neonatal jaundice
Introduction
Introduction to neonatal jaundice Medically, the jaundice of newborns under the full moon (28 days of birth) is called neonatal jaundice. Neonatal jaundice refers to the neonatal period, due to abnormal bilirubin metabolism, causing elevated blood bilirubin levels. For diseases characterized by skin, mucous membranes and scleral jaundice, the disease is physiologically and pathologically divided. Physiological jaundice occurs 2 to 3 days after birth, peaks at 4 to 6 days, resolves 7 to 10 days, and premature infants last longer. There are no other clinical symptoms except for mild appetite loss. If jaundice occurs 24 hours after birth, daily serum bilirubin rises more than 5mg/dl or >0.5mg/dl per hour; duration is long, full-term children >2 weeks, premature infants >4 weeks still do not retreat, even Continue to deepen after aggravation or relapse, or appear within a week to a few weeks after birth, are all pathological jaundice. basic knowledge The proportion of illness: 80% Susceptible people: infants and young children Mode of infection: non-infectious Complications: congenital biliary atresia in newborns
Cause
Neonatal jaundice
Congenital factors (25%):
The same family of immune hemolysis, such as Rh blood group incompatibility, ABO blood group incompatibility, other blood types are incompatible. Erythrocyte enzyme defects such as glucose-6-phosphate dehydrogenase (G-6-PD) deficiency and the like. Abnormal erythrocyte morphology such as hereditary spherocytosis, hereditary elliptic polycythemia, hereditary polycythemia, and infant erythrocytosis.
Disease factors (20%):
Hemoglobin diseases such as thalassemia. Polycythemia such as mother-child-placenta, blood transfusion between twins, intrauterine growth retardation, infants of diabetic mothers, etc., can cause increased red blood cells and increased damage. Hemorrhage in the body such as head hematoma, subcutaneous hematoma, intracranial hemorrhage, etc.
Bacterial infection (20%):
Both infected bacteria and viral infections can cause hemolysis, and common intrauterine infections such as cytomegalovirus, Epstein-Barr virus, and parvovirus B19 can cause blood. Severe infections such as sepsis, pneumonia, meningitis caused by bacterial infections such as Staphylococcus aureus and Escherichia coli.
Drug factors (15%):
It can induce erythrocyte membrane defects and cause hemolytic anemia, such as sulfonamide, furantanidine, terpene, salicylate, vitamin K3, camphor, berberine, etc., which can induce hemolysis in neonates with G-6-PD deficiency. . When the pregnant mother delivers a large amount of oxytocin and glucose solution before delivery, the fetus can be in a hypotonic state, resulting in increased red blood cell permeability and fragility and hemolysis.
Prevention
Neonatal jaundice prevention
The prevention and care of neonatal jaundice should pay attention to the following points:
1, fetal yellow often suffer from hot and humid invasion of the pregnant mother and affect the fetus, resulting in fetal fetal yellow after birth, so during pregnancy, pregnant mothers should pay attention to diet, but eat cold, but hungry, and avoid alcohol and hot The product to prevent damage to the spleen and stomach.
2. If a woman has had a baby with fetal yellow, she should be prevented from pregnancy and take Chinese medicine on time.
3, the baby is closely observed after the birth of the sclera jaundice, found that jaundice should be treated as soon as possible, and observe the change of jaundice color to understand the advance and retreat of jaundice.
4, pay attention to observe the fetal systemic symptoms of fetal yellow, with or without mental wilting, lethargy, difficulty in breast-feeding, convulsions, strabismus in both eyes, limbs or convulsions in order to facilitate early detection of severe cases.
5, close observation of heart rate, heart sounds, degree of anemia and liver size changes, early prevention and treatment of heart failure.
6, pay attention to protect the baby's skin, umbilical and buttocks clean, to prevent damage.
7. When blood transfusion therapy is needed, the air in the hospital should be disinfected in time, and all blood and various drugs, articles, and strict operating procedures should be prepared.
Complication
Neonatal jaundice complications Complications Neonatal congenital biliary atresia
Sepsis, neonatal pneumonia, biliary atresia, breast milk jaundice.
Symptom
Neonatal jaundice symptoms Common symptoms Skin sclera yellow-stained neonatal breastfeeding... Physiological jaundice nuclear jaundice biliary atresia
First, medical history
1, the occurrence of jaundice within 24 hours of the occurrence of common sputum should first consider neonatal hemolysis, followed by CMV and other congenital infections; 2 to 3 days of physiological jaundice is the most common, ABO hemolytic should also be excluded; 4 ~ Seven days of sepsis, breast milk jaundice is more common; 7 days after the presentation of jaundice, sepsis, neonatal pneumonia, biliary atresia, breast milk jaundice are possible.
2, the development of jaundice is the fastest in neonatal hemolysis, followed by the most sepsis, neonatal hepatitis and biliary atresia develop slowly and lasting.
3, the color of feces and urine is very light or gray, and the urine color is deep, suggesting neonatal hepatitis or biliary atresia.
4, family history family with patients with faba disease should consider whether G6PD deficiency disease; parents with hepatitis should be excluded from hepatitis.
5, pregnancy history, production history (premature rupture of membranes, prolonged labor, suggesting birth-time infection), history of medication before the mother.
Second, clinical symptoms:
1. Physiological jaundice is light yellow and limited to the face and neck, or affects the trunk. The sclera can also be yellow-stained. After 2 to 3 days, the skin color will disappear. On the 5th to 6th, the skin color will return to normal. The severe jaundice will also be the first and the second. It can be used throughout the body, and vomit and cerebrospinal fluid can also be yellow-stained for more than 1 week. Especially for some premature infants, it can last for 4 weeks. The feces are still yellow and there is no bilirubin in the urine.
2, the yellow color is light, the color is darker, but the skin is ruddy, the yellow is red.
3, the jaundice is more common in the trunk, the sclera and the proximal extremities are generally not elbows.
4, the general condition of the newborn is good, no anemia, liver and spleen is not swollen, liver function is normal, no jaundice occurs.
5, physiological jaundice in premature infants is more common than full-term children, can be slightly delayed 1 ~ 2d, jaundice is heavier, and the regression is later, can be extended to 2 to 4 weeks.
Examine
Neonatal jaundice examination
an examination
1, serum bilirubin multiple measurements: gradually increased suggestive of biliary atresia, if there is fluctuation or irregular decline suggesting hepatitis.
2, serum aminotransferase: early increase in the test is prompted for hepatitis.
3, other laboratory tests: serum 5'-nucleotidase significantly increased suggestive of biliary atresia; serum alpha-fetoprotein > 40mg / L suggest hepatitis; duodenal drainage fluid containing bile or bile acid can reduce external biliary atresia; lipid Protein-X (LP-X) positive patients suggest biliary atresia.
4, intravenous injection 131I rose red 37 ~ 148MBq (1 ~ 4Ci), collect 3 days of feces (can not be mixed with urine) to measure counts per minute, such as > 10% of the injection can eliminate biliary atresia.
5, radionuclide liver, biliary scan: intravenous injection of 99m labeled iminodiacetic acid (IDA) derivative after scanning, liver development of children with hepatitis is slow and radioactive concentration in the intestine, biliary atresia in children with liver development appears fast The intestine does not develop.
6, B-ultrasound: can be found in the total biliary duct cyst, such as no gallbladder suggestive biliary atresia.
7, liver biopsy: liver structure is basically normal, a large number of bile duct hyperplasia suggest biliary atresia; hepatic lobular structure disorder, hepatocyte necrosis, multinucleated giant cells are easy to see suggestive of hepatitis.
8, exploratory laparotomy: strive to be implemented within 2 months, such as no gallbladder should be further explored; if there is gallbladder, gallbladder angiography should be performed, if abnormal, hepatic jejunostomy should be performed (the sooner the effect is better, at the latest no more than 3 months).
Diagnosis
Diagnosis and diagnosis of neonatal jaundice
Diagnostic identification
Fecal pigmentation should be considered for neonatal hemolysis and sepsis:
1. If there is infection and poisoning, blood and urine culture should be carried out.
2, if there is hemolysis (reticulocyte growth, nucleated red blood cells > 2 ~ 10/100 white blood cells), should check the maternal and child ABO and Rh blood type, anti-human globulin test positive is Rh blood group incompatibility; ABO hemolytic disease The antibody release test is positive, and those who are negative in the above test or those who develop after 3 or 4 days of birth should be excluded from the G6PD defect.
Neonatal hemolysis: The onset time of jaundice is within 24 hours after birth or the next day, lasting for one month or longer, with elevated unconjugated bilirubin. For hemolytic anemia, liver and spleen, maternal and child blood type incompatibility, severe cases of bilirubin encephalopathy.
Neonatal sepsis: The onset time of jaundice is 3 to 4 days or later after birth, lasting 1-2 weeks, or longer, the early unconjugated bilirubin is mainly increased, and the late combined bilirubin is mainly hemolytic. Late and hepatocellular, infected with symptoms of poisoning.
Breast milk jaundice: The starting time of jaundice is 4 to 7 days after birth, lasting about 2 months, with unconjugated bilirubin elevated, no clinical symptoms.
Physiological jaundice: The onset time of jaundice is 2-3 days after birth, lasting for about 1 week, mainly with unbound bilirubin, hemolytic and hepatocellular, no clinical symptoms.
G-6-PD deficiency: The starting time of jaundice is 2-4 days after birth, 12 weeks or longer, and the increase of unconjugated bilirubin is mainly caused by hemolytic anemia.
Neonatal hepatitis: The onset time of jaundice is several days to several weeks after birth, lasting for 4 weeks or longer, combined with increased bilirubin, obstructive and hepatocellular, dynamic changes in jaundice and stool color, and elevated GPT The hormone can be yellowed.
