DIFFERENTIAL DIAGNOSIS AND MANAGEMENT TACTICS OF JAUNDICE IN NEWBORNS
Abstract
Modern approaches to the treatment of neonatal jaundice have undergone significant changes over the past decades, which often leads to disagreements among neonatologists. This study aims to explore key controversies in differential diagnosis and management, based on the principles of evidence-based medicine. Several key factors have been found to increase the likelihood of developing significant neonatal hyperbilirubinemia (NH). These include birth before 38 weeks of gestation, and the presence of older children in the family who had neonatal jaundice, which required phototherapy. Also playing a critical role is insufficient feeding of exclusive breast milk and the appearance of noticeable yellowing of the skin in the first days after birth. These circumstances significantly increase the risk of elevated bilirubin levels in the newborn's blood, which may require medical intervention. Current understanding of the sources of jaundice associated with breastfeeding has undergone significant changes in recent years. Studies demonstrate that, provided adequate breastfeeding is provided during the first five days of a newborn's life, the intensity of jaundice does not show significant differences compared to formula-fed infants. In breastfeeding-associated jaundice, it has been confirmed that unconjugated bilirubin (UNB) levels naturally return to normal levels. It is recommended that newborns with jaundice be breastfed frequently, at least 8-12 times a day, including daytime and nighttime. This diet helps avoid calorie deficiency and dehydration, which in turn helps reduce the concentration of bilirubin in the blood. Maintaining adequate hydration and nutrition plays a key role in managing infants with neonatal jaundice. Oral administration of water or glucose is not effective in preventing or reducing serum bilirubin levels in hyperbilirubinemia. If full breastfeeding is difficult, it is recommended to supplement the newborn with expressed breast milk. The use of infusion therapy is justified only when the volume of breast milk consumed is insufficient to meet the daily fluid requirement.
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List of references
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