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Treating jaundice, less “bold”, more “heart detail”

As the saying goes, “Ten Babies and Nine Yellows”, but the high incidence, high hospitalization rate, and serious disability rate of neonatal jaundice still make pediatricians worry.

Looking back at the two cases of the neonatal department of Baoding Seventh Hospital, let us see the power of jaundice again.

1 Children are yellow, just sun

The daughter of Xiaoyu, the blood type of the mother and baby ABO is inconsistent. The full moon cesarean section is produced in the obstetric department of our hospital. On the second day after birth (about 24 hours after birth), slight jaundice appears. It is recommended to check neonatal hemolysis test, and the family refuses.

On the 3rd day (48 hours) after birth, jaundice worsened, and the skin bilirubin 13 mg/dl was rejected. On the third day, 15 mg/dl, the obstetric director repeatedly discouraged to the newborn department, but still refused and signed.

Five days after birth, the child became a “little golden man”. Under the severe demands of the obstetric director, he was reluctant to be diagnosed in the newborn department for the third time. The doctor once again talked about the severity of newborn hemolysis, and asked the family members to apply for hospitalization immediately. Dad was not present and the mother asked to discuss.

Reasons for no hospitalization

Children are yellow, just take the sun, and now they eat and drink very well. They want to be discharged home with their mother.

Faced with such ignorant parents and looking at the poor child, the doctor had to say a “ruthless words”: if you still want this child, you will immediately be hospitalized.

As a pediatrician for many years, he knew that bilirubin was threatening the child’s brain and even life, but his family members were indifferent because of ignorance or distrust of the doctor. The helplessness in his heart was even angry. It may be that the doctor’s expression and attitude really scared the family members, and the mother finally nodded and promised to be hospitalized for a few days.

Then there is a tense diagnosis and treatment. White protein, globulin, strong phototherapy, enzyme -induced agent, improved auxiliary examinations, jaundice dropped, but repeatedly increased, accompanied by hemoglobin, until blood transfusion. Other hemolytic jaundice patients hospitalized during the same period were discharged from the hospital, and only this doll was still yellow and white. After blood transfusion, hemoglobin rises briefly, and the bilirubin is still above 300 mmol/L. A series of evidence shows that this jaundice is not simple, and it is very likely that there are rare diseases. After discussion, contact the Beijing Bayi Children’s Hospital for further diagnosis.

Family members began to complain: You delayed us. The Bayi Children’s Hospital was not formal. Then rejected the transshipment vehicle of Beijing, which was hard to find. In this way, from the morning plan to transfer to the hospital, it was not until 9 o’clock in the evening, and I went to Beijing, and I went to the inaccurate Bayi Children’s Hospital in their mouths.

2 Biliary Twiling, which requires liver transplantation for cure

The son of Xiaoyan, the third child, was born early in 33 weeks, and the two women got a son afterwards. Everything goes well during the treatment, good milk, good breathing, and good response, jaundice appears 4 days after birth, 7 days of jaundice worse, active blue light treatment, jaundice is temporarily dropped, optical treatment is 2 hours, and the skin color is getting darker and darker Essence The re -examination of liver merits gradually increased, the abdominal ultrasound, the gallbladder was unclear, and the review was still unclear. Highly doubt obstructive jaundice.

Experts from the Beijing Children’s Hospital of the Beijing Children’s Hospital will consider the biliary lock. It is recommended to choose to spend an operation and cure liver transplantation. Family members are not good at talking, but they are well communicated. The joy of afterbirth, the trust of doctors during communication, and the cooperation of treatment, how can we hope that this is just an ordinary jaundice. However, all we can do now are feeding and care, and use some liver and gallbladder medicine appropriately. Watching him is getting yellow, darker and darker, praying for him to grow meat quickly, and perform surgery early.

Both are newborn jaundice, but the yellow color number is different, the cause is different, and the treatment method is different, but the ending after delay treatment will be the same: disability or even death!

3 Newborn jaundice is really not easy!

Newborn jaundice is mostly caused by incoming bilirubin. Most of the newborn in my country will have “temporary total bilirubin increase”, which is traditional called “newborn physiological jaundice”. This type of jaundice generally appears 2 or 3 days after birth, reached its highest peak in about a week, and basically subsided in about two weeks.

However, if the jaundice time is early and the progress is fast, it has reached the level of severe jaundice (the jaundice extends to the limbs and palms), or the fading is significantly slow, which needs to be alert to the possibility of pathological jaundice.

Table: The difference between physiological jaundice and pathological jaundice

There are many factors that cause pathological jaundice, such as::

Breast milk jaundice

Premature birth

Infection in the palace

Neonatal sepsis

Red blood cells increase

Extraction of blood is like skull hematoma

ABO hemolytic, broad bean disease

Endocrine metabolism disorder

Gastrointestinal and gallbladder disease

However, the level of damage to different newborn individuals is also different, and medical staff need to analyze specific cases for specific cases. If the pathological jaundice cannot be treated in time, it is huge to the newborn baby!

Harm of pathological jaundice

Neurological dysfunction: can be manifested as one or more system dysfunction, such as cognition, learning, motor disorder, or only manifestation of deafness or hearing disorders, such as hearing neuropathy, etc.;

Acute hyperbalin encephalopathy: During 1 week, the acute central nervous system damage caused by bilirubin neurotoxicity, early manifestations of reduced muscle tension, drowsiness, screaming, and sucking poorly, and then the muscle tension increases , Excitement, fever, convulsions, severe cases can cause death, low birth weight children usually lack typical symptoms when bilirubin encephalopathy occurs, but manifested as respiratory suspension, cyclic respiratory function has deteriorated Chronic, permanent damage, and sequelae caused by bilirubin neurotoxicity, including vertebral vitamin dysfunction, sensory nervous hearing loss, eyeball disorders, and abnormal enamel development.

4 painful lesson

The two painful lessons made us have to call on our parents to recognize that the jaundice is “what square monster”. Non -professional family members, despite the child’s most dear person, without Sun Wukong’s fire eyes, do not easily conclude, and do not expect that the mixed Baidu of fish and dragons is your “demon mirror”. Newborn jaundice is the most common and most complicated disease of the neonatal department. Professional doctors are not easy to understand. Don’t think that you will be better than the five years of university and experience the test of the devil titles.

Less bold, more careful, less questioning, more trust, less self -righteousness, more humble and cautious children, whether you have no ability to take care of your own ability, or even life and death, and even life and death are between your thoughts.

Jaundice is really not easy. Don’t wait for your child to become a “little golden man”, and then think of looking for a doctor!

Reference materials:

1. Expert consensus of the principle of newborn jaundice diagnosis and treatment, “Chinese Pediatric Magazine”, September 2010, Vol. 48, Issue 9;

2. The consensus of the diagnosis and treatment of neonatal high bilirubin ledmia, “Chinese Pediatric Magazine”, October 2014, Volume 52, Issue 10;

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