infant bronze syndrome
Introduction
Introduction to infant bronze syndrome Infant bronze syndrome (bronzebabysyndrome) is a complication of phototherapy. In 1972, Kopeman first reported that a premature infant (body weight 1474g) was born 4 days after birth, because serum bilirubin reached 359.1mol/L (21mg%), direct bile The erythropoietin was 137 mol/L (8.0 mg%) and phototherapy was performed. After 48 hours, the skin was gray-brown, and the serum and urine were similar in color, and the name was bronze infant syndrome. basic knowledge The proportion of illness: 10% Susceptible people: good for babies Mode of infection: non-infectious Complications: ascites
Cause
Infant Bronze Syndrome
Increased direct bilirubin (35%):
Children with jaundice who have a significant increase in direct bilirubin, after treatment with phototherapy, cause bronze disease. The "bronze" pigment is biliverdin, bilirubin, etc., while direct bilirubin is more susceptible to oxidation to biliverdin, but " "Bronze" pigments not only exist in the skin, serum, liver, spleen, kidney, pericardium and ascites, so there is "bronze" pigment accumulation in the body.
Have liver damage (45%):
Because children have liver damage at the same time, bilirubin can not be excreted from the liver and gallbladder through the product of photooxidation, which is another condition for phototherapy to cause this disease.
Concomitant symptoms (20%):
When the child has both liver damage and elevated bilirubin, the phototherapy will be complicated by bronze. However, it is also believed that phototherapy has damage to the liver and causes this disease.
Prevention
Infant Bronze Syndrome Prevention
Prevention should pay attention to the situation, in the case of neonatal hyperbilirubinemia and direct increase in bilirubin, take a cautious approach to phototherapy, and check liver size and liver function (transaminase and alkaline phosphatase) ), such as liver function abnormalities, it is not appropriate to do phototherapy.
Complication
Infant Bronze Syndrome Complications Complications ascites
Hemolysis and liver damage.
Symptom
Infant Bronze Syndrome Symptoms Common symptoms Ascites hemolytic jaundice
After phototherapy, in addition to skin, serum, urine color changes brown, but also accompanied by hemolysis, that hemolysis is also caused by phototherapy, immature children due to less skin pigmentation, subcutaneous fat, low serum carotene concentration, red blood cells for phototherapy Sensitive and hemolysis, but there are also reports of thousands of premature infants who have received phototherapy. No photolysis has been found to cause hemolysis. Therefore, whether there is any internal relationship between hemolysis and bronze disease remains to be studied. Clak found liver and spleen at autopsy. The kidney, pericardium and ascites are all bronzed and the cerebrospinal fluid and brain parenchyma do not have this pigment, indicating that the "bronze" pigment itself does not cause damage to the nervous system. The connection between bronze disease and nuclear jaundice remains to be elucidated.
Examine
Examination of infant bronze syndrome
1. Blood examination of peripheral blood red blood cell count, hemoglobin content is reduced, blood smears can be seen broken red blood cells, abnormal red blood cells, etc., red blood cells appear in the peripheral blood, mainly late red blood cells, due to the appearance of reticulocytes and young red blood cells, it can be expressed Increased red blood cells, increased reticulocytes, up to 5%.
Serum total bilirubin increased significantly, direct bilirubin increased significantly, transaminase increased.
2. Urine examination showed a change in urine color and an increase in urinary biliary excretion.
3. Red blood cell life measurement is a reliable indicator for detecting hemolysis. The commonly used 51Cr, 3P-DFP or diisopropylfluorophosphate-labeled red blood cell method can reflect the index of red blood cell life. This measurement shows that the shortened red blood cell life indicates hemolysis.
According to clinical needs, choose B-ultrasound and other tests.
Diagnosis
Diagnosis and identification of infant bronze syndrome
According to the clinical jaundice, after the phototherapy, the skin and urine color are brown, and it can be diagnosed with hemolysis.
It is mainly necessary to identify the cause of jaundice and to provide reasonable guidance for treatment.
