In medicine, jaundice in newborns within 28 days of birth is called neonatal jaundice. Neonatal jaundice refers to the condition in which the level of bilirubin in the blood is elevated due to abnormal bilirubin metabolism, resulting in yellowing of the skin, mucous membranes, and sclera. It is the most common clinical problem in newborns. This condition can be classified into physiological and pathological jaundice. Physiological jaundice refers to temporary jaundice caused by the characteristics of bilirubin metabolism. It appears 2-3 days after birth, peaks at 4-6 days, and resolves by 7-10 days. Premature infants may have a longer duration of jaundice, but they generally do not exhibit other clinical symptoms except for mild loss of appetite. Pathological jaundice refers to jaundice that appears within 24 hours after birth, with a daily increase in serum bilirubin levels exceeding 5mg/dl or more than 0.5mg/dl per hour. It lasts longer, persisting beyond 2 weeks in full-term infants and 4 weeks in premature infants, even deepening or recurring after regression, or appearing one to several weeks after birth.
1. Physiological Jaundice
Mild cases present as yellow discoloration limited to the face and neck, or may extend to the trunk. The sclera may also be yellow-tinged and will resolve after 2-3 days, with normal skin color returning by the 5th-6th day. Severe cases of jaundice will spread throughout the body and may affect vomit and cerebrospinal fluid for more than 1 week. In particular, some premature infants may have prolonged jaundice lasting up to 4 weeks, with their stools still being yellow and no bilirubin in their urine.
(1) The color of jaundice is light yellow in mild cases and darker in severe cases, but the skin remains reddish pink.
(2) Jaundice is most commonly seen on the trunk, sclera, and proximal limbs, but rarely extends beyond the elbows and knees.
(3) Newborns with physiological jaundice generally have good overall condition, no anemia, normal liver and spleen size, and normal liver function. They do not develop nuclear jaundice.
(4) Physiological jaundice is more common in premature infants and may appear 1-2 days later. The degree of jaundice is more severe and takes longer to resolve, lasting 2-4 weeks.
2. Pathological Jaundice
The characteristics of pathological jaundice are as follows: (1) It appears within 24 hours after birth; (2) The severity of jaundice is greater, with total bilirubin levels exceeding 12.9mg/dl in full-term infants and 15mg/dl in premature infants; (3) It progresses rapidly, with a daily increase in serum bilirubin levels exceeding 5mg/dl; (4) It lasts longer or recurs after regression.
(1) In addition to the face and trunk, jaundice can also affect the limbs and the palms and soles of the feet.
(2) The color of jaundice is mainly due to unconjugated bilirubin elevation, appearing orange or golden yellow. When conjugated bilirubin levels are elevated, the color appears dark green or olive yellow.
(3) Hemolytic jaundice is accompanied by anemia, hepatosplenomegaly, bleeding, edema, and heart failure. Infectious jaundice is accompanied by fever, symptoms of infection, and signs of infection. Obstructive jaundice is accompanied by hepatomegaly, pale stools, and yellow urine.
(4) Systemic symptoms occur in severe cases of jaundice, characterized by poor response, mental lethargy, anorexia, low muscle tone, irritability, high-pitched crying, difficulty breathing, convulsions or opisthotonus, and increased muscle tone.
Jaundice is the most common phenomenon in newborns, but many parents are concerned when their baby has yellowing. Today, I will introduce the massage treatment for jaundice without changing the original meaning of the article.
Damp-Heat Jaundice (Yang Huang)
The skin and face appear yellow, with a bright color and possible fever. The urine is dark yellow.
Massage points: Daqing Bu Pi (300 times), Pinggan (300 times), Qingwei (300 times), Qing Tianhe Shui (150 times), Qingdachang Jing (300 times), Boyangchi (300 times).
Cold-Damp Jaundice (Yin Huang)
The skin and face appear yellow, with a dull color. The baby may feel tired, have cold limbs, pass loose and pale gray stools, and have a white or slippery tongue coating.
Massage points: Wailaogong (300 times), Daqing Bu Pi (300 times), Pinggan (300 times), Erma Xue (300 times), Yongquan Xue (300 times).
Other Treatments
1. Phototherapy
This is a simple and effective method to reduce unconjugated bilirubin levels in the blood. Unconjugated bilirubin undergoes photoisomerization, structural isomerization, and photo-oxidation after exposure to light. Among them, the formation of structural isomers is the most important. It can be rapidly excreted from bile and urine without undergoing hepatic metabolism. This is the main reason why phototherapy reduces total bilirubin levels.
Blue light irradiation is currently the most commonly used method in China. The newborn is placed in a phototherapy unit with the eyes protected by a black eye mask to prevent retinal damage. The perineum and anus are covered with a diaper, while the rest of the body is exposed. Single-sided or double-sided light can be used for 2-48 hours (generally not exceeding 4 days), using continuous or intermittent irradiation until the bilirubin level drops below 7mg/dl, at which point the treatment can be stopped.
2. Exchange Transfusion
Exchange transfusion can effectively reduce bilirubin levels and remove sensitized red blood cells, as well as alleviate anemia. However, exchange transfusion requires certain conditions and can cause adverse reactions, so the indications should be strictly controlled and it is generally used when phototherapy fails.
3. Drug Treatment
Medications can reduce bilirubin production, accelerate bilirubin clearance, or inhibit enterohepatic circulation of bilirubin. This includes supplying albumin, correcting metabolic acidosis, using liver enzyme inducers (such as phenobarbital), and intravenous immunoglobulin.
4. Supportive Treatment
This mainly involves actively preventing and treating hypoxia, hypercapnia, cold injury, hunger, infection, and administration of hypertonic drugs to prevent temporary opening of the blood-brain barrier and the development of bilirubin encephalopathy.
