Pathological jaundice

Introduction Astragalus is common in newborns at any other age. Its cause is special and complex. It has both physiological jaundice and pathological jaundice, as well as breast milk jaundice. These situations should be treated differently and handled. If the child develops jaundice or jaundice within 24 hours after birth, it will develop too fast and last for a long time, even with anemia, abnormal body temperature, poor feeding, vomiting, and abnormal color of urine and urine. Some are yellow sputum that has subsided or reduced and then reappeared and aggravated, mostly pathological jaundice. Common causes of pathological jaundice are neonatal hemolytic disease, neonatal infection, biliary malformation, and neonatal hepatitis.

Cause

Understand the history of pregnancy, childbirth, history of infection and medication before labor, history of blood transfusion, family members with hepatitis, history of jaundice. Pay attention to the parity, whether it is premature, whether there is birth injury, asphyxia, hypoxia, hunger, infection history, inquire about the appearance and duration of jaundice, degree and growth, urine color. Whether there is a history of medication for jaundice (such as sulfonamide, salicylic acid preparation, high-dose vitamin K3, K4, etc.) and history of exposure to naphthalene (such as hygienic balls).

an examination

Related inspection

Erythrocyte serum total bilirubin indirect bilirubin xanthine examination choledochoscopy urinary p-hydroxyphenylpyruvate

an examination:

(1) blood routine, reticulocyte count and nucleated red blood cell count.

(2) Determination of total bilirubin and direct bilirubin, serum bilirubin full-term 205mol / L (12mg / dl) premature infants 256mol / L (15mg / dl) should be alert to the occurrence of bilirubin encephalopathy in children.

(3) urine routine and urinary tricholinal test.

(4) Pay attention to the color of urine and urine, and if necessary, check the original stool.

(5) According to the condition, the following tests are selected:

1 suspected neonatal hepatitis for liver function tests, at the same time check mother and child HB-sAg, HBeAg, HBV DNA, anti-HBc-IgM, etc., alpha-fetoprotein (normal newborn alpha-fetoprotein positive, turned negative in January after birth) .

2 suspected neonatal sepsis blood culture, local infection exudate for smear and culture.

3 suspected of giant cell inclusion disease, for urine sediment examination to find giant cells with inclusion bodies, conditions for virus isolation and serological examination.

4 suspected neonatal hemolysis for related tests, see neonatal hemolysis.

5 suspected erythrocyte G6PD deficiency detection of methemoglobin reduction rate (normal people > 75%, patients decreased); denatured globin corpuscle (Heinz body) production test; condition can be used for G6PD activity determination.

6 suspected hereditary spherocytosis, for erythrocyte fragility test (normal people began to hemolysis 0.40% ~ 0.46%, complete hemolysis 0.30% ~ 0.36%, patients with increased red blood cell fragility).

7 suspected galactosemia for the urine Ban test, conditions can determine the blood galactose concentration and erythrocyte galactose-1-phosphate uridine activity.

8 suspected 1-antitrypsin deficiency for serum protein electrophoresis test (with 1-globulin <2g / L), conditional for 1-antitrypsin activity assay.

9 suspected congenital biliary obstruction, should pay attention to the dynamic changes of blood bilirubin and stool color, if necessary, for lipoprotein X test, B-mode ultrasound, CT and other tests.

10 other hereditary metabolic defects.

Differential diagnosis

Neonatal hemolysis: The onset time of jaundice is within 24 hours after birth or the next day, lasting for one month or longer, mainly with unconjugated bilirubin. It is hemolytic anemia, liver spleen, maternal and child blood group incompatibility Severe cases are complicated by bilirubin encephalopathy.

Neonatal sepsis: The onset time of jaundice is 3 to 4 days or later after birth, lasting 1-2 weeks, or longer. Early non-conjugated bilirubin increased, late combined with bilirubin increased, hemolytic, advanced and hepatocellular, infection symptoms.

Breast milk jaundice: The starting time of jaundice is 4 to 7 days after birth, lasting about 2 months, with unconjugated bilirubin elevated, no clinical symptoms.

Physiological jaundice: The starting time of jaundice is 2-3 days after birth, lasting for about 1 week, mainly with unbound bilirubin, hemolytic and hepatocellular, no clinical symptoms.

G-6-PD deficiency: The starting time of jaundice is 2-4 days after birth, 12 weeks or longer, the main combination of unconjugated bilirubin, hemolytic anemia, often has the cause of the disease.

Neonatal hepatitis: The onset time of jaundice is several days to several weeks after birth, lasting for 4 weeks or longer, in combination with increased bilirubin, obstructive and hepatic. The color of jaundice and stool has dynamic changes, GPT is elevated, and hormones can be yellowed.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.