1/DS: Physiological neonatal jaundice.
2 / Mass / Growth index u003d 60.7 (N-60-80 /)
3 / reticulocytosis is associated with hemolysis of fetal hemoglobin, S.I. = Lf. (Phys. cross.)
5/ increased indirect B. because the breakdown of fetal hemoglobin is increased., cholesterol is slightly increased because there is cholestasis.
6/ 1. Increased B. formation (N-in cord blood-26-34 µmol/l) 145 µmol/kg/day. because of :
a) shortened life expectancy of Er. due to the predominance of Er. with fetal hemoglobin;
b) pronounced ineffective erythropoiesis;
c) increased formation of B. in the catabolic phase of metabolism from non-erythrocyte sources of heme (myoglobin, hepatic cytochrome, etc.)
2. Reduced functional ability of the liver, manifested by:
a) reduced capture of NB. by hepatocytes,
b) low ability to glucuranate B. due to the low activity of glucuranyl transferase and uridine diphosphoglucose dehydrogenase, mainly due to their suppression by mother’s hormones,
c) reduced ability to excrete B. from the hepatocyte
3. Increased intake of NB. from the intestines into the blood due to:
a) high activity of B-glucuronidase in the intestinal wall,
b) the flow of part of the blood from the intestine through the ductus arans into the inferior vena cava, bypassing the liver. e. violation of hepatoenterogenic circulation B.
c) sterility of the intestine and weak rebuc- tion of bile pigments.
7/ HDN will not develop (THB – according to the Rh factor, according to the ABO system, when the mother has 1 (O) blood group, and the child has 2 (A) or 3 (B) blood groups.
8/ hemolysis H b, low enzymatic activity of the liver.
9/ physical jaundice – appears on day 2-3, B. indirect 140-150 μmol / kg / day, B. umbilical cr. 26-34 μmol / l., general condition does not suffer, passes by day 10. – Hemolytic well .- are present at birth and appear on the first day or in the second week of life, last more than 7-10 days in full-term and 10-14 days in premature babies, proceed in waves, the growth rate of NB. more than 5 µmol / l / hour or 85 µmol / l / day, the level of NB. in cord blood serum – more than 60 μmol / l – on the 2nd day of life, the maximum level of NB. more than 25 μmol / l.
10 / At high numbers B. 340 µmol / l in full-term and 170 µmol / l unedo-x. the risk of developing bilirubin encephalopathy 4 phases –
1) bilirubin intoxication: lethargy, decreased muscle tone and appetite up to refusal of food, poor movements, monotonous cry, incomplete expression of the Morro reflex, regurgitation, vomiting, pathological yawning, wandering eyes.
2. nuclear jaundice: spasticity, stiff neck, forced position of the body with opisthotonus, periodic excitement and a sharp brain cry, bulging of the large fontanel, twitching of the muscles of the face, large-scale tremor of the hands, convulsions, a symptom of the setting sun, nystagmus, Graefe’s symptom, bradycardia, lethargy , increased body temperature.
3.per. imaginary well-being and disappearance of spasticity (starting from the 2nd week of life),
4. The formation of neurological complications begins at the end of the neonatal period or at 3-5 months of life: cerebral palsy, athetosis, choreoathetosis, paralysis, paresis, deafness, etc.
11/ Indications for PKC – B. above 342 µmol/l, the rate of increase of B. above 6.0 µmol/l-h and its level in cord blood above 60 µmol/l, severe anemia (Hb less than 100 g/l), in children with malnutrition, depending on the degree of malnutrition, from 342 to 222 µmol / l
12/ jaundice does not require treatment.
14/ the prognosis is favorable.
Tasks for Pediatrics 3
Boy G., 1 day old, is in the maternity hospital.
From the anamnesis it is known that the mother is 25 years old, she has A (P) Rh-negative blood group. The first pregnancy was 3 years ago, ended in a medical abortion at a period of 9 weeks, there were no complications.
This pregnancy is the second, proceeded with toxicosis in the first trimester, in the third trimester there were periodic rises in blood pressure up to 145/90 mm Hg. In the antenatal clinic was observed irregularly. Birth urgent, independent. 1st period – 6 hours 30 minutes, 2nd – 25 minutes, anhydrous period – 3 hours. Body weight at birth 3300 g, body length 51 cm Apgar score 7/8 points. Immediately at birth, icteric staining of the skin, membranes of the umbilical cord and amniotic fluid was noted.
At the first examination by a pediatrician, an increase in the size of the liver up to + 3 cm and the spleen up to + 1.5 cm was revealed.
Additional research data for the task of pediatrics
Additional examination: cord blood bilirubin amounted to 105 µmol/l.
In a biochemical blood test of a newborn taken at the age of 4 hours of life, the level of indirect bilirubin was 175 µmol/l.
Hb peripheral blood, determined by cito, 149 g/l.