Hepatitis vaccinations for newborns!!!

Jaundice in newborns

It happens that on the second or third day after birth the child turns yellow. This is not a pathology, it is a natural process that occurs due to the baby’s adaptation to environmental conditions. And it is called physiological jaundice. Let's figure out what jaundice is and how it develops.

Jaundice is a symptom, not a disease. And it is not the condition that needs to be treated, but the cause that caused the condition.

Human blood contains red blood cells - red blood cells, designed to transport oxygen and carbon dioxide in the body. The period of their existence is 120 days, after which they die. Thus, every day, 1% of the total pool of red blood cells is destroyed. During the destruction process, metabolic products are released into the blood. One of them is the pigment bilirubin, which gives the skin its yellow color. Bilirubin is toxic to the body, so it neutralizes it and removes it with the help of the liver. In it, liver enzymes neutralize, and the pigment is excreted through the intestines. If this process is disrupted, bilirubin levels rise, resulting in jaundice.

Physiological jaundice of newborns

And now about a specific condition - jaundice in newborns. She is not dangerous. Immediately after birth, a large amount of fetal hemoglobin breaks down in the baby’s body, resulting in the release of a lot of bilirubin into the blood. And the liver enzymes necessary to neutralize bilirubin have not yet matured in the liver. Therefore, 50-60% of newborns develop physiological jaundice 2-3 days after birth. It takes time for the liver to learn how to neutralize and eliminate bilirubin. The likelihood of development is higher in premature babies and is 80-90%. And that's okay.

• How can I understand that my child has physiological jaundice? Isn't it dangerous jaundice?

Only a doctor can accurately determine the cause of jaundice and the degree of danger. However, it is worth knowing that with physiological jaundice, the yellowness of the sclera, skin and mucous membranes is not accompanied by other symptoms. With jaundice caused by other causes, the baby does not feel well, cries, eats poorly, and does not gain weight.

• Is it possible to get vaccinated against hepatitis B with physiological jaundice?

Neonatal jaundice does not appear to be a contraindication for hepatitis B vaccine or other vaccinations.

• Does physiological jaundice affect the child’s condition in the future?

No, newborn jaundice does not affect the baby’s health in any way.

Features of the treatment of jaundice in newborns

In most cases, jaundice goes away within 2-3 weeks. Complications from such jaundice occur extremely rarely, however, an excessive increase in bilirubin (especially indirect) is dangerous due to toxic effects, and the lack of appropriate treatment can lead to adverse consequences.

The doctor takes into account all the associated factors in order to plan the frequency of examinations and determine the risk of an increase in bilirubin:

• current bilirubin content;
• presence of prematurity;
• child's activity and appetite;
• mother's lactation level;
• hereditary predisposition to severe jaundice.

Treatments to reduce bilirubin levels in the blood may include the following.

• Phototherapy. The child is placed under special lamps with high-intensity blue-green spectrum light. Such light has the ability to transform the structure and shape of indirect hemoglobin so that it becomes water soluble, sufficient for its disposal in urine and feces. This procedure is harmless, since the ultraviolet spectrum is blocked by a special filter and does not reach the baby’s skin.
• Intravenous injections of immunoglobulin. If the cause of jaundice is incompatibility between the blood of mother and child, intravenous administration of immunoglobulin can be used. This method will help reduce the level of antibodies. This may be enough.
• Blood transfusion. It is used to quickly reduce bilirubin and is performed in the intensive care unit. A certain volume of blood is taken from a child with high bilirubin levels, and at the same time donor blood with normal levels is injected. This reduces bilirubinemia and normalizes hemoglobin.
• Plasmapheresis. This method is applicable in complex medical cases. Repeated small volumes of blood are taken from the child, purified from plasma with high levels of bilirubin and antibodies, diluted with saline or donor plasma and injected back intravenously. Like transfusion, plasmapheresis is very effective. However, both methods are carried out in extreme cases, for example, when hemolytic disease is present.
• If jaundice is not severe, you can get by with some dietary changes. More frequent feedings stimulate the activity of bowel movements, due to which bilirubin is excreted more actively.
Remember that only a doctor can determine whether jaundice in a newborn is pathological or normal. In any suspicious cases, make an appointment with your pediatrician!

Jaundice of a newborn: should it be treated?

Typically, the following factors contribute to severe jaundice:

• prematurity
• immaturity
• presence of hemorrhages on the skin
• breast-feeding
• incompatibility of blood between mother and child

Normal physiological jaundice does not require treatment and can go away on its own within 3-4 months from birth. It is important to provide the baby with comfortable living conditions and establish feeding.

If the doctor has identified a risk of severe jaundice, then additional tests and studies will be prescribed, and supplemental feeding and feeding may also be prescribed. If severe jaundice is detected, the baby will be hospitalized and treated in a hospital.

Typically, severe jaundice is treated with light or phototherapy. The child is placed under special lamps, the light of which is very intense and has a blue-green spectrum. It is important to understand that this is not ultraviolet radiation, the procedure is absolutely safe for the baby. The mechanism of action is that under the influence of powerful light from the lamp, the shape and structure of indirect bilirubin changes and it turns into water-soluble. This is enough for bilirubin to begin to be excreted from the body in urine and feces, bypassing the liver.

If this treatment does not help, the doctor decides to use other types of therapy.

Decoding indicators

Antibodies to the surface antigen of the hepatitis B virus (Anti-HBs Ag) can be detected at the end of the acute period, usually 3 months after the onset of infection, but sometimes later (up to a year).
Antibodies to the surface antigen neutralize the virus, their presence is considered a sign of immunity. Anti-HBs Ag are detected for a long time, can persist for life and indicate the presence of infection (current or previous) or post-vaccination immunity.

When quantifying anti-HBs Ag:

• Anti-HBs below 10 mIU/l - vaccination against hepatitis B is indicated;
• Anti-HBs 10-100 mIU/l - vaccination should be postponed for 1 year;
• Anti-HBs more than 100 mIU/l - vaccination is not indicated; re-examination is recommended after 5 years.

Antibodies of the IgM class (anti-HBc IgM) are detected at the beginning of the acute phase of the disease 1-2 weeks after detection of HBsAg, sometimes at the end of the incubation period.
They reach maximum values ​​2-3 months after HBsAg is detected. IgM antibodies circulate in the blood for several months until recovery, and then disappear, which is considered a sign of cleansing the body of the virus. Detection of anti-HBc IgM indicates active reproduction of the virus, the presence of an acute infection, especially if the result is negative for HBsAg, and in some cases, chronic hepatitis B.

If anti-HBc IgM is detected, the answer is “positive”, if they are absent - “negative”, with very low values ​​(“gray zone”) - “doubtful, we recommend repeating in 10-14 days”. A negative anti-HBc IgM result does not exclude the presence of acute or chronic hepatitis.

Antibodies to HBcAg of the IgG class appear in the acute period almost simultaneously with anti-HBc IgM, reach maximum values ​​5-6 months after detection of HBsAg and persist throughout life. Anti-HBc IgG is a marker of chronic or past infection caused by the hepatitis B virus.

If total anti-HBc antibodies are detected, the answer is “positive”; if they are absent, the answer is “negative”. A positive result indicates the presence of hepatitis B. A negative result for total anti-HBc does not exclude hepatitis B.

Anti-HBe appears in the acute period, persists up to 5 years after the infection and indicates the active elimination of the hepatitis B virus from the body and minor infection. Their appearance is considered a sign of a favorable course of the disease, indicating a decrease in the rate of virus reproduction.

If anti-HBe is detected in the blood serum, the answer is “positive”; if they are absent, the answer is “negative” (qualitative test). A positive result indicates the presence of infection (acute hepatitis B convalescent phase or chronic hepatitis B, as well as chronic asymptomatic carriage of the hepatitis B virus).

A negative anti-HBe result does not exclude the presence of acute or chronic hepatitis.

Interpretation of the results of laboratory tests for antibodies to the hepatitis B virus is carried out only taking into account the identification of other markers of hepatitis. The table presents some criteria for laboratory diagnosis of several variants of the course of infection caused by the hepatitis B virus.

Breastfeeding during jaundice is beneficial

When breastfeeding, the baby must eat a lot and dirty the diaper often. This is due to the fact that colostrum has a laxative effect. With jaundice, this arrangement is very useful, because bilirubin leaves the body with feces and urine. The more the baby eats and the more often it is freed from waste products, the faster the jaundice goes away.

Moreover, early feeding is an excellent prevention of neonatal jaundice. In babies who immediately began to eat mother's milk, increased bilirubin occurs less frequently than in other children. And if jaundice appears, it goes away faster.

Conclusion: breastfeeding is useful for jaundice and helps the disease go away quickly and without consequences.

Interestingly, with phototherapy, the baby can be fed directly during treatment. To do this, you need to take the lamp with you to bed, shine the light on the baby and at the same time give him the breast. If you are treated at the IMT Medical Center, our doctors will show you how to best position your baby to feed him during the procedure.

Is physiological jaundice dangerous in infants?

Although the increase in bilirubin concentration in physiological jaundice is not caused by disease and goes away over time, hyperbilirubinemia is neurotoxic, that is, it causes damage to nerve cells in the child. For example, high concentrations of bilirubin in the blood can cause acute encephalopathy, accompanied by a variety of neurological disorders, including cerebral palsy and sensorimotor impairment. An even more severe consequence of the neurotoxicity of elevated bilirubin concentrations may be kernicterus, caused by the deposition of free (unconjugated) bilirubin in the basal ganglia and nuclei of the brain stem. Typically, bilirubin bound to serum albumin remains in the intravascular space, but sometimes it can cross the blood-brain barrier:

• With a high concentration of bilirubin in the serum (acute or chronic).
• When the concentration of serum albumin decreases (for example, in premature infants).
• When bilirubin is displaced from albumin by competitive binders (drugs:
• sulfisoxazole, ceftriaxone, aspirin) or free fatty acids and hydrogen ions (for example, in malnourished and starving children).

For neonates born at less than 35 weeks' gestation, the threshold bilirubin levels for treatment are lower because preterm infants are at greater risk of neurotoxicity.

Physiological jaundice

Physiological (benign) jaundice has common symptoms:

• never occur within the first 24 hours after birth
• bilirubin increases due to indirect (free) bilirubin
• the concentration of total bilirubin is no more than 265-290 µmol/l (according to various sources) on the third day of life (usually 86-103 mmol/l (AAFP, 2002)
• never lead to kernicterus
• not dangerous to the child's health
• do not require treatment
• THEY ARE NOT A CONTRAINDICATION TO VACCINATION

Among these harmless jaundices there are three types:

1. PHYSIOLOGICAL JAUNDICE OF NEWBORNS

Absolutely all newborns have it, but the degree of severity varies from mild yellowness of the sclera (the white part of the eyeballs) to obvious staining of the skin and mucous membranes.

MAIN REASONS:

• turning off the placenta
• low UDP-GT enzyme activity
• relatively high content of red blood cells in the blood
• high production of free bilirubin due to the short lifespan of red blood cells containing fetal hemoglobin
• immature processes of absorption and binding of bilirubin by liver cells
• increased absorption of bilirubin from the intestine and return to the bloodstream

IS NOT A CONTRAINDICATION TO VACCINATION

2. BREAST MILK JAUNDICE

(persistent benign hyperbilirubinemia)

In the United States, it occurs in 20-30% of newborns aged 3 to 4 weeks.

The reason has not been clearly established.

Possible reasons:

• neutralized bilirubin is excreted from the body with bile into the intestinal lumen. Breast milk contains components that promote the transition of bound bilirubin back to the unbound form and its absorption from the intestines into the bloodstream;
• Progesterone metabolites contained in breast milk can block the enzyme that converts free bilirubin into bound bilirubin.

• Appears at 1-2 weeks of life
• Can last 8-12 weeks
• Does not require discontinuation of breastfeeding

• Not dangerous to the child's health
• Goes away on its own and does not require treatment

IS NOT A CONTRAINDICATION TO VACCINATION

3. BREASTFEEDING JAUNDICE

(jaundice associated with lactation deficiency)

The reason is that a small volume of breast milk leads to insufficient intake of fluids and nutrients into the child’s body and, as a result, to a slow removal of bilirubin from the body.

• Occurs in the first week of life
• Not dangerous to the child's health
• Possible loss of more than 8-10% of body weight

• Breastfeeding needs to be established!
• Should not become a reason to cancel breastfeeding!!!
• IS NOT A CONTRAINDICATION TO VACCINATION

What to do:

• early breastfeeding in the maternity hospital
• feeding on demand
• excluding supplementation with water and formulas in order to normalize lactation.

If you have difficulties with breastfeeding or feeding techniques, seek help from a lactation consultant.