Today is the 1389th day of pharmacy wisdom to accompany you
As the saying goes, "nine yellows for ten babies", jaundice is a common condition in newborns, but it is also a terrible existence in the eyes of many new mothers. Why do newborn babies have so many jaundice? During the fetal period, the child's oxygen is supplied by the mother through the umbilical cord, his oxygen partial pressure is relatively low, so there will be more red blood cells to carry oxygen, and after the child is born, he has his own breath, the oxygen supply increases significantly, he no longer needs so many red blood cells, so a large number of red blood cells are destroyed, the destroyed red blood cells will release hemoglobin, and hemoglobin will eventually produce bilirubin. Term newborns produce 2-3 times more bilirubin than adults, but their liver function is not yet mature and cannot be processed during the "peak period". Bilirubin accumulates in the body, and physiological jaundice follows. Most babies will develop jaundice of varying severity around three days after birth. Physiological jaundice mostly subsides after two weeks, but if it is pathological jaundice, it is slightly trickier. Let's learn the symptoms, professional treatment plans and precautions of neonatal jaundice with the pharmacy Huixiang!
[Manifestations of neonatal jaundice]
The main cause of jaundice in newborns
1. Excessive bilirubin production. Because the lifespan of neonatal erythrocytes is shorter than that of adults, the hemoglobin of senescent red blood cells is metabolized into bilirubin and the intestinal and hepatic circulation is increased, which increases serum unbound bilirubin.
2. Hepatic bilirubin metabolism disorder, due to the low function of hepatocyte uptake and binding bilirubin, the serum unbound bilirubin is elevated.
3. Bile excretion disorders. Hepatocyte excretion combined with bilirubin disorders or obstruction of the bile ducts can lead to hyperconjugated bilirubinemia.
4. Breastfeeding-related jaundice is mainly caused by insufficient intake of calories and body fluids, delayed fetal stool, etc. Jaundice caused by this cause is generally alleviated by increasing the amount and frequency of breastfeeding, and breast-milk jaundice refers to the fact that the newborn still has jaundice in the first three months of life as unbound bilirubin is elevated[1].
Classification of neonatal jaundice
Physiological jaundice
It generally begins to appear 2 to 3 days after birth, peaks at 46 days, resolves in term infants at 10 to 14 days, and resolves at 2 to 3 weeks in preterm infants. Although there is jaundice, the baby can still eat and sleep, weight gain, feces are yellow, urine is not yellow, generally do not need treatment, as long as early feeding, supply enough milk can be.
Pathological jaundice
Generally early, yellowish complexion can occur 24 hours after birth, and jaundice rises quickly, (exceeding the bilirubin monitoring alert value) for a long time, > 2 weeks in term infants, > 4 weeks in premature infants, or jaundice recurs, and the following conditions are common:
1. Infectious jaundice
Can be caused by bacteria (such as E. coli staphylococcus) and viruses (such as cytomegalovirus, hepatitis B virus, rubella virus, etc.), many of which are intrauterine infections, in addition to yellow face, can also be manifested as not eating, not crying, body temperature suddenly high and low, poor response, weight is not long and so on. Common diseases such as neonatal sepsis, neonatal hepatitis, etc.
2. Breast-milk jaundice
Common in breastfed babies, experts believe it may be related to the activity of certain enzymes in breast milk. Jaundice may occur during the physiological jaundice phase (2 days to 2 weeks after birth) but does not resolve with the disappearance of physiological jaundice. For the sake of the baby's health, the mother should not easily give up breastfeeding, can take a small number of multiple feedings, or stop breastfeeding for 48 to 72 hours (modified formula feeding), jaundice will drop to about 50% of the original. It usually subsides after 3 to 4 months, and the baby has a good prognosis.
3. Obstructive jaundice
Most often caused by congenital biliary malformations, the main disease is congenital biliary atresia or common bile duct cysts. The baby's face, skin gradually turns yellow, tears turn yellow, urine color is dark yellow like tea, stool color becomes lighter like putty, abdomen bulges, liver and spleen enlargement, hardening, etc., must be diagnosed in time, early surgical treatment.
4. Hemolytic jaundice
There are two types: one is Rh blood group incompatibility hemolysis, which is more likely to occur in patients whose mother's blood type is Rh-negative and the baby's blood type is Rh-positive, or whose mother has received blood transfusion treatment in the past and whose mother's blood type is Rh-negative and grandmother's blood type is Rh-positive.
Neonatal jaundice is common with the following symptoms
Physiological jaundice symptom manifestations
Newborns develop yellowing of the skin, white eyeballs, and oral mucosa on the 2nd to 3rd day after birth, ranging from mild to severe. It is generally more pronounced on the face and chest, but the palms of the hands and feet are not yellow. It is most pronounced on days 4 to 6, with term resolves 10 to 14 days after birth and preterm babies last up to week 3. During this period, the child is generally in good condition and has no other manifestations of discomfort.
Symptoms of pathological jaundice
Jaundice may occur within 24 hours of birth, or persist, or recur after resolution, or progressive exacerbation of jaundice.
Pathological neonatal jaundice can also cause manifestations of other disorders, such as kernicterus. At the time of occurrence, jaundice in children is significantly worsened and begins to manifest as drowsiness, weakness or choking on milk, and hypotonia. If the treatment is not timely, serious symptoms such as moaning, screaming, convulsions, and respiratory failure may occur. Some children die of respiratory failure, and surviving children often have sequelae such as intellectual disability and cerebral palsy.
How to distinguish between these 2 types of jaundice?
1. The time is different
Physiological jaundice
It generally begins to appear 2 to 3 days after the baby is born, reaches its peak in 4 to 5 days (that is, when the yellow is the most severe), and can subside for about 7 to 10 days;
Pathological jaundice
May occur earlier (within 24 hours of birth), faster (rise in excess of 5 mg/dl per day), higher (generally > 12.9 mg/dl), duration greater than 2 to 4 weeks, or even long-term non-regression).
2. The baby behaves differently
Pathological jaundice appears within 24 hours of the baby's birth. There will be vomiting, fever, convulsions, drowsiness, stool whitishing, etc., and the disease progresses quickly and lasts for a long time.
Hemolytic jaundice also has symptoms such as fever, chills, headaches, vomiting, etc., and the urine is soy sauce or brown.
[Professional Treatment Plan]
General treatment
Because there are many causes of jaundice, the treatment should mainly target the cause, and only when the cause is eliminated can the jaundice be alleviated or subsided.
Pharmacotherapy
1. Liver enzyme inducer, increase the liver's ability to process bilirubin, commonly used phenobarbital. However, phenobarbital, as a sedative, hypnotic, anticonvulsant, can appear dizziness, drowsiness and other adverse reactions after medication, and long-term use can produce drug resistance.
2. Supplement albumin and immunoglobulin, combine with bilirubin to prevent the occurrence of bilirubin encephalopathy, and the effect is better in the initial stage.
3. Montmorillonite powder combined with indica has a certain effect on neonatal jaundice. The treatment of jaundice in gardenia can cause diarrhea, tiredness, etc. in children, and clinically the use of ingenia has gradually reduced, and if it is used, it is necessary to cooperate with montmorillonite powder to alleviate diarrhea symptoms.
Light therapy
It is a simple and effective way to reduce serum non-binding bilirubin, and the total serum bilirubin level in term infants is greater than 205 μmol/L (12 mg/dl), which can be given phototherapy. It can convert excess bilirubin in the blood into photosyrubin, and then excrete it from the body with bile or urine, and generally irradiate for 24 to 48 hours to obtain satisfactory results.
The specific method is to let the baby strip naked and lie in the phototherapy box to receive radiation, in order to avoid light damage to the baby's retina and genitals, the doctor will cover the baby's eyes, private parts and small buttocks.
The side effects of light therapy are: fever, diarrhea, rash, hypocalcemia, bronze disease, etc., and in the light therapy box, the baby can not contact the mother, lack of security.
[Precautions]
1. Let the baby's fetal stool be discharged as soon as possible
In the early stage, we should feed the newborn as soon as possible, so that the fetal stool is discharged as soon as possible, because the fetal stool contains a lot of bilioflavin, if the fetal stool does not excrete clean bilioflavin will be re-absorbed into the blood through the newborn's special liver and intestine circulation to increase jaundice. The main thing is to see the tire stool from black tire to yellow tire is to drain clean.
2. Give the newborn sufficient water
The way to judge whether the newborn's fluid intake is sufficient is to look at the newborn's urine, generally normal newborns urinate 6-8 times a day, if the number is insufficient, it is possible that his fluid intake is not enough, and urinating too little is not conducive to the excretion of bladioflavin. We should ensure that the newborn's fluid intake, the general newborn's fetal stool should be drained in 2-3 days, so as to reduce the degree of jaundice.
3. Pay attention to observation
The general symptoms of yellow babies, whether there is mental malaise, drowsiness, difficulty sucking milk, panic, direct eyes, limb rigidity or convulsions, etc., in order to detect and deal with severely ill children early and deal with them in time. Closely observe changes in heart rate, heart sounds, degree of anemia, and liver size, and prevent and treat heart failure early.
4. Pay attention to cleanliness
Protects baby skin, umbilicus and buttocks from breaking infections.
5. Precautions for Bao Mama
During pregnancy, pregnant mothers should pay attention to a balanced diet, avoid cold and hot foods, and smoke alcohol. Supplement with fruits and vegetables rich in vitamin C, such as tomatoes, apples, kiwis and other fresh foods.
Extended learning
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