Children's Jaundice3
The two intern girls asked Teacher Huang,"In summary, the teachers all call the children with icterus Yang Huang." What is Yang Huang?" "Hehehe-" Teacher Huang said,""Let's start with the icterus," Teacher Huang continued,""Simply put, icterus is bile. icterus is a clinical manifestation of the increased concentration of bile in the blood caused by the metabolism disorder of bile color, which leads to the yellowness of the retina, mucus membrane, and skin. Bile secretion is an important function of the liver. Due to various harmful factors, bile secretion and secretion are hindered, resulting in bile stagnation. If the disease is in the liver, it is called hepatic bile stagnation, and if it is outside the liver, it is called extrahepatic bile stagnation.”
In medicine, Jaundice was the clinical manifestation of hyperbillirubinuria. It was a phenomenon in which the increase in the amount of Bilirubin in the blood caused yellow staining of the retina, skin, mucus membranes, and other tissues and body fluids. The normal level of serum Bilirubin is no more than 17 micromole/L(1.0ml/ml). If the level of Bilirubin exceeds the normal level and the naked eye cannot detect the icterus, it can be called latent or subclinical icterus. It was not an independent disease, but a symptom and sign of many diseases, especially those of the liver, gallbladder, and kidneys. Icterus was an important pathological change of liver incompetence, but not all icterus was caused by liver malfunction. There were also prehepatic icterus such as hemolytic icterus caused by red blood cell destruction, and posthepatic icterus such as obstructed bile duct obstruction.
"Do you understand what I'm saying?”" Mm." The two intern girls nodded. Teacher Huang said,"In order to make it easier to understand, let's summarize and classify the icterus."
There were a few reasons for this:
1. Physiological icterus
Physiological Jaundiced Neonates were a phenomenon unique to newborns. Due to the fetus being in a low oxygen environment in the womb, there was too much red blood cell production in the blood. Moreover, these red blood cells were mostly immature and easily destroyed. After the fetus was born, it caused the production of too much Bilirubin, which was about twice as much as that of adults. On the other hand, the newborn's liver function was not mature, so the metabolism of bile was limited, which caused the newborn to have a period of icterus.
The physiological jaundices of a full-term infant began on the second to third day. At this time, the skin was light yellow, the retina (white eyeballs) was slightly yellow, and the urine was slightly yellow but not stained with diapers. It was the yellowest on the fourth to fifth day. The full-term infant subsided on the tenth to fourteenth day. The liver function was normal and the serum uncombined Bilirubin increased. Premature infants 'physiological icterus would appear earlier, higher, and last longer. It could be delayed for three to four weeks. Although she had icterus, the child did not feel any discomfort and was generally in good condition. Physiological icterus was a normal physiological phenomenon and did not require treatment.
2. Breast-feeding icterus
Neonates who were fed breast milk had breast milk icterus, which was a special type of pathological icterus. A small number of newborns who were breastfed had a degree of icterus that exceeded normal physiological icterus, and the reason was not very clear. The characteristic of icterus was that the icterus continued to worsen after the peak of physiological icterus. If breast-feeding was continued, the icterus would continue to decline slowly after a period of time at a high level. If breast-feeding was stopped for 48 hours, the icterus would obviously decline. If breast-feeding was repeated, the icterus would rise again. Because breast milk contained the hormone gestaglyol, it could suppress the activity of the newborn's liver, causing the metabolism and secretion of bile in the blood to be delayed. As a result, the concentration of bile in the blood increased, causing the newborn's skin and retina to turn yellow.
After the occurrence of breast-feeding icterus, it generally did not affect the health of the child, nor did it have symptoms of fever and poor appetite. If the mother stops feeding in time, the icterus will weaken in about 2-4 days and disappear completely in 6-10 days. For breast milk icterus, it generally did not cause damage to the nervous system. There was no need to panic about breast-feeding icterus. Milk could be used as a temporary substitute when stopping breast-feeding. After the icterus improved, she could continue to breast-feed.
3. Hemolytic icterus
The most common cause of hemolytic icterus was ABO hemolysis, which was caused by the incompatible blood types of the mother and fetus. The most common cause was when the mother's blood type was O and the fetus 'blood type was A or B, and the icterus caused was more severe. Others, such as the mother's blood type is A, the fetus 'blood type is B or AB; It was rare for the mother to have B blood type and the fetus to have A or AB blood type, and the icterus caused was relatively mild. It was reported that the incidence of hemolyzed newborns due to blood type disagreement was 11%. 9%。The characteristic of newborn hemolytic jaundiced was that it appeared within 24 hours after birth and gradually worsened. Blood transfusion therapy could be performed in the early stage. If it was a mild symptom caused by the ABO blood type, light therapy could be used.
4. Liver cell icterus
Liver cell icterus was caused by viral or bacteria infection, which damaged the function of liver cells. The most common viral infections were the Cytomegalo Virus and the Liver B Virus. The other viral infections were the Rubella Virus, the Epstein-Barr Virus, and the Toxoplasma Gondhiosis, which were relatively rare.
5. Obstructive Jadestus
Most of the congenital bile duct abnormalities were caused by congenital bile duct atresia. Congenital bile duct atresia was more common. The characteristic of this kind of bile duct obstruction was that the bile duct would appear for 1-2 weeks and gradually deepen. At the same time, the color of the stool would gradually turn light yellow or even white. This kind of bile duct obstruction could be diagnosed by B-ultrasound.
In addition, there was also drug-induced icterus. For example, it was caused by drugs such as vitamins K3, K4, novomycins, etc. Hereditary diseases such as red blood cell 6-Phosphate-Gluconose Dehydrase (G6PD) deficiency, red blood cell Pyruvate Kinase deficiency disease, sphereosis, gallosporemia, alpha-1 antiTrypsin deficiency, and Cystic Fibers disease can also cause icterus.
Why would icterus cause the skin and pupils to turn yellow? How would icterus cause the skin and pupils to turn yellow? The icterus leading to yellowing of the skin and retina was mainly caused by poor liver function and elevated levels of Bilirubin.
Teacher Huang summarized two points: physiological and pathological icterus. There was no need for treatment for physiological icterus, but for pathological icterus, the cause of the disease should be identified and treated according to the patient's condition.
"Is there any harm to the child's icterus? How to prevent it?" The two intern girls asked Teacher Huang.
Teacher Huang said,"Pathological Jaundiced Children, regardless of the cause, are extremely harmful.
There was an important structure in the human brain called the blood-brain barrier. It prevented many substances from entering the brain to protect the brain, the most important central organ in the human body. The development of the blood-brain barrier in newborns was not perfect, and indirect Bilirubin could easily enter the brain through the blood-brain barrier. In children with severe icterus, the indirect Bilirubin in the blood can enter the brain tissue and cause brain damage. This is called Bilirubin Brain Disease (also known as Nuclear Jaundicus). When the blood level of Bilirubin increased sharply, if the baby had a series of symptoms such as poor mental health, drowsiness, soft or tight limbs, difficulty in feeding or not feeding, straight eyes, screaming, convulsions, etc., it meant that there was already a Bilirubin Enpathy. Some seriously ill babies would die because of this. Many of the children who survived the rescue eventually had sequelae of the nervous system, such as motor function disorder, hearing disorder, and low intelligence. Therefore, the emphasis should be placed on prevention of newborn pathological jaundices, such as preventing toxoplasmosis and rubella virus infection during pregnancy, especially in the early stages of pregnancy. prevent the occurrence of infection after birth; The newborn was given a vaccine against liver B at birth. Parents should closely observe the changes in their children's icterus. If there are signs of pathological icterus, they should be sent to the hospital for treatment in time.”Guiding opinion: The appearance of icterus, indicating that the elevation of the serum level is relatively high, you need to find out what the reason is. You can check the liver color ultrasound of the two halves of the second liver. Under normal circumstances, physiological causes of newborn icterus mainly appeared within 2 to 3 days after birth. It was the most serious at 5 to 7 days, and it would disappear by 14 days. The disease, rational icterus, mainly appeared within 24 hours of birth. It was likely to be infected with the liver virus or the liver virus.”
Teacher Huang emphasized two points: 1. The time of appearance and peak time of pathological icterus was very similar to physiological icterus. Neonatal icterus that persisted was mostly caused by liver disease and bile duct atresia. As long as the symptoms were eliminated, the patient could receive treatment in the phototherapy box through the method of infrared radiation, and then be treated with medicine. 2. If the newborn's icterus does not subside during the liver function test, it is normal. There is no need to receive treatment. You can use sugar water to feed it, which can promote the resolution of icterus. Then, if you cooperate with the treatment, you can recover the child's health as soon as possible.
In the end, Teacher Huang revealed the secret of Chinese medicine's classification of icterus into two categories: Yang Huang and Yin Huang.
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