the skin, due to the accumulation of bilirubin in the blood. Normally, it starts in the craniocaudal direction (from the head to the feet)”, explains the pediatrician and graduate in nutrology from Abran (Associação Brazilian Nutritionist) Amanda de Santana Ferreira.
Bilirubin is a substance produced during the filtration of red blood cells and released into the bloodstream. After performing this function, it is transported to the liver to be metabolized and then eliminated in the urine.
In most cases, physiological jaundice in babies is due to the extra amount of red blood cells they have during birth. This excess number is needed during the gestational period to deliver oxygen to the placenta.
After the baby is born, red blood cells that are no longer needed are destroyed, generating a high concentration of bilirubin.
“As your liver may not be fully developed to process all this substance, more bilirubin than normal will remain in the body”, explains the SBP.
Amanda adds that the body’s metabolism “is not yet prepared to eliminate this compound quickly”. Therefore, jaundice may worsen around the third to fourth day of life, but it normalizes by the thirtieth.
“We have a graph that characterizes this jaundice by zones. Zone 1 only affects the face; zone 2 is up to, more or less, the inframammillary line; zone 3 reaches the inguinal region; zone 4 reaches the feet and zone 5 affects the entire body, especially the palm of the hands — this [conta com] very high levels of bilirubin in the blood”, exemplifies Giuliana Taveira, coordinator of the Núcleo de Pediatria at BP — the Beneficência Portuguesa Hospital of São Paulo.
Treatment varies according to the degree and risk factors of the child, but, in general, intervention in cases of physiological jaundice is simple.
“He [o tratamento] It ranges from maintaining the baby’s hydration through breastfeeding or even milk formula, in order to be able to increase the excretion of bilirubin, to performing the famous light bath (phototherapy) [como ocorreu com Lua]”, adds Amanda.
The evolution becomes clear right after treatment, with improvement in skin color and a decrease in serum bilirubin levels (in jaundice it is above 5 mg/dl).
In more severe cases, an exchange transfusion may be required — the baby’s blood is removed and replaced with that of a compatible donor.
“If the baby was discharged with jaundice, but with no indication for treatment (mild conditions or onset after 48 hours of life), parents can press the baby’s skin with their finger and observe the color of the area; if it is yellow, they should look for your pediatrician to assess the degree of involvement”, advises Amanda.
It is important to emphasize that the face is the last part of the baby’s body to lose its yellowish color.
Breastfeeding
Babies who receive breast milk are more likely to develop physiological jaundice compared to bottle-fed babies, according to the SBP.
Jaundice commonly appears between the second and fourth day of life, reaches a peak between the fourth and fifth, and disappears by the third week. However, it can also continue until the baby’s 2 or 3 months – in which case, it’s important to assess whether the coloring is not related to other diseases.
The picture happens in healthy babies, with good suction and adequate weight gain. Therefore, it is still not clear what triggers jaundice. Two possible explanations are that breast milk may have the ability to increase bilirubin absorption or genetic variations in the newborn.
Camila Bueno, pediatric neonatologist at BP – Beneficência Portuguesa de São Paulo, adds that it can also happen due to “low calorie intake or dehydration”.
Although breast milk may be related, temporarily withholding breastfeeding is not recommended, as it may impair exclusive breastfeeding.
It is noteworthy that breastfeeding brings a series of benefits to the child. According to the Ministry of Health, it reduces the risk of diabetes, hypertension, hypercholesterolemia (increased cholesterol) and obesity in adult life. Furthermore, it helps with cognitive, face and speech development, for example.
Severe consequences of jaundice
Although, most of the time, it is physiological (simple) jaundice, it can also occur due to a pathological process and reach extremely high concentrations of bilirubin – before 24 hours of life.
Among these processes are liver, biliary or metabolic abnormalities, infections, blood incompatibility (mother type O and baby type A or B, or mother RH negative and baby RH positive), prematurity and others.
“Newborns with these factors can develop jaundice early (before 24 hours of life) and, if not treated in time, this yellowish pigment can impregnate the brain and bring consequences to the baby’s neurological and psychomotor development”, warns Amanda .
According to Giuliana, human beings have a blood-brain barrier responsible for preventing or hindering the passage of substances from the blood to the central nervous system.
However, the younger the age group, the more this structure is permeable to bilirubin.
“With very high levels [de bilirrubina], the substance passes this barrier and there is a risk of cerebral impregnation, resulting in neurotoxicity. This is the main consequence of neonatal hyperbilirubinemia, leading to an acute encephalopathy, which can be followed by a variety of neurological deficits, including cerebral palsy and sensory and motor deficits”, he warns.
There is also the possibility that the baby will develop acute bilirubin encephalopathy with lethargy. [profunda e prolongada inconsciência]hypotony [diminuição do tônus muscular] and weak sucking in the first days of life.
This condition may be reversible if treated quickly and aggressively. However, most of the time, it progresses to kernicterus, a chronic form of the disease, with permanent neurological sequelae.
“Some cases can cause seizures and even cause the baby’s death. There are still patients who face, as a result of kernicterus, mental retardation, cerebral palsy and hearing loss. In milder cases, learning disorders and problems in motor coordination may occur. ’ says Camilla.
*Intern at R7under the supervision of Giovanna Borielo
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