Жовтуха новонародженого: причини, лікування, наслідки

Жовтуха новонародженого: причини, лікування, наслідки

Жовтуха новонародженого: причини, лікування, наслідки

Нерідко, перебуваючи в пологовому будинку, матусі помічають, що шкіра новонародженого набуває жовтуватий відтінок. А якщо при цьому чують від лікуючого дитячого лікаря незрозумілу фразу: «У вашого малюка желтушка», – починають судорожно вишукувати ознаки захворювання у свого малюка, з’ясовувати, не заразився він.

Перш ніж торкатися теми жовтяниці потрібно чітко знати, що це за стан і від чого буває жовтяниця у новонароджених.

Жовтуха – це стан, при якому в крові підвищується рівень білірубіну, який відкладаючись в тканинах, надає шкірі, слизових і білкам очних яблук відтінок від лимонного до апельсинового кольору.

Білірубін – це пігментну речовину, яка утворюється при розпаді червоних кров’яних тілець (еритроцитів) у крові і виводиться з організму за участю спеціальних ферментів вироблюваних печінкою. Цей процес триває постійно в організмі кожної людини. Але у новонародженої дитини, в силу ряду його фізіологічних особливостей, білірубін утворюється в підвищеній кількості і виводиться більш повільно. Існує безліч причин призводять до збільшення рівня білірубіну, але основними з них можна вважати:

    підвищене число особливих еритроцитів, необхідних для повноцінного функціонування плода внутрішньоутробно в умовах пониженого вмісту кисню і їх йнування при народженні дитини, з надмірною звільненням пігменту білірубіну; функціональну незрілість печінки малюка, в силу чого спостерігається дефіцит спеціального білка, забезпечує перенесення білірубіну через мембрани печінкових клітин і його виведення з організму.

Тому в нормі у багатьох новонароджених дітей може бути жовтяниця, звана фізіологічної. З’являється фізіологічна жовтяниця зазвичай на третій-четвертий день після народження дитини. Жовтушність шкірних покривів зберігається приблизно 2-3 тижні, потім інтенсивність жовтяниці поступово зменшується. У недоношених дітей жовтяниця може зберігатися до місяця, іноді на довший термін. Фізіологічна жовтяниця новонароджених не заразна, загальний стан дітей не страждає. Фізіологічна жовтяниця новонароджених, як правило, не потребує будь-яких лікуванні і проходить без стороннього втручання.

Сприяє більш інтенсивному наростанню рівня білірубіну пізніше (пізніше доби) відходження меконію (первородного калу), голодування чи переохолодження дитини. Тому найкращою профілактикою і лікуванням фізіологічної жовтяниці новонароджених є ранні і часті годування груддю. Молозиво, або «раннє молоко» перших кількох днів, діючи як проносне, допомагає швидше вийти меконію і, як наслідок, сприяє більш швидкому виведенню з організму білірубіну. Тому в нашому пологовому будинку співробітники намагаються докласти всіх зусиль для раннього відновлення природного процесу грудного вигодовування. Активно практикується раннє прикладання до грудей, починаючи з пологового залу; спільне перебування матері та дитини з перших годин життя (при хорошому стані обох і відсутності протипоказань); по можливості раннє «об’єднання» жінки після операції кесаревого розтину з її малюком.

Іноді, найчастіше у дітей з хорошою збільшенням ваги і великою кількістю молока у матері, жовтяниця з’являється після 1-го тижня життя. Це теж різновид фізіологічної жовтяниці, але зустрічається вона набагато рідше (приблизно 1% випадків) і пов’язана з прийомом молока матері. Причина в тому, що грудному молоці можуть у великій кількості містяться речовини – естрогени, що перешкоджають природному виведенню з організму білірубіну або навіть підвищують його зворотне всмоктування. У разі якщо підозрюється саме цей варіант перебігу жовтяниці, необхідно припинити грудне вигодовування на 24 -48 години. Зменшення рівня білірубіну в крові немовляти після перерви в грудному вигодовуванні підтвердить діагноз. У цьому випадку необхідно буде відлучити малюка від грудей на кілька днів і годувати зцідженим, пастеризованим на водяній бані протягом 5 хвилин грудним молоком.

Однак батькам слід знати, що крім фізіологічної жовтяниці, є ще і патологічна жовтяниця. Це найбільш часта патологія характерна для періоду новонародженості. За даними нашого пологового будинку патологічну жовтяницю переносять 50 -70 дітей з 1000 народжених. Причинами розвитку патологічної жовтяниці найчастіше є:

    гемолітична хвороба. пов’язана з несумісністю крові матері та новонародженого по групі і / або по резус-фактору. Виражена жовтяниця часто буває при наявності у матері першої групи крові, а у дитини – другий або (рідше) третьою; або у матері з негативним резус-фактором, при наявності у дитини позитивного. патологічна жовтяниця може бути раннім проявом різних вроджених інфекційних захворювань, що вимагають тривалого спеціального лікування. ще однією з причин розвитку патологічної жовтяниці є передчасне розродження. малюки, народжені від мам з цукровим діабетом, навіть з’явилися «тимчасово» під час вагітності (гестаційний цукровий діабет), більш схильні до появи вираженої і довгостроково поточної жовтяниці. іноді джерелом підвищеного вмісту білірубіну служать різні дрібні крововиливи у дитини. заглоченная кров, наприклад з тріщин сосків. введення матері під час пологів деяких ліків, наприклад окситоцину, а малюкові деяких антибіотиків (ампіцилін, цефазолін) може також спровокувати жовтяницю. батькам ж слід стривожитися, коли, разом з зберігається більше трьох тижнів жовтяницею, вони помітили, що у немовляти забарвлюється сеча і знебарвлюється стілець. Ці прояви можуть бути ознакою вродженого захворювання жовчних шляхів.

Будь патологічна жовтяниця зажадає проведення лікування. Основним методом лікування жовтяниці новонароджених в даний час є світлолікування – фототерапія. При фототерапії зазвичай використовуються спеціальні лампи, довжина світлових хвиль яких підібрана таким чином, що вони розщеплюють білірубін, перетворюючи його в нетоксичний похідне, яке вже через 10 – 12 годин інтенсивно виводиться з калом і сечею з організму дитини. Дуже гарне поєднання проведення фототерапії та збереження при цьому повноцінного грудного вигодовування. Тому в практику роботи відділень новонароджених нашого пологового будинку впроваджена методика проведення світлолікування дитини без «відриву» від матері (зберігається спільне перебування).

Однак у більш важких випадках при високому вмісті білірубіну в крові або недостатньої ефективності фототерапії для лікування може знадобитися проведення інфузійної терапії, а в особливо важких випадках застосовується операція замінного переливання крові.

Зустрічаються ситуації, коли потрібно тривалий час для отримання ефекту від проведених лікувальних заходів або необхідні додаткові методи обстеження, ретельний контроль і спостереження за дитиною. Тоді малюка переводять з пологового будинку в дитячий стаціонар. У таких випадках мамі і родичам потрібно чітко розуміти, що переклад це не «примха» лікуючого лікаря, а необхідна міра, оскільки існує небезпека негативної дії білірубіну на ще недосконалу центральну нервову систему немовляти.

Однак у більшості випадків середня тривалість лікування жовтяниці новонародженого досягає 96 годин. Тому при ефективно проведене лікування мама і малюк дуже скоро можуть бути виписані додому, і в найближчому часі відпаде необхідність ретельно вдивлятися в колір новонародженого і порівнювати його з ципленочка або лимончиком. А співробітникам відділення новонароджених пологового будинку залишиться тільки побажати їх маленьким пацієнтам та їх матусям щасливоїдороги, і чекати зустрічі з новими малюками.

Завідуючий відділенням новонароджених Ількевич Н. Г.

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