1. diligent observation
Infant jaundice is a disease that cannot be underestimated in newborns. Newborns should seek medical attention in time when the following situations occur.
Severe yellowing of the skin, loss of appetite (dislike of breast-feeding), yellowing of urine (direct yellowing of diapers), and listlessness (lack of strength to cry or cry)! Jaundice generally begins to appear in 2-3 days after birth, and is most obvious in 4-5 days, and then gradually weakens. It's basically gone in half a month!
2. Feed the baby with water regularly.
Newborn babies belong to physiological jaundice, so they should be fed more water, but not too much water each time. You can feed it several times. It is recommended to feed it every 2 hours, with a dose of about 20ml each time, and boiled water is the best! Drinking more water can speed up the frequency of urination and accelerate the elimination of jaundice!
Often bask in the sun
Be careful not to let your eyes get the sun. My practice is to cover my eyes with a cotton scarf, or face the sun sideways, or let the baby lie sideways in the mild sunshine!
Note that the best time to bask in the sun is 9:00-9:30 in the morning and 4:00-4:30 in the afternoon for 20 minutes each time. The sunshine is mild during this time and won't hurt the baby's skin! (In fact, this principle is to irradiate ultraviolet rays. )
Frequent eating
Try to breastfeed. At present, no milk powder can reach the composition of breast milk. Breast milk is a baby's best partner, which can enhance the baby's immunity. Regular and adequate breastfeeding can enhance your baby's physique and vitality! The baby's healthy constitution helps to get rid of the pain caused by jaundice as soon as possible!
Get enough sleep
This is mainly to provide a quiet and comfortable environment for the baby and help the baby fall asleep quietly. Generally, the baby is just born, and there are more people visiting, and many relatives and friends will hug it, which will affect the baby's rest!
It is easy to cause baby irritability, which is not conducive to baby recovery! When the baby is born, the mother had better sleep with him, which can increase the baby's sense of security and sleep more soundly!
Second, the causes of neonatal jaundice
1. Excessive bilirubin production.
Due to the destruction of excessive red blood cells and the increase of intestinal and hepatic circulation, free bilirubin in serum increased. The common causes are polycythemia, extravascular hemolysis, alloimmune hemolysis, infection, increased intestinal and hepatic circulation, lack of erythrocyte enzymes, abnormal erythrocyte morphology and hemoglobinopathy.
2. Liver bilirubin metabolism disorder
Due to the low function of liver cells to absorb and bind bilirubin, the free bilirubin in serum increases. Common causes are: hypoxia and infection, Krieger-Naggar syndrome, Gilbert syndrome, Lucy-driscoll syndrome, drugs (such as sulfanilamide, salicylate, indomethacin, pilocarpine C, etc. ) and congenital hypothyroidism.
3. Bile excretion disorder
Obstruction of liver cell excretion combined with bilirubin or bile duct obstruction can lead to high compound bilirubin, but if liver cell function is impaired at the same time, unconjugated bilirubin may also increase. The common causes are: neonatal hepatitis, congenital metabolic defect and bile duct obstruction.
Third, the symptoms of neonatal jaundice
1, fever
Neonatal jaundice often has symptoms of acute cholangitis, and the baby will also have symptoms of chills.
2. Abdominal pain
Jaundice accompanied by severe colic or pain in the upper abdomen is more common in biliary calculi, biliary ascariasis or liver abscess, primary liver cancer and so on. Most patients with viral hepatitis show persistent swelling and dull pain in the right upper abdomen; Liver abscess or liver cancer can also be manifested as dull pain or swelling pain in the upper abdomen or right upper abdomen.
3, itchy skin
Jaundice with skin itching is more common in cholestatic jaundice caused by intrahepatic and extrahepatic bile duct obstruction, such as choledocholithiasis, cancer or primary biliary cirrhosis, recurrent jaundice during pregnancy, etc. Some patients with hepatocellular jaundice can also be accompanied by skin itching, while hemolytic jaundice often has no skin itching.
4. Color of urine and feces
When obstructive jaundice occurs, the urine color is as deep as strong tea, and the stool color can be light. When the biliary tract is completely blocked, the stool is muddy. The urine of patients with hemolytic jaundice is like soy sauce color, and the color of feces is also deepened; However, in hepatocellular jaundice, the urine color is slightly darker and the stool color is yellowish.
5, loss of appetite, fullness in the stomach, nausea and vomiting.
If the baby still has viral hepatitis, jaundice will be accompanied by symptoms of nausea and vomiting.
Long-term aversion to greasy food or eating greasy food induces pain or colic in the right upper abdomen, mostly chronic gallbladder disease; When elderly patients with jaundice are accompanied by dyspeptic symptoms such as loss of appetite, they should be considered as cancer, often accompanied by progressive emaciation and even high malnutrition.
6, gastrointestinal bleeding
Jaundice with gastrointestinal bleeding is more common in liver cirrhosis, liver cancer, common bile duct cancer, ampullary cancer or severe hepatitis.
7. Jaundice color of sclera and skin
According to the color of jaundice, the cause or type of jaundice can be preliminarily judged. Scleral skin jaundice is lemon color, suggesting hemolytic jaundice; When it is light yellow or golden yellow, it is often suggested as hepatocellular jaundice; When it is dark yellow or yellow-green, it is often suggested that the longer the obstructive jaundice lasts, the more obvious the yellow-green jaundice is.
8. Other skin abnormalities
If there is pigmentation on the face and exposed parts of the skin, and there are manifestations such as liver palm, spider nevus, telangiectasia of neck and chest skin, varicose veins of abdominal wall, etc., it is often suggested that it is active hepatitis, liver cirrhosis or primary liver cancer. If the skin has itchy scratches, pigmentation and xanthoma of eyelid, it is often suggested as obstructive jaundice. Patients with hemolytic jaundice generally have light skin color.
9. Hepatomegaly
In viral hepatitis and acute biliary tract infection, the liver is slightly or moderately swollen, soft in texture, smooth in surface and often tender; The liver is slightly swollen, hard in texture, with irregular edges or small nodules on the surface, which is more common in patients with early cirrhosis and late cirrhosis. When the liver is obviously enlarged or gradually enlarged, the texture is hard, the surface is uneven, and there is a sense of nodules, it is often suggested that it is primary liver cancer.
10 with splenomegaly
Jaundice with splenomegaly is more common in viral hepatitis, various liver cirrhosis, liver cancer, hemolytic anemia, septicemia, leptospirosis and other diseases.
Fourth, the examination of neonatal jaundice
1. Bilirubin detection
It is an important index to diagnose neonatal jaundice, and the serum bilirubin concentration (TSB) can be determined by venous blood or trace blood. Percutaneous bilirubin analyzer is a noninvasive detection method with simple operation. There is a good correlation between transcutaneous bilirubin (TcB) and trace bilirubin. Because this method is influenced by the skin thickness and skin color of the measurement site, it may mislead the jaundice and can be used for screening. Once a certain threshold is reached, it is necessary to detect serum bilirubin.
2. Other auxiliary inspections
(1) Routine examination of red blood cells, hemoglobin, reticulocyte and nucleated red blood cells is necessary for neonatal jaundice, which is helpful for screening hemolytic disease of newborn. In hemolytic diseases, red blood cell count and hemoglobin decrease and reticulocyte increases.
(2) Blood types include the blood types of father, mother and newborn (ABO and Rh systems), which is very important, especially when the newborn is suspected to have hemolytic diseases. If necessary, further serum specific antibody examination will be helpful for diagnosis.
(3) The erythrocyte fragility test suspected that jaundice was caused by hemolysis, but excluded hemolytic diseases caused by blood group incompatibility, so this test can be done. If brittleness increases, hereditary spherocytosis and autoimmune hemolysis should be considered. If the brittleness is reduced, it can be seen in hemoglobin diseases such as thalassemia.
(4) The decrease rate of methemoglobin is normal >: 75%, and the deficiency value of G-6PD is decreased, so the determination of G-6PD activity should be further checked to make a definite diagnosis.
(5) Blood, urine and cerebrospinal fluid culture, serum specific antibody, C-reactive protein and erythrocyte sedimentation rate are suspected to be jaundice caused by infection. Blood, urine, cerebrospinal fluid culture, serum specific antibody, C-reactive protein and erythrocyte sedimentation rate should be done. The white blood cell count in routine blood tests increased or decreased, with toxic particles and the nucleus shifted to the left.
(6) The total bilirubin and conjugated bilirubin were measured by liver function test. Alanine aminotransferase is a sensitive method to reflect the damage of liver cells, and alkaline phosphatase can be increased when biliary obstruction or inflammation occurs in the liver.
(7) Abdominal ultrasound is a noninvasive diagnostic technique, especially suitable for newborns. Biliary system diseases, such as bile duct cyst, bile duct dilatation, gallstones, biliary atresia, absence of gallbladder, etc., can all show lesions.
(8) Electrophysiological examination of auditory and visual functions, including brainstem auditory evoked potential (BAEP), can be used to evaluate the functional state of auditory conduction nerve channels, predict brain damage caused by bilirubin poisoning at an early stage, and help to diagnose temporary or subclinical bilirubin neurotoxicity.