I. Physiological jaundice
Newborns appear on the second to third day after birth with yellowing of the skin, conjunctiva and oral mucosa, both light and heavy. Generally more obvious in the face and forehead, but the palms of the hands and feet are not yellow. It is most pronounced on days 4 to 6 and subsides 10 to 14 days after birth in full-term infants and may persist until the third week in premature infants. During this period, the child is generally well and shows no other signs of discomfort. No treatment is required.
Second, pathological jaundice
It requires oral medication or even hospitalization and is mainly seen in
(1) Jaundice within 24 hours after birth.
(2) High serum bilirubin, total bilirubin >220.6μmol/L (12.9mg/dl) in term infants and >256.5μmol/L (15mg/dl) in preterm infants.
(3) Long duration of jaundice, >2 weeks in term infants and >4 weeks in preterm infants.
(4) jaundice receding and reappearing.
Third, the main causes of pathological jaundice
1, ABO hemolytic jaundice.
(2) neonatal infections: bacterial and viral infections
3, congenital erythrocyte G-6-PD enzyme deficiency (serotonin)
4, starvation, hypoxia, constipation, dehydration, acidosis, cephalohematoma, giant babies, infants of diabetic mothers, etc.
5, breast milk jaundice.
Fourth, the danger of pathological jaundice – nuclear jaundice
Regardless of the cause, when pathological jaundice is severe, the blood bilirubin concentration is high (transdermal bilirubin > 300umol/L), and the high concentration of bilirubin can pass the blood-brain barrier in newborns, damaging brain cells and causing “nuclear jaundice”, which has a poor prognosis, in addition to causing neurological damage, and in severe cases, may also inhibit the respiratory center, causing early death in newborns. Therefore, prevention of neonatal pathological jaundice should be emphasized, and oral medication is required for mild pathological jaundice, while hospitalization is required for severe pathological jaundice.
V. Treatment options for jaundice
1, physiological jaundice: more sun exposure in the morning and evening sun exposure precautions: more than one hour each morning and evening sun exposure is good. When sunbathing, cover the baby’s eyes, in summer you can put the baby on his back and expose the skin of his back and limbs to the sun, in winter you can expose the skin of the baby’s face and hands and feet to the sun. The principle of sunbathing is to be comfortable, and to expose the skin as much as possible to the sun, if the baby has a rash or the weather is too cold or too hot, then do not sunbathe.
2, mild to moderate pathological jaundice: oral medication + morning and evening sunshine, the best conditions for children with blue light treatment.
Note: In pathological jaundice, the bilirubin may continue to rise after taking medication, so it is still necessary to recheck the bilirubin value daily until the jaundice value steadily decreases, and some babies may still have a jaundice value of more than 300umol/L after taking medication, which needs to be changed to hospitalization to avoid bilirubin encephalopathy.
3, severe pathological jaundice: including patients with jaundice within 24 hours of birth and patients with transcutaneous bilirubin measurement >300umol/L (>17.5gm/dl) must be hospitalized.