Symptoms and hazards of neonatal bilirubin encephalopathy that mothers must know

Although every baby will experience neonatal jaundice, if the bilirubin level is high enough to pass through the blood-brain barrier and affect the brain's nervous system, and develop into bilirubin encephalopathy, the harm caused will be irreversible. So what are the common dangers of jaundice?

1. The degree of jaundice:

Children with bilirubin encephalopathy often have severe jaundice, with severe yellowing of the skin and mucous membranes all over the body. If the limbs, hands, and soles of the feet are all yellow, bilirubin encephalopathy may also occur in premature infants when the bilirubin levels are low, and it is positively correlated with gestational age.

Second, the most vulnerable time:

Bilirubin encephalopathy is common within 1 week after birth, and neurological symptoms may appear as early as 1 to 2 days after birth. Hemolytic jaundice appears early, usually occurring 3 to 5 days after birth. Premature infants or those caused by other reasons mostly occur 6 to 10 days after birth. The serum bilirubin threshold for bilirubin encephalopathy varies with postnatal age. That is to say, the earlier it occurs, the lower the threshold for bilirubin encephalopathy.

3. High risk factors for disease

When there are high-risk factors such as premature birth, asphyxia, dyspnea or hypoxia, severe infection, hypoalbuminemia, hypoglycemia, hypothermia, acidosis or body weight less than 1.5 kg, bilirubin encephalopathy may also occur when serum bilirubin is lower than the critical value.

4. Symptoms:

Typical symptoms of bilirubin encephalopathy. In the past, bilirubin encephalopathy was divided into four stages: warning stage, spasm stage, recovery stage and sequelae stage. Now the first three stages are often called acute bilirubin encephalopathy, and the fourth stage is called chronic bilirubin encephalopathy. Typical acute bilirubin encephalopathy goes through 3 clinical stages.

The first stage is during the first few days after birth, with slightly reduced responsiveness, lethargy, mild hypotonia, decreased activity, weak sucking, and a slightly high-pitched cry. If the bilirubin level can be quickly reduced at this stage, the above symptoms are reversible.

The second stage is characterized by irritability, high-pitched crying, refusal to feed, apnea, irregular breathing, difficulty breathing, drowsiness and increased muscle tone. Increased muscle tone affects the extensor muscles and may present as opisthotonos, which may be accompanied by convulsions or fever. So it doesn’t mean that jaundice accompanied by convulsions means bilirubin encephalopathy. Many cases do not even involve convulsions.

The third stage usually occurs after one week, when the increased muscle tone disappears and turns into decreased muscle tone. Then the sucking ability and reaction to the outside world gradually recover, and then the breathing improves. After 1 to 2 weeks, all the acute symptoms will disappear.

After the third stage, it turns into chronic bilirubin encephalopathy. Neurological symptoms are nonspecific, and some symptoms may not stabilize until 6-7 years of age.

5. Sequelae

The typical sequelae of kernicterus consist of a tetrad of symptoms:

① Movement disorders: The symptoms are relatively persistent or last a lifetime, mainly manifested as athetosis of hands and feet. Severely affected children may have difficulty speaking, strange facial expressions, drooling, and difficulty chewing and swallowing.

② Hearing abnormalities: Hearing impairment is a prominent manifestation of bilirubin neurotoxicity

③ Eye movement disorder: manifested as difficulty in eye movement, especially limited upward gaze, often resulting in "baby eyes".

④ Abnormal enamel development: There are green teeth or brown teeth, and the incisors have crescent-shaped defects due to incomplete enamel development.

6. Treatment Methods

The treatment of acute bilirubin encephalopathy is effective and common.

1. Phototherapy

2. Photoexchange transfusion is the fastest way to treat hypercholesterolemia.