*For medical professionals only
Do you really understand these questions?
Recently, colleagues have been talking about the TV series "Dear Child". Xiao Lu and Fang Yinuo have been married for many years and welcome Guizi. With the birth of their children, the new parents also began to meet the challenges of identity conversion.
A dispute caused by the child's jaundice is fiercely unfolded between Yinuo, Xiao Lu, Yuejie, and mother-in-law. The actors in the play use superb acting skills to vividly restore the series of questions about neonatal jaundice in daily life. From the perspective of a neonatal doctor, how to answer these questions in the play?
1. The child jaundice, the sister-in-law said it is okay, is it really okay?
Yinuo found that the child's skin was yellow, and asked the sister-in-law: Is the child jaundice like this, is it okay? Sister-in-law Yue calmly replied: It's okay, just born children are like this.
Figure 1 Source network
The sister-in-law must have cared for many newborns with physiological jaundice, so from the probability of occurrence, the sister-in-law's answer is very affirmative. The problem is the word "all", overconfidence, easy to give the mother the wrong feeling: all like this, there is no need to deal with it.
Indeed, neonatal jaundice is one of the common manifestations, with physiological jaundice occurring in about 50%-60% of term infants and 80% of preterm infants. But not all. A small percentage of children who develop jaundice also have pathological jaundice that needs attention.
The jaundice index that mothers often ask in outpatient clinics is normal, how much is physiological jaundice, and how much is pathological jaundice, which cannot be defined by a single value, and is related to the child's daily age or even age, weight, and risk factors.
There is one concept here that deserves more attention than physiological jaundice and pathological jaundice, and that is neonatal hyperbilirubinemia. For neonates with a gestational age of ≥35 weeks, the neonate hourly bilirubin line chart or AAP recommended light therapy reference curve produced in the United States is currently used as a reference for diagnosis or intervention criteria. When bilirubin levels exceed 95 percentiles, it is defined as hyperbilirubinemia and should be intervened.
Figure 2 Neonate hourly bilirubin lineogram
2. What is too high? Xanthophylloids?
Neonatal jaundice is a yellow stain on the skin or other organs caused by the accumulation of bilirubin in your child's body. Although it is called neonatal jaundice, the substance that causes jaundice is called "bilirubin", not "scabies".
Figure 3 Source network
Neonatal bilirubin is a metabolite of heme, and about 80% is derived from hemoglobin.
Aging erythrocytes rupture and release hemoglobin, which is reduced to free bilirubin under the action of multiple enzymes. Free bilirubin binds to proteins in the blood plasma, forming a bilirubin protein binder that is transported in the bloodstream and binds to the proteins of the liver cells when it reaches the liver. Free bilirubin in the liver is bound by glucuronic acid transferase and converted to binding bilirubin, which is excreted into the intestines along with bile.
The metabolic process of bilirubin is closely related to the cause of jaundice and the determination of whether treatment is needed and the treatment regimen.
Figure 4 Bilirubin metabolism process
3. Fang Yinuo is puzzled,
Why is a child's jaundice so high?
Figure 5 Source network
The causes of high levels of serum bilirubin in newborns are as follows: excessive bilirubin production; There are many specific causes, and I will not list them all here.
Due to the common, causes and complex pathogenesis of neonatal jaundice, in addition to detailed medical history, comprehensive physical examination and necessary tissue and imaging examination, a professional doctor is required to diagnose and differentially diagnose jaundice according to certain laboratory tests.
It is understandable that even professional medical students need to think about it. Neonatal jaundice, like the fever of older children and adults, is the most common, the most easily treated, and also the most complex, with the most causes, and once conventional treatment does not get better, it is necessary to pay close attention to and dig deep into the cause of the disease. Therefore, even a very experienced doctor who encounters a child with pathological jaundice needs to make a thought and confirm the diagnosis.
4. Less milk secretion, less excretion of children eating less,
Jaundice recedes slowly, is it true?
Sister-in-law is very right!
Delayed fecal excretion for any reason increases the reabsorption of bilirubin.
Figure 6 Source network
Disease conditions include congenital intestinal atresia, congenital pyloric hypertrophy, megacolon, etc., and are more commonly caused by hunger and delayed feeding.
Causes of breastfeeding failure are lack of breastfeeding techniques, breast swelling, and cleft nipples.
Factors such as ineffective sucking in newborns, affecting breastfeeding attempts, or limited milk intake in the first 24-48 hours after birth, affect the success rate of breastfeeding, so that milk secretion is reduced, and newborns are in a state of hunger, dehydration and nutritional deficiency, which delays the excretion of meconium and increases the intestinal and hepatic circulation, resulting in aggravation of jaundice.
Breastfeeding should be encouraged in small amounts and multiple times to ensure adequate milk intake and energy intake. Pay attention to avoid the wrong feeding of sugar water, so that the number of breastfeeding is reduced, which is not conducive to milk production.
After giving birth to a child in the play, Yinuo has always been in a state of high anxiety, distrust of anyone, coupled with lack of sleep and insufficient rest, resulting in less milk secretion, which may be the main cause of jaundice.
5. What is breast-milk jaundice?
▌ Xiao Lu said what is the breast milk jaundice?
Figure 7 Source network
As early as 1860, foreign scholars proposed that breastfeeding was related to jaundice. The main clinical manifestation is jaundice in breastfed newborns, which is more common in term infants. Breast-milk jaundice occurs within the time frame of physiological jaundice, peaking higher than physiological jaundice and resolving later than physiological jaundice.
In general, the condition is good, the feeding is good, the stool color is yellow, the urine color is not yellow, it does not affect the growth and development, the liver is not large, the liver function is normal, and there is no manifestation of liver disease and hemolysis. According to different pathogenesis and onset time, there are two clinical types: early onset and late-onset.
Early-onset breast-milk jaundice is also called breastfeeding jaundice, which is the problem of insufficient breastfeeding and increased intestinal and liver circulation in the previous section, which will not be repeated here.
Focusing on late-onset breast-milk jaundice, the clinical appearance is slightly later, often occurs after 1 week, and can be followed by physiological jaundice, peaking at 2-3 weeks after birth, lasting 4-6 weeks or can be extended to 2-3 months. Jaundice is mainly mild to moderate, and the general bilirubin value is 12-20mg/dl. Once breast milk is stopped and formula-fed, jaundice can be significantly reduced after 48-72 hours, and if breastfeeding is started again, jaundice will continue to occur, but not to the original level.
▌Do I need a medical consultation for breast-milk jaundice?
Breast-milk jaundice currently lacks specific diagnostic means, which requires a specialist to carefully exclude various possible causes of pathological jaundice through detailed collection of medical history, physical examination and various necessary auxiliary examinations before diagnosis. Family members without medical background should not easily judge that the child must be breast-milk jaundice, delay treatment, and need to go to the hospital for treatment.
6. As long as the spirit is good, do you not need to go to the hospital to measure the jaundice value?
Sister-in-law Yue said: I think the child's spirit is very good. The mother-in-law said: At the beginning, I said to measure the jaundice value. So whether the child is in good spirits or does he need to go to the hospital to check the level of jaundice, and when do he need to go to the hospital for treatment?
Figure 8 Source network
Mental status is not an indication of whether or not a doctor is required.
First of all, the mental state is very subjective, and the judgment standards of family members with non-medical backgrounds are different from those of the sister-in-law.
Secondly, once there is a problem with the mental state, it often represents the occurrence of serious diseases such as bilirubin encephalopathy and neonatal sepsis, and it is easy to delay the condition and cause serious consequences at that time. Each newborn is assessed by a doctor for risk factors before discharge, and if necessary, extend the length of hospital stay appropriately.
Common risk factors include jaundice within 24 hours of birth, presence of blood group incompatibility, premature infants, hematomas or apparent ecchymosis of the skull, inadequate breastfeeding, and excessive weight loss. Before discharge, the family must obey the doctor's medical advice, conduct outpatient follow-up according to the prescribed time limit, and monitor bilirubin on time.
Table 1 Follow-up plan for newborns after discharge
In addition to regular review, if the mother sees the baby's skin yellowing gradually worsening, regardless of whether the spirit is good or not, it is necessary to go to the hospital in time.
7. What is Blue Light? When is blue light therapy needed?
Many parents are like Xiao Lu, what is blue light?
Figure 9 Source network
Light therapy is a simple and easy way to lower serum unbound bilirubin.
Phototherapy produces isomers by transforming bilirubin, which changes from fat-soluble to water-soluble, and is excreted from bile or urine without the union of the liver.
Blue light is the best light source for artificial illumination. Phototherapy is simple, convenient, economical and effective, and is the preferred treatment option for most pathological jaundice.
In November 2009, the editorial board of the Chinese Pediatric Journal of the Chinese Medical Association and the Neonatology Group of the Science Branch of the Chinese Medical Association held an academic seminar on neonatal jaundice in Guilin. The panelists also agreed to replace the "Diagnostic Criteria for Pathological Jaundice in Term Neonates" and the "Indications for Phototherapy for Neonatal Jaundice in Term Neonates" based solely on a total bilirubin value.
Table 2 Recommended criteria for jaundice interventions in term neonates of different birth ages
brief summary
In the play, a war caused by neonatal jaundice has made many families with similar experiences feel empathy. In real life, jaundice is far more serious than drama. Mothers do not need to talk about jaundice discoloration, anxiety is like a promise, nor can they ignore the jaundice changes and let it develop. Correctly understand the jaundice of newborns, and do not blindly follow the opinions of the sister-in-law and elders. Instead of arguing, it is better to review regularly and seek professional judgment to help the mother and baby successfully pass the confinement period.
bibliography:
Neonatology Group of Science Branch of Chinese Medical Association. Expert consensus on the diagnosis and treatment of neonatal hyperbilirubinemia[J]. Chin J Pediatrics,2014,52( 10) ∶745 - 748.
This article was first published: Pediatrics Channel of the Medical Professions
This article is written by Li Yuelan
Editor-in-Charge: Wen