1-year-old baby Nan Nan can’t stand or talk yet, but her legs are very strong. Nan Nan’s mother supported him to stand on her mother’s leg, and she could step on her thigh so much that it hurt so much, and sometimes it was bruised, but she didn’t feel abnormal at all, she said proudly when she saw people: “My Nan Nan is so strong, she looks like a The calf is very powerful.”
At first, she heard the neighbor’s grandmother say “it doesn’t matter if you can’t stand, some people are early and some are late, what’s the hurry”, so she never took it to heart. When Nan Nan was 1 year and 5 months old, and other babies were able to walk away, Nan Nan couldn’t stand up yet. Her mother was in a hurry, so she hurriedly took Nan Nan to the local top three hospital to get an expert number.
The doctor asked, “Where was your baby born? How was it at birth? When did the skin turn yellow? Did you have any cramps?”
Nan Nan’s mother replied: “My family Nan Nan was full-term and gave birth naturally. She was born in our county hospital. Everything was fine when she was born, and I was discharged from the hospital with my baby the next day. When I was discharged from the hospital, the doctor asked me to check my skin for yellowing every day after I was discharged from the hospital. Then the day after I was discharged from the hospital, it started to turn yellow, and it became more and more yellow. sentence.
Sometimes my brows are wrinkled. I wanted to ask my mother-in-law to take my Nannan to the hospital, but the mother-in-law said, ‘Every child who is fed by mother’s milk has yellowishness. All five are yellow, no fuss’. As soon as I heard it, I also felt that it was normal for the baby to have yellow skin, so I didn’t go to the hospital. Later, the baby gradually faded away. “
The doctor checked Nan Nan from head to toe and said, “Hey, I’m on tiptoes and can’t follow my feet. I’m afraid it’s cerebral palsy, so hurry up and get checked.”
Image source: Zhanku Hailuo
Nan Nan’s mother hurriedly took her child for a cranial MRI. After the test results came out, the doctor said, “Your baby is indeed cerebral palsy.”
My mother cried when she heard it and regretted it.
The doctor explained: “Nan Nan’s skin was very yellow not long after she was born. In fact, the bilirubin in the blood was very high, which caused the baby to have bilirubin encephalopathy. It’s because of the high intracranial pressure; the frowning for a while is the manifestation of the convulsions during the spasm at that time. Now he is on tiptoe every day, can’t walk and can’t speak, it is the sequelae of bilirubin yellow entering his brain.”
Such a serious consequence was something that Mother Nan Nan, who was a new mother, could never have imagined. Is newborn jaundice really that scary? So many babies have yellow, why is it Nan Nan who has a problem?
Today, I will tell you how to properly face neonatal jaundice.
1. What is the cause of neonatal jaundice?
The jaundice in a newborn baby is originally a physiological phenomenon, which is related to the bilirubin metabolism characteristics of the newborn.
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Newborn Jaundice
When the baby is in the mother’s womb, all oxygen and nutrients are provided by the mother’s placenta, and the oxygen concentration is relatively low. Therefore, the fetus needs more than adults. Red blood cells and hemoglobin transport oxygen to themselves.
After the baby is born, he begins to breathe on his own. At this time, the oxygen concentration in the blood increases. On the one hand, so many red blood cells are no longer needed. The lifespan of red blood cells is also shorter than that of adults. A large number of red blood cells age and disintegrate, releasing a large amount of bilirubin into the blood.
But at the same time, the newborn baby’s liver is still very immature and lacks a lot of enzymes. The excess bilirubin cannot be decomposed by the liver in time; and several proteins that can transport bilirubin in the blood are also insufficient.
All of this leads to the fact that the production speed of bilirubin far exceeds the processing and excretion speed. The accumulation of bilirubin in the body causes the baby’s skin to turn yellow.
In the blood of adults, as long as bilirubin exceeds 2mg/dl, the skin and eyes will appear yellow; but in newborn babies, it will be more than 5mg/dl to see yellow skin.
However, as long as the curve of serum bilirubin over time is within the normal range and the baby has no other abnormal manifestations, it is normal physiological jaundice.
More than 80% of normal newborns will have yellow skin in the early postnatal period[1], but it usually occurs 2 to 3 days after birth, only on the face, neck, whites of the eyes, and part of the body. Yellowing, but the calf, forearm, palms and soles are not obviously yellow, and there is no abnormality in breastfeeding, mental response, and sleep. The duration may only be 5 to 7 days, and it usually subsides within 2 weeks, and no special treatment is required. .
However, there is also a condition in which the skin of the whole body becomes very yellow within 24 hours after birth and lasts for more than 2 weeks, which is called pathological jaundice. It has a variety of causes and can be divided into three categories:
1. Generates too many
For example, if the blood type of the mother and the baby do not match (for example, the mother is type O and the baby is type A or B), the mother’s bodyThe antibodies produced enter the baby’s body through the umbilical cord, causing a large number of damage to the baby’s red blood cells, causing hemolysis. Hemolysis is the most serious cause of neonatal jaundice.
There are also bleeding in different parts of the body, infections, red blood cell enzyme deficiencies (such as “broad bean disease” that most people have heard of), abnormal red blood cell morphology, and various hemoglobinopathies. cause pathological jaundice.
2. Bilirubin metabolism disorders
It means that the liver “can’t catch” bilirubin in the blood, which may be due to hypoxia, drug effects, or a variety of inborn errors of metabolism caused by heredity.
3. Bilirubin excretion disorder
It means that the liver can “grab” bilirubin, but cannot excrete it. The specific causes are hepatitis, congenital metabolic defects, biliary atresia, etc. [1].
No matter which of the above reasons, mothers should not take it lightly. If they find that the baby’s skin is yellow, they should go to the hospital for treatment in time. Common treatment methods include phototherapy, exchange transfusion therapy, drug therapy, etc., which need to be determined by doctors in combination with specific conditions [2].
In addition, there is a special type of jaundice called breast milk jaundice, which often occurs in babies who are exclusively breastfed. Certain substances in breast milk cause the liver to abnormally metabolize bilirubin. But the baby has no other abnormal phenomenon except yellow, which can last for 1 to 3 months, and does not need special treatment.
Image source: Zhanku Hailuo
Second, what misunderstandings do novice parents have about neonatal jaundice?
The first misunderstanding is that it is easy for novice parents to follow the concept of the older generation, thinking that “everyone has sex, if you worry about it, you will retire in time”.
Situations like Nan Nan’s mother are often seen in hospitals, and it is easy to miss the best time for treatment, causing irreparable damage to the baby and a heavy blow to the family.
Secondly, there is another extreme. When the parents see the yellow skin of the newborn baby, they are terrified and can’t wait to rush to the hospital for treatment. After going to several hospitals, all the doctors said it was normal, so I went home uneasy.
Third, what is the correct approach?
If the baby has yellow skin, parents can take the baby to the hospital for a simple bilirubin measurement through the skin (transcutaneous bilirubin level measurement, no need to puncture the skin); If the result is abnormal, the liver function and other tests (such as serum bilirubin measurement, etc.) should be done under the advice of the doctor, and the doctor will decide whether to be admitted to the hospital according to the situation.
References:
[1] Wang Weiping, Sun Kun, Chang Liwen. Pediatrics [M]. 2nd printing of the 9th edition in August 2018. Beijing: People’s Health Publishing House, 2018: 111 -115.
[2] Neonatal Group of Pediatrics Branch of Chinese Medical Association, Editorial Board of “Chinese Journal of Pediatrics”. Expert consensus on diagnosis and treatment of neonatal hyperbilirubinemia[J]. Zhonghua Journal of Pediatrics, 2014, 52(10):745-748.
*The content of this article is for the popularization of health knowledge and cannot be used as a specific diagnosis and treatment suggestion, nor can it replace the face-to-face consultation of a licensed physician, and is for reference only.
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