Athetosis of the newborn's hands and feet

Introduction Neonatal hand and foot pulsation is a sequelae in the clinical manifestation of neonatal bilirubin encephalopathy (usually occurring 2 months or later after birth). Performance: manifested as hand and foot movement, eye movement disorder, deafness, mental retardation or enamel Dysplasia and so on.

Cause

1. The enzyme system is immature: Hepatocytes cannot effectively bind unbound bilirubin to bind bilirubin.

2. Severe hyperbilirubinemia: more common, such as neonatal hemolytic disease, congenital non-hemolytic jaundice (Kinner's syndrome), and drug poisoning (vitamin K3), etc., can make unbound Increased bilirubin.

3. The blood-brain barrier function is poor: unconjugated bilirubin is easy to pass and combines with brain tissue, and premature infants are worse. Various infections, asphyxia and hypoxia factors can affect the integrity of BBB barrier function.

4. Low plasma albumin content: Limited ability to attach unbound bilirubin.

5. Acidosis: Newborns are prone to acidosis.

6. Capture albumin linkage to free bilirubin: exogenous sulfamethoxazole, salicylate, sodium benzoate, novobiocin, cephalosporin, new penicillin II, indomethacin, etc., endogenous with positive iron Erythramine, bile acid and hunger, hypoglycemia or increased free fatty acids in the body during cold stimulation.

an examination

Related inspection

Blood test neurological examination

The disease is clinically divided into 4 stages, the first to third stages appear in the early neonatal period, and the fourth stage appears in the neonatal period.

(1) Warning period: manifested as lethargy, decreased sucking reflex and decreased muscle tone. Most of the jaundice suddenly became noticeably deeper. It lasted 12 to 24 hours.

(B) the flood season: light only two eyes gaze, paroxysmal muscle tension increased; heavy two hands clenched, forearm internal rotation, horn arch reversal, and sometimes screaming. It lasts about 12 to 24 hours.

(3) Recovery period: Most of the first weekend, the first sucking power and the response to the outside world gradually recovered, and then gradually reduced and disappeared. It lasted about 2 weeks.

(4) sequelae: often occurs 2 months after birth or later. It is characterized by hand and foot movements, eye movement disorders, deafness, mental retardation or enamel dysplasia.

Differential diagnosis

1, the disease should be distinguished from pseudo-hand and foot akines. The latter caused damage to the frontal, posterior and lateral columns or peripheral nerve damage due to the loss of position of the limb.

2, very slow hand and foot Xu movement caused abnormal posture is quite similar to twisting sputum, the latter mainly invades the proximal limb, neck muscle and trunk muscle, and the typical performance is torsion with the trunk as the axis.

3, should pay attention to the identification of different clinical types such as dance - hand and foot hyperactivity, dance - hand and foot hyperactivity disorder patients with a wide range of limbs, trunk and face, involuntary movement, showing coarse, variable and rapid beating.

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