Ask what is the most common disease of the neonatal department, it must be neonatal jaundice.
When studying at the First Hospital of Peking University, a senior newborn expert was called “Captain Captain” by us in private.
Newborn jaundice refers to the level of bilirubin in the blood of neonatal, which is characterized by skin, mucous membranes and sclera yellow stains.
It is mainly caused by too much bilirubin and low ability of neonatal liver metabolism.
But a seemingly simple sentence contains a series of complex causes and various diseases. On the way to “Sweeping”, it is never smooth sailing. From time to time, you will encounter a road blocking ghost, and it will even be a “demon” that hurts people!
The son of Xiaofang, 7 days after birth, the skin is yellow for 3 days, good milk eats, good response, the frontal amount of the skin bilirubin is 19 mg/dl, the chest is 17 mg/dl, the hemoglobin is 143 g/L, the white blood cells 16.5 × 109/109/109/109/109/109/109/ L, platelet 254 × 109/L. On the second day of admission, the baby had fever, accompanied by cold war, cold limbs, and irritation. Hemoglobin dropped to 130 g/L. Saa, PCT, and CRP all increased to varying degrees.
After questioning the medical history, the mother’s repetitive respiratory infection was accompanied by fever, and her sister had a cough and was closely in contact with the child.
Consider jaundice caused by newborn infections.
After the blood training, the antibiotics are used, the body temperature is gradually stable, and the condition is better. However, jaundice has risen repeatedly, hemoglobin decreases, and hemolysis is present.
3 days of blood culture returns: methamphetamine Golden Pugioe, at the same time, check the cerebrospinal liquid return: 340 × 106/L in white blood cells, low sugar, increased protein.
Supplementary diagnosis: neonatal sepsis, purulent meningitis. It is more clear about neonatal jaundice and anemia caused by the severe infection of sepsis and meningitis.
The sensitive antibiotics are replaced, and the symptoms are supported. Children’s hemoglobin has not continued to decline at 80 g/L, and jaundice fades.
“So, why does neonatal jaundice involve such serious problems?”
Everyone knows that the first type of pathological jaundice is too much bilirubin. The causes of excessive bilirubin include increased red blood cells, vascular hemolysis (large scalp hematoma, subcutaneous hematoma, intracranial hemorrhage, etc.), immune hemolysis (ABO or RH blood type hemolytic disease), and so on.
Another important reason is infection. Bacteria, viruses, spirals, chlamydia, mycoplasma, and raw insects can cause hemolytic, but the sepsis caused by ginsembly bacteria and E. coli is common.
Here we mentioned newborn sepsis. In clinical work, once we explain sepsis with family members, the first reaction of many family members is: What? Our children have leukemia!
In addition to the pronunciation of sepsis and leukemia, it is actually two different diseases.
■ Newborn sepsis is a systemic infection caused by bacteria or fungi into blood circulation and growing and breeding in it, producing toxins, and active and effective anti -infective treatment, which can be cured;
■ Neonatal leukemia is a malignant proliferative disease of the blood system. The condition has developed rapidly and has a poor prognosis. It dies more than weeks or months.
Newborn sepsis is severe infection. The clinical manifestations are not specific. They often affect various systems, and various performances, such as fever or no increase in body temperature, poor milk eating, weakened crying, abdominal distension, shortness of breath, drowsiness, etc. There is jaundice.
Sometimes jaundice is the only manifestation of sepsis, which is often delayed by physiological jaundice, or jaundice begins after 1 week. The progress of jaundice has rapidly aggravated or recovered, jaundice, which cannot be explained in other reasons, should be suspected of this disease.
Our cases are fever, jaundice, and anemia. Naturally, it will consider sepsis, and blood culture has also confirmed this diagnosis.
Newborn sepsis sounds serious enough. How can it become purulent meningitis again?
Pyxular purulent meningitis system refers to meninges caused by hydamius causing gceives within 4 weeks after birth. Generally, 25%of newborn sepsis can occur with purulent meningitis.
Puruocular meningitis is more common in the newborn period than other ages, and its disease mortality in developing countries is 40% to 58%. In the past 20 years, the mortality of neonatal purulent meningitis has declined significantly, but the residual rate has not changed significantly. Therefore, early identification symptom signs and diagnosis are the key to improving their prognosis.
The clinical manifestations of psurioneral meningitis are similar to sepsis. There may be fever, convulsions, jaundice, and mental deficiency, and have no difference. Newborns have not obvious symptoms of increasing intracranial pressure due to the function of the door and cranial joint buffer. Comprehensive treatment such as early diagnosis and scientific and effective anti -infection is the key to the success of the disease.
Newborn physicians should fully grasp the clinical characteristics of neonatal purulent meningitis. If there is a history of fever, convulsions, poor body temperature, etc., and abnormalities such as premature fetal membranes in the perinatal period, they should be alert to the possibility of purulent meningitis. It is necessary. Time to check the waist.
Foreign information also shows that the symptoms and signs of hydrogenulitis in the neonatal child are not typical. In order to avoid missed diagnosis, children with suspicious or diagnosis of sepsis should be performed.
Newborns, especially premature babies, have low self -immunity, so it is more likely to cause bacterial infections. When bacteria break through the blood -brain barrier, it will cause purulent meningitis after reaching the central nervous nerve. Therefore, the disease should be diagnosed and early treatment. If it fails to take timely and effective treatment, it will cause sequelae such as hydrocephalus and cause serious consequences such as mental retardation or death. Let’s take a bit of the relationship between jaundice, sepsis, and purulent meningitis:
Symptoms are the most common clinical manifestations of newborns;
Sometimes jaundice is the only manifestation of sepsis;
25%of sepsis can occur with purulent meningitis.
In other words, jaundice for unknown causes must be considered, and once diagnosis is diagnosed, there will be 1/4 of the opportunity to combine purulent meningitis. If diagnosis is diagnosed with purulent meningitis Otherwise, the sequelae of the nervous system may be left.
On the way to “Sweeping Pornography”, we must show all our own skills, accurately identify the “ghosts” of various ways, and encounter huge mana such as sepsis and purulent meningitis. Destroy pathogenic bacteria.
At the same time, I remind their families again: Jaunda is fine! Do not blindly say, others say, grandma said, mother said, but ask professional newborn doctors to evaluate and monitor.