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*The professional part involved in this article is only for medical professionals to read for reference.
Or maybe? Neonatal jaundice is the most common neonatal disease.
Many people think that jaundice is a self-limiting disease and does not require too much intervention.
In fact, many children treated with jaundice are not as simple as the underlying disease, and the harm is also caused.
Unexpectedly, the following case fully illustrates this point.
Zheng XX, born in Xushui District, Baoding City, Hebei Province, female, 8 days old, Manchu, first child and first child, gestational age 38+5 weeks, due to intrauterine growth restriction at 14:31 February 19, 2021 Born by cesarean section.
The birth weight was 2.
62Kg.
Maternal blood type "A", Rh (+), father blood type O, and child's blood type A, Rh (+).
Breastfeeding, the amount of milk is sufficient, meconium is discharged for the first time about 3 hours after birth, the amount is large, and the stool gradually turns yellow about 48 hours after birth.
The mother had no premature rupture of fluid, and the umbilical cord, amniotic fluid and placenta were normal.
She denied the history of asphyxia and amniotic fluid aspiration.
Heel blood has been taken.
His mother was in good health during pregnancy and had regular birth checkups.
Color Doppler ultrasound at 32 weeks of gestation found that the fetus was 1 week younger than the fetus of the same gestational age, and at 34 weeks was found to be 2 weeks younger.
Physical examination: the appearance of the newborn, normal reaction, yellowish white skin and mucous membrane, no bleeding spots, petechiae, ecchymosis, no rash.
There is no deformity of the skull, no scalp hematoma, flat bregma, and low tension.
The sclera is yellowish and yellow discharge can be seen in both eyes.
The umbilical cord has not fallen off, there is no oozing or oozing fluid, and the umbilical chakra has no congestion.
The abdomen is soft, and the liver and spleen are not touched under the ribs.
Outpatient measurement of percutaneous bilirubin: head/chest 12.
7/17.
6mg/dl. The main purpose of family members taking their children to see a doctor is to measure the jaundice value! This is not an exceptionally high percutaneous jaundice value.
Does it really require special intervention? In view of the child's yellowish-white complexion and appearance of anemia, he repeatedly communicated with his family and checked the venous blood routine and liver function.
Return: hemoglobin 136g/L, total bilirubin 248.
1umol/L, indirect bilirubin 235.
08umol/L, suggesting that hyperbilirubinemia and anemia are not very serious, but both exist at the same time and need to be vigilant for further progress And actively look for the cause.
The process of mobilizing for hospitalization was not very smooth.
Fortunately, in the end, the family still "reluctantly" left the child in the neonatal ward.
1.
The post-hospital treatment process is as follows: Special care in neonatology, intensive care, incubator to keep warm, monitoring of ECG and blood oxygen saturation, feeding with low-weight formula milk, and monitoring of weight gain.
Intermittent blue light irradiation reduces yellowing, oral vitamin B2 supplements riboflavin, bifidobacterium quadruple viable bacteria tablets regulate the intestinal flora, oral phenobarbital tablets induce liver enzyme activity.
Infusion of A and Rh positive to remove white suspended red blood cells (40ml each time, 2 times in total) and oral iron, folic acid tablets, vitamin B12 tablets to correct anemia treatment.
After a total of 12 days of treatment, the child’s complexion turned red, anemia was corrected, jaundice subsided, and he was discharged from the hospital.
2.
During the hospitalization process, the changes in auxiliary examinations are as follows: 1.
Monitoring blood routine, CRP, and reticulocytes prompt: hemoglobin progressively decreases until 83g/L, after blood transfusion, hemoglobin increases and stabilizes (the following table 3-03HB is 105).
2.
Peripheral blood smear: Lymphocytes are the main nucleated cells in peripheral blood; red blood cells are mild in size, occasionally acute red blood cells; platelets are uncommon.
37% of neutrophils, 0 of neutrophils, 4% of eosinophils, 51% of lymphocytes, and 8% of monocytes.
3.
Liver function test prompts: Bilirubin continues to be high, showing a slow decline process, and indirect bilirubin is always the main increase.
4.
Hemolytic disease test: neonatal blood type A (+), direct anti-human globulin negative, free IgG antibody negative, red blood cell emission IgG antibody negative. Anti-erythrocyte irregular antibodies were negative.
5.
Five items of A Gong: No abnormality.
6.
TORCH: No abnormalities.
7.
Eight infections: no abnormalities.
8.
Urine routine: no abnormalities.
9.
Convenience routine: no abnormalities.
10.
Blood culture: No bacterial growth was seen.
11.
Imaging examination: abdominal ultrasound: abdominal color Doppler ultrasound: the size of the gallbladder after meal is about 2.
3cm×0.
5cm, and there is no obvious abnormality in the liver, spleen and kidney.
12.
Percutaneous bilirubin determination: 3.
Final diagnosis 1.
Neonatal hyperbilirubinemia 2.
Neonatal anemia (severe) 3.
Intrauterine growth restriction 4.
Atrial septal defect 4.
Follow-up and discharge After 3 days of follow-up visit, the jaundice subsided, hemoglobin was stable, and continued oral administration of vitamin D2, iron dextran oral liquid, folic acid tablets, and vitamin B12 tablets.
Monitor weight gain every week.
5.
Summary and experience The causes of coexistence of jaundice and anemia are more common in hemolysis, blood loss, infection and so on.
Hemolysis: The most common hemolysis is immune hemolysis caused by the incompatibility of maternal and infant blood types.
The mother's blood type of this child is A (+).
Neonatal hemolytic disease detection: direct anti-, free, and radiation tests are all negative, and anti-erythrocyte irregular antibodies are negative, so immune hemolytic jaundice caused by blood group incompatibility is not supported.
Hemolytic diseases caused by special reasons include G6PD enzyme deficiency, pyruvate kinase deficiency, hereditary spherocytosis, thalassemia, etc.
The diagnosis is mainly based on specific examination combined with family history.
Evidence of blood loss does not exist, but it can be excluded.
Jaundice and anemia caused by infection are divided into intrauterine infection and extrauterine infection, and are more common in TORCH virus, parvovirus B19, etc.
Mothers infected with the virus are transmitted through the placenta, anemia and thrombocytopenia occur, the most common is CMV infection, and most of them are developmental backward.
, Postnatal developmental delay, liver damage, blood system, nervous system symptoms, the child CMVIgM negative, no liver function and other multiple system damage, does not support.
There is insufficient evidence of bacterial infection to support it.
Combined with the children’s symptoms, signs and auxiliary examinations, our hospital conducts exclusionary diagnosis for the cause, provides symptomatic supportive treatment, close observation, communicates with family members, and recommends further genetic testing to clarify the cause.
Neonatal jaundice is the most common neonatal disease with complex causes and may cause serious consequences such as bilirubin encephalopathy.
You must not rely on a single bilirubin value to determine whether intervention is required.
Comprehensive assessment should be based on the child's gestational age, age, weight, time of appearance of jaundice, speed of progression, and whether there are high-risk factors such as maternal and infant blood group incompatibility, sepsis, anemia, premature delivery, and low birth weight.
If neonatal jaundice appears prematurely, persists, relapses, progresses too quickly, or merges with high-risk factors, it is often necessary to go to the hospital for treatment.
It is important not to simply think that neonatal jaundice is a physiological phenomenon without any harm.
, Wait for it to subside on its own.
Or maybe? Neonatal jaundice is the most common neonatal disease.
Many people think that jaundice is a self-limiting disease and does not require too much intervention.
In fact, many children treated with jaundice are not as simple as the underlying disease, and the harm is also caused.
Unexpectedly, the following case fully illustrates this point.
Zheng XX, born in Xushui District, Baoding City, Hebei Province, female, 8 days old, Manchu, first child and first child, gestational age 38+5 weeks, due to intrauterine growth restriction at 14:31 February 19, 2021 Born by cesarean section.
The birth weight was 2.
62Kg.
Maternal blood type "A", Rh (+), father blood type O, and child's blood type A, Rh (+).
Breastfeeding, the amount of milk is sufficient, meconium is discharged for the first time about 3 hours after birth, the amount is large, and the stool gradually turns yellow about 48 hours after birth.
The mother had no premature rupture of fluid, and the umbilical cord, amniotic fluid and placenta were normal.
She denied the history of asphyxia and amniotic fluid aspiration.
Heel blood has been taken.
His mother was in good health during pregnancy and had regular birth checkups.
Color Doppler ultrasound at 32 weeks of gestation found that the fetus was 1 week younger than the fetus of the same gestational age, and at 34 weeks was found to be 2 weeks younger.
Physical examination: the appearance of the newborn, normal reaction, yellowish white skin and mucous membrane, no bleeding spots, petechiae, ecchymosis, no rash.
There is no deformity of the skull, no scalp hematoma, flat bregma, and low tension.
The sclera is yellowish and yellow discharge can be seen in both eyes.
The umbilical cord has not fallen off, there is no oozing or oozing fluid, and the umbilical chakra has no congestion.
The abdomen is soft, and the liver and spleen are not touched under the ribs.
Outpatient measurement of percutaneous bilirubin: head/chest 12.
7/17.
6mg/dl. The main purpose of family members taking their children to see a doctor is to measure the jaundice value! This is not an exceptionally high percutaneous jaundice value.
Does it really require special intervention? In view of the child's yellowish-white complexion and appearance of anemia, he repeatedly communicated with his family and checked the venous blood routine and liver function.
Return: hemoglobin 136g/L, total bilirubin 248.
1umol/L, indirect bilirubin 235.
08umol/L, suggesting that hyperbilirubinemia and anemia are not very serious, but both exist at the same time and need to be vigilant for further progress And actively look for the cause.
The process of mobilizing for hospitalization was not very smooth.
Fortunately, in the end, the family still "reluctantly" left the child in the neonatal ward.
1.
The post-hospital treatment process is as follows: Special care in neonatology, intensive care, incubator to keep warm, monitoring of ECG and blood oxygen saturation, feeding with low-weight formula milk, and monitoring of weight gain.
Intermittent blue light irradiation reduces yellowing, oral vitamin B2 supplements riboflavin, bifidobacterium quadruple viable bacteria tablets regulate the intestinal flora, oral phenobarbital tablets induce liver enzyme activity.
Infusion of A and Rh positive to remove white suspended red blood cells (40ml each time, 2 times in total) and oral iron, folic acid tablets, vitamin B12 tablets to correct anemia treatment.
After a total of 12 days of treatment, the child’s complexion turned red, anemia was corrected, jaundice subsided, and he was discharged from the hospital.
2.
During the hospitalization process, the changes in auxiliary examinations are as follows: 1.
Monitoring blood routine, CRP, and reticulocytes prompt: hemoglobin progressively decreases until 83g/L, after blood transfusion, hemoglobin increases and stabilizes (the following table 3-03HB is 105).
2.
Peripheral blood smear: Lymphocytes are the main nucleated cells in peripheral blood; red blood cells are mild in size, occasionally acute red blood cells; platelets are uncommon.
37% of neutrophils, 0 of neutrophils, 4% of eosinophils, 51% of lymphocytes, and 8% of monocytes.
3.
Liver function test prompts: Bilirubin continues to be high, showing a slow decline process, and indirect bilirubin is always the main increase.
4.
Hemolytic disease test: neonatal blood type A (+), direct anti-human globulin negative, free IgG antibody negative, red blood cell emission IgG antibody negative. Anti-erythrocyte irregular antibodies were negative.
5.
Five items of A Gong: No abnormality.
6.
TORCH: No abnormalities.
7.
Eight infections: no abnormalities.
8.
Urine routine: no abnormalities.
9.
Convenience routine: no abnormalities.
10.
Blood culture: No bacterial growth was seen.
11.
Imaging examination: abdominal ultrasound: abdominal color Doppler ultrasound: the size of the gallbladder after meal is about 2.
3cm×0.
5cm, and there is no obvious abnormality in the liver, spleen and kidney.
12.
Percutaneous bilirubin determination: 3.
Final diagnosis 1.
Neonatal hyperbilirubinemia 2.
Neonatal anemia (severe) 3.
Intrauterine growth restriction 4.
Atrial septal defect 4.
Follow-up and discharge After 3 days of follow-up visit, the jaundice subsided, hemoglobin was stable, and continued oral administration of vitamin D2, iron dextran oral liquid, folic acid tablets, and vitamin B12 tablets.
Monitor weight gain every week.
5.
Summary and experience The causes of coexistence of jaundice and anemia are more common in hemolysis, blood loss, infection and so on.
Hemolysis: The most common hemolysis is immune hemolysis caused by the incompatibility of maternal and infant blood types.
The mother's blood type of this child is A (+).
Neonatal hemolytic disease detection: direct anti-, free, and radiation tests are all negative, and anti-erythrocyte irregular antibodies are negative, so immune hemolytic jaundice caused by blood group incompatibility is not supported.
Hemolytic diseases caused by special reasons include G6PD enzyme deficiency, pyruvate kinase deficiency, hereditary spherocytosis, thalassemia, etc.
The diagnosis is mainly based on specific examination combined with family history.
Evidence of blood loss does not exist, but it can be excluded.
Jaundice and anemia caused by infection are divided into intrauterine infection and extrauterine infection, and are more common in TORCH virus, parvovirus B19, etc.
Mothers infected with the virus are transmitted through the placenta, anemia and thrombocytopenia occur, the most common is CMV infection, and most of them are developmental backward.
, Postnatal developmental delay, liver damage, blood system, nervous system symptoms, the child CMVIgM negative, no liver function and other multiple system damage, does not support.
There is insufficient evidence of bacterial infection to support it.
Combined with the children’s symptoms, signs and auxiliary examinations, our hospital conducts exclusionary diagnosis for the cause, provides symptomatic supportive treatment, close observation, communicates with family members, and recommends further genetic testing to clarify the cause.
Neonatal jaundice is the most common neonatal disease with complex causes and may cause serious consequences such as bilirubin encephalopathy.
You must not rely on a single bilirubin value to determine whether intervention is required.
Comprehensive assessment should be based on the child's gestational age, age, weight, time of appearance of jaundice, speed of progression, and whether there are high-risk factors such as maternal and infant blood group incompatibility, sepsis, anemia, premature delivery, and low birth weight.
If neonatal jaundice appears prematurely, persists, relapses, progresses too quickly, or merges with high-risk factors, it is often necessary to go to the hospital for treatment.
It is important not to simply think that neonatal jaundice is a physiological phenomenon without any harm.
, Wait for it to subside on its own.
