What Is Pathological Jaundice?

Pathological jaundice mostly refers to neonatal pathological jaundice. Jaundice is more common in neonates than any other age. Its etiology is special and complicated. It includes both physiological jaundice, pathological jaundice, and breast milk jaundice. These situations should be treated differently. If the child develops jaundice or develops too quickly within 24 hours after birth, it lasts for a long time, and may even be accompanied by anemia, abnormal body temperature, poor feeding, vomiting, and abnormal urine color. Some are recurrent and aggravated after the jaundice has subsided or alleviated, and most of them are pathological jaundice.

Basic Information

Causes of pathological jaundice

Common causes of jaundice are neonatal hemolytic disease, neonatal infections, biliary malformations, and neonatal hepatitis. Other diseases include: pediatric spherocytosis, perinatal diseases in children, and so on. When pathological jaundice is severe, it is likely to develop into "nuclear jaundice" that causes damage to the newborn's nervous system and can even cause death.

Other causes of pathological jaundice:

Excessive blood bilirubin

Certain reasons (congenital metabolic enzymes and hereditary defects of red blood cells) and excessive destruction of red blood cells in the body caused by physical, chemical, biological and immune factors, anemia, hemolysis, excess blood bilirubin raw materials can cause prehepatic jaundice. Such as autoimmune hemolytic anemia, hereditary spherocytosis, unstable hemoglobin disease and so on.

2. Biliary obstruction

Due to stones and liver, gallbladder, pancreatic tumors, and other inflammations that cause bile duct obstruction, bile cannot be discharged into the small intestine, which can cause posthepatic jaundice. Common diseases include: suppurative cholangitis, common bile duct stones, pancreatic head cancer, pancreatitis, bile duct or gallbladder cancer.

3. Congenital non-hemolytic jaundice

Gilbert disease and jaundice caused by Dubin-Johnson syndrome and jaundice caused by neomycin are both caused by bilirubin binding disorders and bilirubin metabolic defects in liver cells.

4. severe heart disease

In patients with heart failure, chronic liver congestion and enlargement can cause jaundice.

5. Drug-induced damage

Some drugs, such as chlorpromazine, indomethacin (indomethacin), phenobarbitals, sulfa drugs, p-salicylic acid, and carbachol, can reach toxic hepatitis. At this time, the symptoms of gastrointestinal tract were not obvious, there was no fever before the appearance of jaundice, and the elevation of serum aminotransferase was obvious, but the normal turbidity reaction can be identified.

Clinical manifestations of pathological jaundice

If jaundice occurs within 24 hours after birth, the symptoms of jaundice develop quickly, severely and long, and will not subside in 2 weeks in term infants and 3 weeks in preterm infants. After prolonged jaundice subsided, it reappeared later. In addition to jaundice, babies may have symptoms such as depression, lethargy, difficulty in suckling, panic, binocular strabismus, rigidity of the limbs, or convulsions.

Pathological jaundice

1. Blood routine, reticulocyte count and nucleated red blood cell count.

2. Determination of total bilirubin and direct bilirubin, when serum bilirubin reaches 205mol / L (12mg / dl) in preterm infants, 256mol / L (15mg / dl) in preterm infants should be vigilant against bilirubin encephalopathy in children.

3. Urine routine and urine triple gall test.

4. Pay attention to the color of the stool, and if necessary, perform a fecal and gallbladder examination.

5. Select the following tests according to the condition:

(1) Hepatic function test for suspected neonatal hepatitis, meanwhile check mother and child HB-sAg, HBeAg, HBVDNA, anti-HBc-IgM, etc., alpha-fetoprotein (normal newborn alpha-fetoprotein positive, turned negative one month after birth ).

(2) Suspected neonatal sepsis for blood culture, local infection exudate for smear and culture.

(3) Giant cell inclusion body disease is suspected. Urine sediment examination will be used to find giant cells with inclusion bodies. Conditions can be used for virus isolation and serological examination.

(4) Relevant tests for suspected neonatal hemolysis.

(5) The suspected erythrocyte G6PD deficiency is tested for methaemoglobin reduction rate (normal people> 75%, patients decreased), denatured globin body (Heinz body) generation test, and G6PD activity can be determined under conditions.

(6) Suspected hereditary spherocytosis, conduct red blood cell fragility test (normal people start hemolysis 0.40% to 0.46%, complete hemolysis 0.30% to 0.36%, the patient's red blood cell fragility increases).

(7) Urine Banner's test is suspected of galactosemia, and those with conditions can measure the galactose concentration in blood and galactose-1-phosphate uronidase activity of red blood cells.

Diagnosis of pathological jaundice

Diagnosis is based on medical history, clinical manifestations, and examination.

To understand the history of pregnancy and childbirth of mothers and children, the history of infection and medication before delivery, the history of blood transfusions, the history of family members with hepatitis and jaundice. Pay attention to parity, premature birth, and history of birth injury, suffocation, hypoxia, hunger, and infection. Inquire in detail about the appearance and duration of jaundice, the extent and length of changes, and the color of the stool. Is there a history of medications that cause jaundice after birth (such as sulfa, salicylic acid preparations, high-dose vitamin K3, vitamin K4, etc.) and history of exposure to naphthalenes (such as health balls, etc.).

Differential diagnosis of pathological jaundice

Neonatal hemolysis

Jaundice begins within 24 hours or the next day after birth and lasts for one month or more. It is mainly caused by unconjugated bilirubin. It is hemolytic anemia, liver and spleen, maternal and infant blood type incompatibility, and severe cases with bile Erythroencephalopathy.

2. Neonatal sepsis

Jaundice begins 3 to 4 days or later after birth, and lasts 1 to 2 weeks, or longer. The increase of unconjugated bilirubin in the early stage is mainly, and the increase of conjugated bilirubin in the late stage is mainly hemolytic, and the late stage is hepatocellular, with symptoms of infection and poisoning.

3. Breast milk jaundice

Jaundice begins 4-7 days after birth and lasts for about 2 months. It is predominantly elevated in non-conjugated bilirubin and has no clinical symptoms.

4. Physiological jaundice

The onset of jaundice is 2 to 3 days after birth, which lasts about 1 week. It is mainly caused by the increase of non-conjugated bilirubin, hemolytic and hepatic, without clinical symptoms.

5.G-6-PD deficiency

The onset of jaundice is 2 to 4 days after birth, 12 weeks or more, and the increase of non-conjugated bilirubin is the main cause. Hemolytic anemia is often the cause of disease.

6. Neonatal hepatitis

Jaundice starts from a few days to several weeks after birth and lasts 4 weeks or more. It is mainly combined with increased bilirubin, obstructive and hepatocellular. Jaundice and stool color have dynamic changes, GPT increases, and hormones can fade.

Pathological jaundice treatment

Cause treatment

The cause of pathological jaundice should be identified and the cause removed in a targeted manner.

2. Drug treatment

(1) Enzyme inducer: phenobarbital, side effects include drowsiness and slow breastfeeding.

(2) Glucocorticoid: Prednisone or dexamethasone can be used, but it should be used with caution according to the cause of jaundice.

3. Phototherapy

All indirect bilirubin elevations caused by various reasons can be treated with light. Generally, the total bilirubin in the serum is above 205.2 256.5mol / L (12 15mg / dl). If maternal and child blood group incompatibility hemolysis has been diagnosed, light therapy can be used once jaundice appears. The side effects of using phototherapy include fever, diarrhea, rash, riboflavin deficiency, thrombocytopenia, bronze disease, etc., and they can recover after stopping phototherapy.

4. Blood exchange therapy

Prevention of pathological jaundice

1. During pregnancy, pregnant mothers should pay attention to diet, but food is cold, but hungry and full, and avoid alcohol and hot products to prevent damage to the spleen and stomach.

2. Women who have had babies with fetal yellow should take precautions when pregnant again and take Chinese medicine on time.

3. After the baby is born, closely observe the scleral jaundice, find that jaundice should be treated as soon as possible, and observe the color change of jaundice to understand the progress and retreat of jaundice.

4. Pay attention to observe whether the infants with fetal yellowness are apathetic, lethargic, difficult to suckle, disturbed, binocular strabismus, limb rigidity or convulsions, etc., in order to detect and treat the severely ill children in time.

5. Closely observe changes in heart rate, heart sound, anemia, and liver size, and prevent and treat heart failure early.

6. Pay attention to protect the baby's skin, umbilicus and buttocks to prevent damage and infection.

7. When performing blood exchange therapy, the air in the ward should be disinfected in time, blood and all kinds of medicines and articles should be prepared, and strict operating procedures should be prepared.

8. The prevention of neonatal pathological jaundice is to prevent toxoplasma and rubella virus infection during pregnancy, especially to prevent viral infection in the first trimester; to prevent sepsis after birth; to inoculate hepatitis B vaccine at birth. Parents should closely observe the child's jaundice, and if there are signs of pathological jaundice, they should be sent to the hospital for treatment.