On December 30, the reporter learned from Zhongshan Bo'ai Hospital that in recent months, the number of cases of severe jaundice in newborns in Zhongshan Has increased sharply. Neonatal jaundice refers to the continuous removal of fetal hemoglobin by newborns, resulting in an increase in blood bilirubin levels and the appearance of yellow staining of the skin, mucous membranes and sclera.
Because physiological neonatal jaundice is very common, many people think that more sun exposure, feeding some corn whiskers, and eating some Chinese medicine can get better. It is not known that bilirubin has a certain toxicity.
"When bilirubin accumulates to a certain extent in the body, or there are high-risk factors such as premature birth, hemolysis, infection, acidosis and other high-risk factors in the baby, and parents do not pay attention to it, do not seek medical treatment in time or take inappropriate measures, it may cause serious complications, 'jaundice into the brain' causes bilirubin encephalopathy and regret for life, such lessons are not uncommon!" Chen Guangming, deputy chief physician of neonatals at Zhongshan Bo'ai Hospital, believes that it is necessary to strengthen the attention to the problem of neonatal jaundice.
Chen Guangming, deputy director and physician of the Department of Neonatology of Zhongshan Bo'ai Hospital, was interviewed by the interviewee
The "minion" washes more and more yellow?
Taking a bath with Chinese medicine indiscriminately risks losing your life
A few days ago, the Department of Neonatology of Zhongshan Boai Hospital received a baby with severe jaundice, Junjun (pseudonym). When Junjun was taken to the hospital, his breathing was weak, his reaction was poor, and his skin was extremely severely yellowed, and his condition was critical. It is understood that the baby boy began to have yellow skin on the second day of birth, and the family refused to be hospitalized, but listened to the home remedies of the elderly and relatives at home, bought some kind of Chinese medicine boiling water to bathe the baby to "go yellow", and oral drug treatment of yin gardenia. And Junjun's jaundice not only did not retreat, but became heavier and heavier.
After examination, Junjun's serum bilirubin was as high as 671.3umol/L, which was several times higher than the normal jaundice value, which was dangerous hyperbilirubinemia. The neonatal care team immediately rescued the baby, intubated the trachea, ventilator treatment, and even "blood exchange therapy".
"The child's sequelae will be more severe, even if the child has been released from the ventilator through blood exchange therapy." But jaundice into the brain has caused irreversible damage to the child's nervous system function, and there is even a risk of cerebral palsy. Chen Guangming said that the development of neonatal jaundice to such a serious extent is related to the lack of attention paid by the family.
After further examination, the doctor found that Junjun suffered from severe G-PD deficiency, commonly known as "fava bean disease". It is a hereditary haemolytic disease that is more common in Guangdong, Guangxi, Hunan and Jiangxi. If the mother has fava bean disease, the probability of the child's inheritance is 25%.
Due to Junjun's family, he did not follow the doctor's advice to take Chinese medicine without authorization. Some traditional Chinese medicines are easy to induce acute hemolytic reactions in patients with fava bean disease, causing severe jaundice, anemia and even bilirubin encephalopathy. "High jaundice levels will enter the brain, and after entering the brain, bilirubin cannot be 'discharged' through treatment, and there may be neurological and hearing sequelae, resulting in the child's regret for a lifetime, leaving parents remorseful." Chen Guangming said.
Severe jaundice baby Junjun Courtesy of the interviewee
How to distinguish between physiological jaundice and pathological jaundice?
Most jaundice is mild, physiological jaundice, most of which resolve spontaneously and do not require special treatment. Most newborns develop jaundice in 2 to 3 days after birth, enter the peak period of jaundice in 3-5 days, gradually reduce in 5 to 7 days, full-term jaundice is not more than 2 weeks at the latest, and jaundice in premature infants does not exceed 4 weeks, and will completely subside.
However, in the clinic, some children with jaundice index is very high, exceeding the upper limit of the physiological range, and is pathological jaundice. If left untreated, elevated bilirubin in the blood may enter brain tissue through the child's brain cell membrane. The toxic effect of bilirubin causes lesions in the brain, forming bilirubin encephalopathy. At this time, the child may have drowsiness, milk refusal, poor response, moaning, screaming, etc., and the aggravated person will have staring, nystagmus, head tilted back, angle arch reversal, convulsions, irregular breathing, etc. Severe cases are rescued and often have serious sequelae such as hand and foot convulsions, hearing impairment, mental retardation, and even cerebral palsy.
So, some children are more susceptible to rational jaundice due to high-risk factors? From the index point of view, the child's serum bilirubin is higher than 342umol/L or the child is a premature baby, or has hemolytic disease, G-6PD deficiency, intrauterine infection, family history, etc. Chen Guangming believes: "When finding neonatal jaundice, it is very important to follow the doctor's advice and go to the hospital as soon as possible. Because once bilirubin encephalopathy occurs, the consequences are very serious, and it is easy to leave sequelae such as mental retardation and convulsions. ”
Physician Chen Guangming examines the body of baby Junjun with severe jaundice. Courtesy of respondents
Timely intervention in treatment is key
"Neonatal jaundice is not terrible, parents should find problems in time to diagnose and treat, it is recommended that medical staff to grasp whether treatment is needed." If necessary, the medical staff will determine the treatment plan, and do not listen to rumors and misbelieving the folk remedies, and eventually delay the condition," Chen Guangming said, if the child could be given jaundice treatment in time, the prognosis may not be so bad.
Clinically, obstetric medical staff regularly measure and manage the neonatal jaundice index. Once the jaundice index exceeds the standard, the family will be informed and admitted to the neonatology department for standardized treatment in accordance with China's medical norms. With standardized treatment, neonatal jaundice worsens, resulting in cerebral palsy and other conditions greatly reduced.
However, a small number of parents mistakenly believe that jaundice is a "small disease" that naturally subsides. When the newborn jaundice, the doctor notified the hospitalization, parents think that the hospital "no illness should be treated as a small disease, small illness should be treated as a major illness", holding the psychology of luck, using some local methods for treatment. Finally, bring irreversible physical harm to the child.
"For the health of their children throughout their lives, parents must follow the doctor's advice." Once cerebral palsy occurs, it is necessary to go to the pediatric department and the child rehabilitation department as soon as possible for early intervention and rehabilitation treatment to improve the quality of life of children. Chen Guangming said,
What situations can easily cause the baby to "wash more and yellow"?
Listening to "folk remedies" and "washing more and more yellow" of jaundice babies often occurs. Neonatal jaundice is generally divided into physiological and pathological. If the baby's jaundice is in line with the conditions of "early, heavy, fast, and repeated", it is necessary to seek medical treatment and treatment early.
1. Newborn jaundice appears early, and babies who appear jaundice within 24 hours after birth need to be treated as soon as possible;
2. Jaundice lasts for a long time, with jaundice exceeding 2 weeks in full-term infants and jaundice exceeding 4 weeks in preterm infants being in an abnormal state;
3. Jaundice continues to deepen and worsen or recurs after resolution, the degree of jaundice is high, and the jaundice value is greater than 95% of the average value of newborns of the same gestational age and day-old;
4. Newborns have high-risk factors, such as homogeneous immune hemolysis, G-6PD deficiency, asphyxia, significant drowsiness, body temperature instability, sepsis, metabolic acidosis, hypoproteinemia, etc
Among them, regarding G-6PD deficiency, there are clear dietary and medication contraindications:
1, Chinese herbal medicine: in addition to the various fava beans and fava bean products that must be isolated, some Chinese herbal medicines can not take medicine, such as pearl powder, honeysuckle, Sichuan lotus, ox yellow, wax plum blossom, bear bile, baby protection Dan and so on.
2. Use fever reducers with caution: painkillers, aspirin, analgesics, quinidine, anthazoline, pediatric antipyretic plugs, levodopa, amphemodine, etc.
3. Anti-inflammatory analgesics are prohibited: indomethacin, mefenac, phenylbutazone, etc.
4. Other banned drugs: remmide, methyldopa, rifampicin, quinine, chloramphenicol, clamourea, high-dose vitamin C and vitamin K, etc.
Reporter Zeng Yanchun of Nanfang Daily
【Author】 Zeng Yanchun
【Source】 Southern Press Media Group South + client