Nuclear jaundice is a pathological condition that can occur in newborns as a result of bilirubin intoxication.
The breakdown of hemoglobin and the release of bilirubin is a normal condition for a baby. However, physiology can turn into pathology if the liver is unable to cope with all the formed bilirubin.
Thus, if a part of bilirubin enters the bloodstream and has an irreparable toxic effect on the cells of a young organism. Mainly, bilirubin is dangerous for nerve cells and the brain, affecting them at the nuclear level. Damaged cells have an irreparable effect on the further development of the baby.
Statistics show that nuclear jaundice most often develops in premature babies. It is logical to assume that the predisposition and severity of the development of nuclear jaundice directly depends on the depth of prematurity. The clinical picture of nuclear jaundice in newborns is typical and pronounced.
ETIOLOGY AND PATHOGENESIS OF NUCLEAR JAUNDICE
Depending on the concentration of indirect bilirubin in the blood, the degree of destruction of the brain is determined. When the critical level of 425 mmol/ l is reached, nuclear jaundice develops. This criterion is calculated for a full–term baby, but in the case of a premature baby, the critical bar is reduced. The critical threshold is further reduced by generic hypoxia, the development of generalized infection. All these factors increase the permeability of brain cells to the penetration of indirect bilirubin into them.
A contributing factor in the development of nuclear jaundice is the development of hemolytic disease of newborns, directly related to the Rh conflict of mother and baby.
SYMPTOMS OF NUCLEAR JAUNDICE
Nuclear hemolytic jaundice develops on day 5-9. If a child has already developed hemolytic disease of newborns, jaundice makes itself felt already in the first 24 hours of life or on the second day.
The clinical picture of nuclear jaundice includes the following symptoms:
Rapid and sudden deterioration of the general condition of the child.
The most common symptoms are either apnea attacks or seizures of clonic seizures.
An external examination of the baby reveals hypertonicity of the extensor muscles.
A characteristic sign of nuclear jaundice is the appearance of a symptom of the “setting sun” – a sharp tilting of the head back.
With further increasing jaundice, opisthotonus develops and early signs of mental underdevelopment.
As a rule, in babies whose weight is less than 1000 grams, the clinical picture can be erased.
With the appearance of clinical symptoms of nuclear jaundice, organic brain damage is already irreversible.
TREATMENT OF NUCLEAR JAUNDICE
Depending on the severity of nuclear jaundice and the measures taken to eliminate it, the further development of the child may be limited to curable encephalopathy, as well as complete loss of vision or hearing, other organic lesions.
In the future, children with severe brain damage after nuclear jaundice are drowsy – they sleep constantly, mental activity is inhibited, the reaction to external factors is minimal.
Currently, nuclear jaundice is treated with phototherapy methods. Babies are placed under a special ultraviolet lamp (blue). Under the action of this lamp, the bilirubin in the blood is neutralized to a non-toxic product, then gradually eliminated from the body.
To prevent the development of pathological jaundice, all newborn children are subject to express determination of bilirubin levels. Children who fall into the risk group for the development of nuclear jaundice are prescribed a simultaneous injection of plasma, which dilutes the concentration of bilirubin in the blood, and also prescribe drugs that accelerate the elimination of bilirubin from the body. In particularly severe cases, blood transfusion is indicated for babies.
