Infant jaundice syndrome

2021-03-21 12:00 AM

Type ABO disagreement can occur from the first child, slight jaundice, appear early 2-3 days after birth, increase rapidly, clear urine, yellow stools

Jaundice is a symptom of a variety of causes, jaundice caused by an increase in the level of bilirubin in the blood, yellow when the bilirubin level is above 2mg% in an adult and over 7mg% in a newborn.

Jaundice is common in newborns and the greatest risk is grey-yellow macular.

Metabolism of bilirubin

Bilirubin is produced by catabolism of red blood cells in the body, the hemolysis of infants twice as large as adults, free bilirubin (indirectly) is moved to the liver by the link with albumin, in the liver through enzyme glycuronyl transferase, free bilirubin (indirectly) is converted into combined bilirubin (direct) transferred through the bile into the intestine. Here, part is reabsorbed for renal exclusion, another part further for fecal elimination (the yellow of the nucleus) in the neonatal period has its own characteristic in this metabolism.

Heavy hemolysis due to shorter red blood cell survival and a large proportion of herhoglobin that does not make red blood cells, resulting in high bilirubin.

The binding capacity of albumin is reduced (decreased blood albumin, acidosis, drugs ...).

There is a restriction of the enzyme glycuronyl transferase (due to stricture, acidosis, poor quality ...) thereby reducing the ability to convert bilirubin indirectly into direct.

Intestinal secretion is reversed due to the absence of bacteria.

Poor intestinal cycle.

Classification of different types of neonatal jaundice

There are two large groups of jaundice depending on the type of bilirubin.

Jaundice with increased direct bilirubin (combined)

This uncommon but most severe type is jaundice with dark urine and discolored stools. Two major causes are biliary atrophy, requiring surgical treatment.

Jaundice of indirect (free) bilirubin

As the most common type of jaundice, if not detected and treated promptly, the extremely serious complication is gray-yellow kernels.

Reason

Hemolysis

Hemolysis due to mother-child blood group disagreement:

Is a hemolytic phenomenon due to fellow immunology? It is characteristic of the neonatal age and is the main cause of potentially serious and potentially life-threatening hyperbilirubinemia.

Disagreement ABO:

Hemolysis occurs when the mother has anti-anti B antibodies against the child's A or B red blood cells.

Table: Diagram of disagreement occurring

Mother's blood type

Child blood type

 

Hemolysis

No hemolysis

0

A.BAB

0

A

B.AB

0.A

B

A.AB

O.B

FROM

0

FROM

Normally "natural" antibodies anti A, B in maternal serum "O" group are IgM not through placenta. In the mother's blood, the "immune" antibodies to this red blood cell (A, B depending on) appear in the mother's blood. These antibodies, which are IgG, cross the placenta into the baby's blood and break the baby's erythrocytes. According to Levine and Meyer (Cli, pediatr. 1985), ABO disagreement occurs only 10-20% of cases.

Type ABO disagreement can occur right from the first child, light jaundice, appear early 2-3 days after birth, increase rapidly, clear urine, yellow stools.

Diagnosis: mother - child blood type test, bilirubin (whole, direct, indirect). If there is disagreement, increase the voltage of the resistance.

Progress: if the blood bilirubin is treated early, the blood bilirubin decreases rapidly, bi- lirubin indirectly switches to direct excretion, no consequences. If detected late (more than 5 days) that indirect bilirubin has absorbed into brain cells, the child will have signs of neurological abnormalities such as increased muscle tone, extremities, twisting, twitching, then treatment ^ although positive results such as blood transfusion) also does not bring good results, the child will die or live with neurological sequelae.

The Rh factor disagreement:

Hemolysis occurs when a mother has Rh (-) a Rh (+) child, the number of people with Rh (-) is higher in Europe than in Asia (5-15% of the population). In Vietnam, there is no announcement of the Institute of Hematology, but at BVBM and ss met not many. But the mother's anti-D immune antibodies cross the placenta into the baby's circulation causing very strong hemolysis, often staying in the mother's blood almost permanently after the mother's blood is exposed to D antigens. So jaundice Hemolysis due to Rh disagreement can occur from the first child if the antibody level is high, but usually the following pregnancies get worse.

Diagnosis: thinking about when the child has early jaundice, dark yellow with a family history, but mainly depends on the mother-child Rh blood type test. Blood count, Hb decreased sharply, bilirubin increased indirectly very quickly and high, positive direct Coombs’s test.

Evolution: often Rh disagreement without management or vaccination, indirect bilirubin is too high, easy to leave complications of jaundice, severe body hemolytic children since the fetus, born dark yellow anemia, hepatosplenomegaly, systemic edema, heart failure, vegetable cake edema, usually postpartum death.

Rare factors disagree:

Usually, jaundice is not serious but prolonged, the child's condition is not affected at first, but in the long term, splenomegaly and bone deformation will manifest.

Hemolysis - anemia caused by other types:

Secondary: children with hematoma, hemorrhage in the skin, when hemolytic, increased bilirubin release, also seen in preterm infants, asphyxia and infection.

Primary: children with congenital hemolytic diseases such as Monkovvsky Chauffard Thalassemia ...

Jaundice increases indirect bilirubin

Due to lack or disorder of combined enzymes, lack of enzyme glucuronyl transíerase can be due to infertility such as Gilbert disease, G6PD enzyme deficiency ... or by asphyxiation, infection ... inhibition of production of enzymes.

Treatment of indirect (free) increased bilirubin jaundice

Light therapy

This is an inexpensive and very effective treatment, indicated for all children with indirect increase in bilirubin over 13mg% (22mmol%).

Use blue and white light with a wavelength of 420-480mm, distribution of 5-6Uw / cm2 / nm to 50cm away from children. Place the child in the incubator, undressing, with black eye protection.

Let the light shine directly on the child's skin, change the baby's position every 3 hours, after 5 to 6 hours, take a break for 1 hour, continue until the level of indirect bilirubin falls to normal (B2). During screening, add a quantity of 20ml / kg / day.

Change blood

Blood change is indicated when indirect bilirubin is higher than 20mg% (34mmol%).

Choosing the blood type depends on the blood type of the child and mother (B3).

Time of replacement: depends on the child's weight and age (B4).

Blood volume: 150 - 200 ml / kg.

Gacdenan

5mg / kg / 24 hours x 3 days.

Albumin infusion

1 - 2g / kg / 3 hours. During albumin infusion, light should be stopped temporarily.

Table: Blood type designation

Subgroups

Mother group

Group infusion

0

0, A, B, AB

0

A

A, AB

A or 0

 

0, B

0

B

B, AB

B or 0

 

0, A

0

FROM

A

A or 0

 

B

B or 0

 

FROM

A, B, AB hoặcO

0, A, B

Do not know

0

FROM