Neonatal jaundice is a common pediatric disease, generally divided into physiological jaundice and pathological jaundice. Under normal circumstances, there is no need to worry about physiological jaundice, and the duration will not exceed 2 weeks. However, pathological jaundice should be vigilant, and metabolic diseases may occur, so you should see a doctor immediately.
Overview of jaundice In
medicine , the jaundice of a full-moon baby (within 28 days of birth) is called neonatal jaundice, which refers to the abnormal bilirubin metabolism in the neonatal period, which leads to elevated serum bilirubin levels, jaundice of the skin, mucous membranes and sclera. disease. The main effects of jaundice on infants include bilirubin encephalopathy, anemia, hypovolemic shock, liver function damage and failure, septic shock, etc. The specific effects are related to the etiology and severity of the disease. Physiological jaundice occurs 2 to 3 days after birth, peaks at 4 to 6 days, and subsides at 7 to 10 days. In the early stage of jaundice, the baby has no other clinical symptoms except for a slight loss of appetite. If jaundice occurs within 24 hours after birth, it may not subside within 2 to 3 weeks, and may even continue to deepen and worsen, and recur after subsidence, or begin to appear within one to several weeks after birth, all of which are called jaundice. pathological jaundice.
Classification of neonatal jaundice
jaundice Physiological jaundice refers to the gradual increase of serum bilirubin from 17 μmol/L (1-3 mg/dl) to 86 μmol/L (5 mg/dl) 24 hours after birth; or Higher than clinical jaundice, without other symptoms, and subsided within 1 to 2 weeks. The normal value of serum bilirubin in full-term neonates does not exceed 205 μmol/L (12 mg/dl), and the normal value of serum bilirubin in premature infants does not exceed 257 μmol/L (15 mg/dl). Mild physiological jaundice is limited to the face and neck, may spread to the trunk, and generally appears light yellow; there are no obvious abnormalities in mental status, feeding, defecation, development, sleep, etc., and the sclera appears yellow for 2 to 3 days, which can subside. After 5-6 days, the skin color returned to normal.
Pathological jaundice is caused by excessive production of bilirubin, mainly due to erythrocytosis, hemolysis, infection, and lack of vitamin E. The second is that the metabolism of bilirubin in the liver is blocked, and the biliverdin in the blood cannot be removed in time. In addition, obstruction of bile excretion can also lead to hyperbilirubinemia. Most of the causes are biliary obstruction, hepatitis, or metabolic defects in early infants, and jaundice occurs within 24 hours after birth. Pathological jaundice is golden, or spreads all over the body, such as obvious jaundice on the palms and soles; or serum bilirubin is greater than 12-15 mg/dl. Pathological jaundice is persistent, and will persist or even deepen after 2 to 3 weeks of birth, or deepen after remission; the child is accompanied by anemia or pale stool, abnormal body temperature, loss of appetite, and vomiting. When pathological jaundice occurs, attention should be paid. In addition, when the concentration of unconjugated bilirubin reaches a certain level, it can pass through the blood-brain barrier and damage brain cells (commonly known as kernicterus), which may lead to death or cerebral palsy in children. Therefore, parents should closely observe the changes of their children’s jaundice, and if they find signs of pathological jaundice, they should be sent to the hospital for diagnosis and treatment in time.
jaundice The most common cause of hemolytic jaundice is ABO hemolysis, which is caused by blood group incompatibility between the mother and fetus. But not all newborns with ABO system incompatibility will have hemolysis. According to reports, the incidence of hemolysis in ABO incompatible neonates was 11.9%. Hemolytic jaundice of the newborn is characterized by jaundice that develops within the first 24 hours of life and gradually worsens.
Infectious jaundice is caused by viral or bacterial infection, which mainly damages the function of liver cells. Viral infections are mainly intrauterine infections, among which cytomegalovirus and hepatitis B virus infections are the most common, while other infections such as rubella virus, EBV and toxoplasmosis are relatively rare. Septic jaundice is the most common bacterial infection and is characterized by persistent jaundice following physiologic jaundice, or reappearing after physiologic jaundice resolves.
Obstructive jaundice is mainly caused by congenital biliary malformations, such as congenital biliary atresia, which is caused by bilirubin infiltration into the intestinal wall, swelling and hardness of the liver and spleen, and requires early surgical treatment. When bile stagnation exceeds 12 to 13 weeks, the effect of surgery is not good. The characteristic of jaundice is that jaundice appears 1 to 4 weeks after birth, gradually deepens, and the color of stool gradually changes to light yellow, or even white or clay-colored.
This is a special pathological jaundice that usually occurs in newborns who are exclusively or exclusively breastfed. Breastmilk jaundice clinically has two types: early-onset and late-onset. When healthy full-term breastfed infants develop hyperbilirubinemia 3 to 4 days after birth, early-onset breastmilk jaundice should be considered after hemolytic disease and other diseases are excluded. The peak of jaundice in late-onset patients is usually 7-10 days after birth, and it lasts for 6-12 weeks before it completely subsides. Generally, children with normal growth and development, no anemia, and normal liver function.
Nursing measures for neonatal jaundice
Pay close attention to the color of the newborn’s skin, mucous membrane and sclera, as well as the mental state, breastfeeding and stool color, and deal with any abnormalities in time. During the hospitalization, bathe the newborn every day to keep the skin clean; do a good job of cleaning and nursing the buttocks to prevent the occurrence of red buttocks; take good care of the umbilical cord, wipe the umbilical cord twice a day with 0.75% diluted iodine tincture; wipe the umbilical cord for 3 days after it falls off, Prevent omphalitis.
Dietary Nursing The morning and evening when
newborns defecate have a great relationship with the content of bilirubin. Therefore, encourage breastfeeding as soon as possible and strengthen feeding. After the child urinates and defecates more frequently, it can promote the excretion of bilirubin through urine and feces. When breastfeeding, it can be given in small amounts and multiple times to increase the gastrointestinal motility of newborns and promote defecation.
In clinical nursing, it is necessary to do a good job in postpartum health education and postpartum visits, shorten the appearance time of physiological jaundice, and timely detect and treat pathological jaundice. After the puerpera gives birth, early breastfeeding is advocated to strengthen the intestinal peristalsis of the newborn, promote the smooth excretion of feces, and reduce the enterohepatic circulation of bilirubin and the total amount of bilirubin. When breastfeeding, feed more water and excrete bilirubin through urine. If the jaundice is not significantly relieved after a week, you can use a small dose of traditional Chinese medicine to help the liver clear the jaundice. Most jaundice disappears within two weeks, so get checked out if it doesn’t.
Neonatal jaundice treatment measures
Phototherapy is the “standard” treatment for neonatal jaundice, which can effectively reduce serum bilirubin levels, is easy to use, and has few adverse reactions. This therapy is suitable for any indirect bilirubinemia with bilirubin > 205 μmol/L, using blue light (cold light source) with a wavelength of 420-460 mm for continuous or indirect irradiation for 24-48 h. During phototherapy, the neonate should be evenly irradiated. During single-sided phototherapy, the body position should be changed every 2 hours; during double-sided or multi-sided phototherapy, the condition of the newborn should be checked frequently to prevent injury.
Drug therapy Treatment
with tin porphyrin, the only heme analog approved by the US Food and Drug Administration (FDA) for clinical use. Heme oxygenase (HO) is the rate-limiting enzyme that metabolizes heme to produce bilirubin. By inhibiting its activity, the production of bilirubin can be reduced. Tin porphyrin will not enter the brain tissue, has a wide range of safe doses, will not degrade in the body, and will not affect the excretion of indirect bilirubin in the liver. Undegraded heme blocked by tinporphyrin does not accumulate in tissues, but is excreted in its raw form by the liver into the biliary system and out through the intestine.
Neonatal jaundice is relatively common, and it is necessary to distinguish between physiological jaundice and pathological jaundice. Once pathological jaundice occurs, it should be treated in time to ensure the healthy growth of newborns.