On the care and observation of neonatal jaundice

[Keywords] neonatal jaundice bilirubin care
Neonatal jaundice is the neonatal period because of elevated serum bilirubin concentration, causing the skin, mucous membranes, sclera jaundice neonatal jaundice is a common symptom neonatal period, neonatal jaundice include physiological and pathological, who was born 24 hours, jaundice, serum bilirubin greater than full-term children 221μmol / L, premature children than 257μmol / L can be diagnosed as pathological jaundice [1]. neonatal jaundice, especially jaundice if not actively address the causes of blood bilirubin is too high, easily through the blood-brain barrier, causing kernicterus sequelae or death cause now the care of neonatal jaundice summarized as follows:
As the characteristics of neonatal bilirubin metabolism: neonatal red blood cells and more hemoglobin short life, break down fast, the liver and other tissues of the hemoglobin and red blood cell precursors in the bone marrow and more, so to generate an increase in bilirubin, and liver function development is not perfect, (Y, Z less protein, enzymes excreted less less, so that high levels of serum bilirubin, as well as characteristics of enterohepatic circulation of newborn, neonatal jaundice easily.

An emphasis on perinatal care
Neonatal bilirubin metabolism caused by a variety of factors, non-infectious factors accounted for first, second factor is not infected, non-infectious factors in a high proportion of perinatal factors [2], so good prenatal care is important, as the prevention of premature birth and dystocia, good observation of the production process, improve the delivery technology, and actively deal with fetal distress and neonatal asphyxia, the fetus to prevent or reduce several neonatal bilirubin metabolism due to hypoxia in the activity decreased, resulting in unconjugated bilirubin factors increased. For a long labor, early rupture of membranes, amniotic fluid turbidity, fetal distress, maternal fever, neonatal, Application of antibiotics to prevent infection.

2 care to prevent infection
Net absorption was born in a timely manner the nasopharynx, oral secretions and mucus, put up after each feeding newborn pat back to sucking exhaust inhalation of air, so as not to cause asphyxia and aspiration pneumonia frequently changes the diapers , and after cleaning the buttocks, hips to prevent infection, according to temperature changes increase or decrease in coated to prevent respiratory tract infections. hyperbilirubinemia is the most common complication of neonatal omphalitis [3], so do the umbilical care, to keep the umbilical dry, reduce the incidence of complications. Once the infection, active treatment by the above interventions, factors that reduce or eliminate the infection caused by jaundice.

3 to promote milk secretion, to ensure the supply of nutrients
Colostrum can promote the excretion of meconium, so early after birth contact, early sucking, 24-hour rooming-in every day to suck less than 12 times, frequent and effective breastfeeding sucking indirectly by increasing motility [4 ], to promote digestion and absorption of neonatal excretion. keep quiet and clean, to ensure the mother's rest and nutrition, to promote milk secretion, breast-feeding mother church. of exclusive breastfeeding is still crying after the newborn child, to find the amount of breast milk sucking, indicate inadequate. newborns breast milk can not meet the need, proper use of breast milk increase next intake of the newborn, and promote bowel movements, so that it contains large amounts of bilirubin in meconium faster, reduce jaundice.

4 Application of nursing means to promote excretion of meconium
4.1 after the birth of the newborn to the normal treatment, paraffin oil coated the front anal thermometer inserted into the anus after 2cm, 3 minutes, remove, not only can check the accurate measurement of neonatal body temperature and stimulate the anus and rectum anus to promote the role of defecation.

Not for 12 hours after birth bowel movement, artificial anus for anal stimulation and defecation.

4.2 newborn massage can directly stimulate the gastrointestinal tract, increase food intake and daily defecation and defecation to reduce the amount of bilirubin reabsorption. Massage room temperature 28 ~ 30 ℃ play beautiful music, preferably arranged between the two breast-feeding, and newborn after shower when awake, massage methods with reference manual Johnson & Johnson baby massage, twice a day, gentle movements , pay attention to safety. touching to observe the newborn during the reaction, such as crying, vomiting, skin color changed pause massage, after massage to keep warm. Links to free download http://www.hi138.com 5 oral medicine care
Mummy used to neonatal jaundice love oral, administration must do three investigations of the seven, neonatal medicine less, in order to prevent waste and ensure that the dose of drug and accurate, the best medicine warm water (temperature below 40 ℃ melt on the spoon feeding. the water temperature is too high will kill the active drug, reduce the effect. neonates with or without vomiting after taking the drug, urine and sleep and make a record.

6 Chinese medicine treatment of jaundice in care
Modern Chinese medicine treatment of neonatal jaundice more significant effect, most children with early intervention generally do not need hospitalization, reduced family burden commonly used traditional Chinese medicine treatment of neonatal jaundice with oral jaundice soup, Chinese medicine is an important way of taking one of the elements also affect the efficacy of the link can not be ignored [5]. jaundice soup should pay attention to oral medicine regimens, back a thick yellow soup pan 30ml daily in multiple take liquid, preferably before feeding, warm clothes, medication, observe the number of bowel movements and color, stool frequency and the emergence of water should reduce the dose or suspend the medication.

7-ray therapy of nursing
Treatment of neonatal hyperbilirubinemia is still the main light therapy [6] before irradiation publicity and education work to do family and psychological care. So that families really understand the role of light therapy method, the effect is to obtain their active support. Blue light treatment to maintain room temperature 24 ℃ ~ 26 ℃, humidity 55% ~ 65%. blue box after disinfection plug, adjust the box temperature 28 ℃ ~ 32 ℃. phototherapy before the bath, clean the skin, do not apply powder or coated with oil, so as not to affect efficacy with a black cloth cover the genitals and eyes, so as not to damage the genitals and eyes, to observe whether the fever, diarrhea and other common side effects every 2 hours measured T, P, R time, if the body temperature above 38 ℃, the reasons should be identified and appropriate treatment. Frequently changes the diapers, good hips care, promptly wiped sweat, keeping the skin dry because of dehydration and diarrhea are not dominant, light therapy in the demand side should be fed on breast-feeding or intravenous 10% glucose infusion. Blu-ray after measured with a skin gall bladder bile of neonatal skin and make a record, and check whether the body skin damage, enough to keep warm after a bath.

8 exchange transfusion therapy care
Exchange transfusion therapy is the treatment of severe hemolytic disease of newborns was an effective way, within a short time can be significantly reduced bilirubin concentrations, to prevent bilirubin encephalopathy, shake well before the interpretation and signed informed consent, improve the of checks, strict aseptic operation, to prevent infection, given ECG, respiration, blood pressure, oxygen saturation monitor, while the amount of good shake-out of children's surgery to observe the general condition and response after operation to observe the puncture site redness, swelling, oozing observed timely reporting of abnormal urine color processing. after 2 to 4 hours as well to try to feed children with sugar, such as no vomiting, normal sucking can be properly fed.

9 Summary
In summary, the incidence of neonatal hyperbilirubinemia, although high, but most are reversible, first of all to enhance perinatal care and reduce perinatal factors of hyperbilirubinemia, for all students children, whether or jaundice should take preventive measures to promote bowel movement, reduce the absorption of bilirubin, for the occurrence of hyperbilirubinemia in newborns should be actively symptomatic treatment, to promote the excretion of bilirubin as quickly as possible, for preterm children, high-risk children, jaundice appeared early, rapid development of the newborn attaches great importance to avoid the occurrence of kernicterus. good health and education so that families understand the risk of hyperbilirubinemia, be with family members is to prevent the occurrence of kernicterus the key.

References
[1] Shen Xiaoming, Wang Weiping. Pediatrics (7th edition) [M]. Beijing: People's Publishing House ,2008:114-117.

[2] Wu Li, neonatal hyperbilirubinemia clinical analysis of 380 cases [J]. Practical Medical Techniques, 2005,12 (194-95.

[3] Xiong Yan, Shi Sheng, Peng primitive neonatal hyperbilirubinemia complicated by pneumonia and clinical analysis [J]. Practical Medical Techniques, 2005,12 (187-88.

[4] Wang Huiliang, Denghai Song, Zhao Xiaojing, etc. The early neonatal nursing intervention of ABO hemolytic [J]. Journal of nursing education, 2006,21 (11:1022-1023.

[5] Zhang Jing, attention to the way of taking Chinese medicine [J]. Journal of Clinical Medicine, 200 517 (5:508-509.

[6] Ye Jieqing. Phototherapy of neonatal hyperbilirubinemia position of [J]. Journal of nursing education, 2005,20 (8715-716. Links to free download http://www.hi138.com