Introduction: neonatal jaundice refers to the neonatal period (since the delivery of the fetus umbilical cord ligation to 28 days after birth), due to the accumulation of bilirubin in the body and lead to increased levels of bilirubin in the blood and the emergence of the skin, mucous membranes and sclera yellow staining as a characteristic of the disease, the disease is divided into physiological jaundice and pathological jaundice. Physiological jaundice in full-term infants appears 2-3 days after birth, peaks in 4-5 days, subsides in 5-7 days, and does not exceed two weeks at the latest; it lasts longer in preterm infants, and there are generally no other clinical symptoms except for a slight loss of appetite. Here we see what the symptoms of neonatal jaundice are.
I. Symptoms of neonatal jaundice
1. Excessive bilirubin production
Neonatal bilirubin is a decomposition product of hemoglobin, about 80% of which is derived from hemoglobin, and about 20% of which is derived from hemoglobin and other tissues of liver and bone marrow in the erythrocyte precursors. The daily production of bilirubin is significantly higher in neonates than in adults (8.8 mg/kg in neonates versus 3.8 mg/kg in adults.
2. Plasma albumin is not sufficiently able to link bilirubin
Bilirubin from the mononuclear phagocyte system enters the blood circulation, where it is linked to albumin and transported to the liver for metabolism. Bilirubin that associates with albumin cannot cross cell membranes and the blood-brain barrier causing cell and brain tissue damage. The newborns often have varying degrees of acidosis, which can affect the bilirubin-albumin linkage. In addition, the smaller the gestational age of the preterm infant, the lower the content of albumin, and the lower the amount of bilirubin linkage.
3. Hepatocytes have a poor ability to process bilirubin
Unconjugated bilirubin enters the hepatocyte and combines with the Y and Z proteins in the endoplasmic reticulum in the light surface, mainly through the catalytic action of ureidosine diphosphoglucuronosyltransferase (UDPGT) to form a water-soluble, non-permeable conjugated bilirubin. Bilirubin, which is water-soluble and cannot pass through semi-permeable membranes, is excreted into the intestine via the bile. Neonates are born with very low levels of intracellular Y-protein (normal 5-10 days after birth) and low levels of uridine diphosphate glucuronosyltransferase (near normal 1 week after birth) and poor activity (0-30% of normal), so the amount of conjugated bilirubin produced is low.
2. What are the causes of neonatal jaundice
(1) erythrocytosis: i.e., venous blood erythrocytes >6×10^12/L, hemoglobin >220g/L, hematocrit >65%. It is common in mother-fetal or fetus-fetus transfusions, delayed umbilical cord ligation, congenital cyanotic heart disease and infants of diabetic mothers.
(2) Extravascular hemolysis: such as larger cranial hematomas, subcutaneous hematomas, intracranial hemorrhage, pulmonary hemorrhage, gastrointestinal hemorrhage, or hemorrhage from other sites.
(3) Homozygous immune hemolysis: seen in blood group incompatibility, such as ABO or Rh blood group incompatibility, etc. ABO hemolytic disease is common in China.
(4) hereditary diseases: erythrocyte 6.phosphate glucose dehydrogenase (G6PD) defects are common in the south of China, the incidence of kernel jaundice is higher; others, such as erythrocyte pyruvate kinase defective disease, globular erythrocytosis, galactosemia, αl antitrypsin deficiency, cystic fibrosis and so on.
(5) increased enterohepatic circulation: intestinal atresia, congenital pyloric hypertrophy, megacolon, hypothyroidism, starvation, and delayed feeding can delay the excretion of meconium and increase the reabsorption of bilirubin; the mechanism of breastfeeding jaundice is still not clear, and it may be related to the β-glucuronidase of breastmilk that enters into the intestines of the children, which increases the production of unconjugated bilirubin in the intestinal tract, and the test stops. If you try to stop breastfeeding for 3 to 5 days and the jaundice decreases or subsides, it will help you make a diagnosis.
Three, newborn jaundice health care
First, care
can be appropriate to more sun, absorb ultraviolet rays, it must be outdoors, bare leakage of part of the skin. In feeding, pay attention to drink more water, sugar water helps jaundice subside, if breast milk jaundice, need to suspend breastfeeding for 3 to 5 days. Closely observe the baby's skin color changes, jaundice are yellow from the head, from the feet start to recede, and the eyes of the earliest yellow and the latest receding.
Precautions for newborn jaundice:
Pay attention to whether your baby has grayish-white stools, once you find that the stools are white or getting lighter and lighter in color, and at the same time the skin is suddenly yellow, you must go to the hospital immediately.
Do not feed Chinese medicine containing ingredients such as Chuanlian and Lamei flower, especially for children with jaundice caused by "fava bean disease".
Observe the baby with fetal jaundice.
Diet
Breastfeeding mothers should pay attention to dietary hygiene, avoid alcohol and spicy food, and should not eat too much tonic food. If breastfeeding jaundice, you need to suspend breastfeeding for 3 to 5 days.
It is important to give the newborn sufficient water, too little urine is not conducive to the excretion of bilirubin.
Fourth, what is the prevention of neonatal jaundice
First, prevention:
1) Fetal jaundice is often due to the mother suffered from dampness and heat invasion of the fetus, resulting in fetal jaundice, the fetus was born, so the pregnant mother should pay attention to dietary hygiene during pregnancy, eating and drinking in a regular manner, but not eat cold, not too hungry and too full, and avoid alcohol and spicy hot products in order to prevent damage to the baby. The most important thing to remember is to avoid the use of hot and pungent products to prevent damage to the spleen and stomach.
2) If a woman has a history of hepatitis or has given birth to a baby with pathologic jaundice, it is advisable to measure the antibodies in the blood and their dynamic changes before delivery, and take appropriate preventive medication measures. During labor and delivery, the baby should be closely monitored and treated as soon as symptoms appear.
3) Couples with incompatible blood types (especially mother's blood type O and father's blood type A, B or AB), or mother's RH blood type is negative, should regularly do the relevant serology and amniotic fluid examination, and deliver the baby under close supervision, in order to prevent the occurrence of hemolytic disease in the newborn.
4) Babies should be closely observed for scleral jaundice right after birth to know the time of appearance of jaundice and the time of its subsidence, and should be treated as early as possible when jaundice is detected, and changes in the color of jaundice should be observed to know the progression and regression of jaundice.
5) Newborns pay attention to warmth, early start to open the milk.
2. Other precautions:
1) Observe the general symptoms of fetus yellow babies, whether there is depression, lethargy, difficulty in sucking milk, alarm and restlessness, squinting, limb straightening or convulsions, in order to find out early and timely treatment of serious illnesses.
2) Closely observe the heart rate, heart sounds, the degree of anemia and liver size changes, early prevention and treatment of heart failure.