Nannan, a 1-year-old baby, can't stand or speak, but her feet are so strong. NanNan's mother supported him to stand on his mother's leg, and he could stomp his thighs so painfully, sometimes there were bruises, but she didn't feel abnormal at all, and when she saw people, she said triumphantly: "My nannan is so strong, like a calf, with great strength." ”
At first, she heard the neighbor's grandmother say, "It doesn't matter if you can't stand, someone is early and someone is late, what's the hurry", so she has not taken this matter to heart. Until Nan Nan was 1 year old and 5 months old, when other babies could leave happily, Nan Nan actually could not stand, and her mother was really anxious, and quickly took Nan Nan to the local top three hospitals to hang up an expert number.
The doctor asked, "Where was your baby born?" What was the situation at birth? When is the skin yellow? Have you ever had any cramps? ”
Nannan's mother replied: "My family Nannan is full-term, and she is also in a normal birth, and she was born in our county hospital." Everything was fine at birth, and the next day I was discharged from the hospital with my baby, and when I was discharged, the doctor asked me to check whether my skin was yellow every day after I was discharged. Then the next day after discharge, it began to yellow, and it became more and more yellow, and for a few days I did not breastfeed, I looked so irritable that I screamed a few words at every turn. Sometimes my eyebrows are wrinkled, and I originally wanted to ask my mother-in-law to take my nannan to the hospital, but my mother-in-law said, 'Every child who eats my mother's milk has yellow, and I have given birth to five of them, so there is no fuss'. As soon as I listened, I also felt that the baby's yellow skin was normal, so I did not go to the hospital, and then the baby slowly faded yellow. ”
The doctor examined Nan Nan from head to toe and said, "Hey, tiptoeing and heeling, I'm afraid I'm cerebral palsy, so let's go for the examination." ”
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Nannan's mother listened and quickly took the child to do a head magnetic resonance. After the test results came out, the doctor said: "Your baby is indeed cerebral palsy." ”
My mother cried on the spot and regretted it.
The doctor explained: "Nan Nan was born not long ago, the skin is very yellow, in fact, the bilirubin in the blood is particularly high, resulting in the baby's bilirubin encephalopathy." When the baby screamed, it was a lot of pressure in the skull; a series of frowns were all manifestations of convulsions during the spastic period. Now he tiptoes every day, can't walk or speak, which is the sequelae left by bilirubin yellow into his brain. ”
Such a serious consequence is something that Nan Nan's mother, who has just become a mother, could not have imagined. Is neonatal jaundice really that terrible? So many babies have yellow, why is nan nan a problem?
Today, I will tell you how to correctly face neonatal jaundice.
1. What exactly causes jaundice in newborns?
The appearance of jaundice in newborn babies is originally a physiological phenomenon, which is related to the bilirubin metabolism characteristics of the newborn itself.
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Neonatal jaundice
When the baby is in the mother's belly, all oxygen and nutrients are provided by the mother's placenta and are in a state of relatively low oxygen concentration, so the fetus needs more red blood cells and hemoglobin than adults to transport oxygen to itself.
After the baby is born, it begins to breathe on its own, at this time the oxygen concentration in the blood becomes higher, on the one hand, there is no longer so much red blood cell, and the excess red blood cells rupture on their own; on the other hand, the red blood cell life of the newborn baby is also shorter than that of adults. A large number of red blood cells age and lyse, and a large amount of bilirubin is released into the bloodstream.
But at the same time, the newborn baby's liver is still very young, lacking a lot of enzymes, and the extra bilirubin liver is too late to decompose; and the blood can transport bilirubin several proteins are not enough.
All this leads to the production of bilirubin far faster than the processing and excretion rate, and the more it accumulates in the body, it causes the baby's skin to turn yellow.
In adult blood, bilirubin only needs to exceed 2mg/dl to appear yellow skin and yellow eyes; but newborn babies need more than 5mg/dl to see yellow skin.
However, as long as the curve of serum bilirubin changes over time is within the normal range and the baby has no other abnormal manifestations, it is normal physiological jaundice.
More than 80% of normal newborns will have yellow skin in the early postnatal period [1], but generally appear only after 2 to 3 days after birth, only the face, neck, whites of the eyes, part of the skin of the body becomes yellow, but the calves, forearms, palms and feet are not obviously yellow, breastfeeding, mental reactions, sleep and other aspects are not abnormal, the duration may only be 5 to 7 days, generally no more than 2 weeks will subside, no special treatment is required.
However, there is also a condition in which the skin of the whole body is severely yellow within 24 hours of birth and lasts for more than 2 weeks, which is called pathological jaundice. It has a variety of causes and can be divided into three categories:
1. Too many builds
For example, if the blood type of the mother and the baby do not match (for example, the mother is O type, the baby is type A or B), the antibodies produced by the mother enter the baby's body through the umbilical cord, causing a large number of red blood cells in the baby to be destroyed and causing hemolysis. Hemolysis is one of the most serious causes of neonatal jaundice.
In addition, there are bleeding in different parts of the body, infection, erythrocyte enzyme deficiency (such as "fava bean disease" that most people hear), abnormal red blood cell morphology, and various hemoglobinopathies, which can also cause pathological jaundice.
2. Bilirubin metabolism disorders
That is, the liver "can't grasp" the bilirubin in the blood, which may be hypoxia, drug influence, or a variety of congenital metabolic defects caused by genetics.
3. Bilirubin excretion disorder
That is, the liver can "grasp" bilirubin, but it cannot be expelled, and the specific causes such as hepatitis, congenital metabolic defect diseases, biliary atresia, etc. [1].
No matter which of the above reasons, the mothers can not take it lightly, and if they find that the baby's skin is yellow, they must go to the hospital in time for treatment. Common treatment methods include phototherapy, blood exchange therapy, and drug therapy, which require doctors to decide on specific conditions [2].
In addition, there is a special type of jaundice called breast-milk jaundice, which often occurs in babies who are exclusively breastfed, and it is certain substances in breast milk that cause the liver to metabolize bilirubin abnormally. However, in addition to yellow, the baby has no other abnormal phenomena, which can last for 1 to 3 months, and does not require special treatment.
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Second, about neonatal jaundice, what are the misunderstandings of new parents?
The first misunderstanding is that it is easy for new parents to listen to the concept of the older generation, thinking that "everyone has yellow, what kind of heart, when the time comes."
Situations like Nannan's mother, which can often be seen in hospitals, are easy to miss the best time for treatment, causing irreparable harm to the baby and dealing a heavy blow to the family.
Secondly, there is another extreme, parents are terrified when they see the yellow skin of the newborn baby, and they are eager to rush to the hospital for hospitalization immediately. After running to several hospitals, all the doctors said it was normal, they went home nervously.
Third, what is the right approach?
If the baby has yellow skin, parents can first take the baby to the hospital to do a simple bilirubin measurement through the skin (percutaneous bilirubin level measurement, no need to puncture the skin); if the results show abnormal, then do liver function and other tests (such as serum bilirubin measurement, etc.) on the doctor's advice, and the doctor will decide whether to be admitted to the hospital according to the situation.
bibliography:
Wang Weiping,Sun Kun,Chang Liwen. Pediatrics[M]., August 2018, 9th edition, 2nd printing. Beijing:People's Medical Publishing House,2018:111-115.]
[2] Neonatology Group, Science Branch of Chinese Medical Association, Editorial Board of Chinese Journal of Pediatrics. Expert consensus on the diagnosis and treatment of neonatal hyperbilirubinemia[J]. Chin J Pediatrics, 2014, 52(10):745-748.
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