Neonatal jaundice is due to the accumulation of bilirubin (mostly unconjugated bilirubin) in the body and the skin, mucosa and sclera yellow staining, divided into physiological jaundice and pathological jaundice.
It's important to distinguish between types
1. Physiological jaundice jaundice generally appears within 2 - 3 days after birth, and reaches the peak in 4 - 5 days. In general, full-term infants subside within 2 weeks, and preterm infants can be postponed to 3-4 weeks.
2. Pathological jaundice appears early, usually within 24 hours after birth; the degree of jaundice is serious, serum bilirubin is more than 205.2-256.5 μ mol / L (12-15 mg / dl); jaundice progresses rapidly, serum bilirubin rises more than 85 μ mol / L daily; jaundice lasts for a long time, term infants > 2 weeks, premature infants > 4 weeks; jaundice regresses and reappears; serum bound bilirubin > 26.5 μ mol / L μmol/L（1.5 mg/dl）.
3. Nuclear jaundice is also known as bilirubin encephalopathy. Generally occurred in 2 - 7 days after birth, premature infants are more likely to occur. Clinical divided into warning period, spasm stage, recovery stage, sequelae stage.
Warning period: drowsiness, weak sucking power, low muscle tension, lasting for 12 - 24 hours.
Spasmodic manifestations: fever, staring at both eyes, increased muscle tension, convulsion, clenching fists with both hands, extension and internal rotation of both arms, and angular kyphosis. Most of them died of respiratory failure or pulmonary hemorrhage, lasting for 12-48 hours.
Recovery stage performance: convulsion reduced or disappeared, recovery of sucking ability, reaction improved, this period lasted for about 2 weeks.
Sequelae stage: it appears at 2 months or later after birth, which is characterized by athetosis, ocular dyskinesia, hearing impairment, enamel dysplasia, mental retardation, etc.
How to treat it?
Blue light therapy
The indirect bilirubin in blood can be decomposed into water-soluble bilirubin after illumination, which can be easily discharged from bile and urine. It is suitable for the treatment of neonatal hyperbilirubinemia caused by various reasons.
Methods: the naked children were put into the phototherapy box, and their eyes and perineum were covered. The wavelength of 425 - 475 μ m blue light was used to irradiate for 24 - 48 hours, and the longest was less than 96 hours. When bilirubin decreased to 20.4 μ mol / L, the irradiation was stopped.
What complications does neonatal jaundice have
The most serious complication is the possibility of bronze. After phototherapy, the skin of the infant appears cyan or grayish yellow green, and the serum and urine are similar in color. Even the liver, spleen, kidney, pericardium and ascites can have bronze pigment. Bronze disease is often seen in infants with high bilirubin, poor liver function or septicemia before phototherapy. Therefore, it is not suitable to use phototherapy when there are hepatocyte damage, obstructive jaundice and septicemia.
How to care
1. Condition observation: observe the progress and regression of jaundice, monitor the bilirubin value; observe the degree, range and change of skin yellow staining; pay attention to the color of urine and stool. Pay attention to the early manifestations of bilirubin encephalopathy, such as antifeedant, drowsiness and hypotonia;
2. Avoid inducing factors: avoid low temperature, hypoglycemia, asphyxia, hypoxia, acidosis, infection and other factors, and do a good job in keeping warm. Avoid using drugs that affect bilirubin metabolism, such as sulfonamides, indomethacin, etc;
3. Prevention of infection: strengthen the care of skin, mucous membrane, umbilical cord and buttocks, and wash hands before contacting children;
4. Others: keep the stool unobstructed. Avoid rapid infusion of hypertonic drug solution, so as to avoid temporary opening of blood-brain barrier and bilirubin into brain tissue.
