Nsuo a Ɛma Nkokoaa a Wɔawo Wɔn Foforo, Akisikuru a Ɛyɛ Den (Bilirubin), ne Nnawɔtwe a Edi Kan no Frɛmfrɛm Kɔkɔɔ¶

Onipa asetra mu nnafua 7 a edi kan, titiriw Nnafua 2 kosi 5, bere a wɔayi akokoaa bi afi ayaresabea awo dan mu akɔ fie ntɛm ara no, gyina hɔ ma nipadua mu nsakrae a ɛyɛ mmerɛw kɛse. Wɔ saa mfɛnsere yi mu no, ɛna no asaabo da so ara dan nufusu a ɛho akokwaw (lactogenesis II, a ɛtaa ba wɔ awo akyi nnɔnhwerew 72 kosi 96), abofra a wɔawo no foforo no mmerɛbo a ennyinii no repere sɛ ɛbɛka awotwaa mu mogya mu nkwammoaa kɔkɔɔ a abubu (bilirubin) a ɛrekɔ soro kɛse no abom, na akokoaa no asaabo reyɛ nsakrae wɔ awotwaa mu nsu a ɛwɔ akyi no mu kari pɛ. Esiane sɛ hyperbilirubinemia a emu yɛ den ne hypernatremic dehydration hyɛ wɔn ho wɔn ho den wɔ kyinhyia bɔne mu nti, abofra a wɔawo no foforo a nsu nnim no da dodo sɛ ɔbɛma no nufu, na ɛma nsu a ɛba no gyae na ɛhyɛ bilirubin ma ɛsan twetwe fi dwensɔtwaa no mu san kɔ mogya no mu, ayaresabea sɛnkyerɛnne ahorow a ɛnyɛ anifere betumi ayɛ kɛse abɛyɛ amemene mu opira a ɛtra hɔ daa (kernicterus) anaasɛ hypovolemic shock wɔ ne mu Nnɔnhwerew 12 kosi 24.

Awofo foforo taa di mfomso susuw sɛ pathological lethargy (akokoaa a awuduru wom, nsu nnim, anaasɛ septic a ontumi nna hɔ mma aduan) sɛ "ɔda pa, ɔyɛ komm." Ɛdenam ayaresabea kyerɛwtohɔ ahorow a ɛyɛ pɛpɛɛpɛ, a wɔde wɔn ani asi so, da biara da mpaboa dodow a ɛyɛ nsu na ɛho ntew, Kramer nkɔso a ɛba wɔ honam ani yare kɔkɔɔ mu, ɔfe ne nsu kɔla, ne akyi berɛmo mu hyew a wodi akyi so no, awofo betumi ahu ntɛmpɛ a ɛde wɔn nkwa to asiane mu nnɔnhwerew bi ansa na ɔsɛe a wontumi nsakra no aba.

Yɛ eyi mprempren¶

1. Frɛ wo mpɔtam hɔ ntɛmpɛ nɔma ntɛm ara sɛ wo ba a wɔawo no foforo no da ntini, ɔhome, anaa bilirubin haw ho sɛnkyerɛnne biara a emu yɛ den adi: Trɛ 911 wɔ United States ne Canada, 112 wɔ Europa Aman Nkabom no nyinaa mu, 999 wɔ United Kingdom, anaa 000 wɔ Australia (hwɛ nɔma ahorow a egye ntɛmpɛ) sɛ wo ba a wɔawo no foforo no entumi sɔre mma aduane, ɔte nka sɛ ɔyɛ mmerɛw te sɛ ragdoll anaasɛ ɔbɔ wɔn kɔn ne wɔn akyi denneennen kɔ akyi (opisthotonos), ɔwɔ ɔteɛteɛm a ɛkorɔn, a wontumi nnya awerɛkyekye, ɔwɔ jaundice kɔkɔɔ wɔ nnɔnhwerew 24 a edi kan wɔ awo no mu anaasɛ odu nsateaa ne ne nan ase nan, anaasɛ ɔrehome ntɛmntɛm sen ahome 60 simma biara a mpampam a ɛtwetwe anaasɛ anofafa bruu**.
2. Kɔ Ayaresabea Dwumadibea a Ɛho Hia Ntɛmntɛm ntɛm ara sɛ wo ba a wɔawo no foforo no fe nsu a ɛyɛ ahabammono a ɛhyerɛn anaa neon kɔkɔɔ-ahabammono (bilious emesis): Ntwɛn mma mmofra oduruyɛfo frɛ no bio sɛ ​​abofra a wɔawo no foforo no teɛteɛm anaasɛ ɔfe nsu a ɛyɛ ahabammono tuntum anaa sare/neon-ahabammono a ɛhyerɛn (te sɛ green marker ink). Nea ɛnte sɛ nufusu fitaa fitaa a asiane biara nni ho anaasɛ formula spit-up no, bilious green femit wɔ abofra a wɔawo no foforo mu no kyerɛ sɛ oprehyɛn dwensɔtwaa no asiw (malrotation with midgut volvulus), baabi a dwensɔtwaa a twitwiw no betumi awu wɔ nnɔnhwerew kakraa bi mu a wɔnyɛ mmofra oprehyɛn ntɛm.
3. Fa dijitaal akyi berɛmo mu hyew wɔ abofra a wɔawo no foforo biara a wada, ɔyɛ basabasa, ɔyɛ hyew, anaasɛ ɔte nka sɛ onwini ho: Wɔ akokoaa biara a onnii nnafua 28 (na wadi nnafua 60) mu no, akyi berɛmo mu hyew yɛ digrii Celsius 38.0 (digrii Fahrenheit 100.4) anaa nea ɛboro saa, anaasɛ akyi berɛmo mu hyew a ɛba fam a ɛba fam sen digrii Celsius 36.0 (digrii 96.8 Fahrenheit) (hypothermia ne mmofra a wɔawo wɔn foforo dodow a wɔda sepsis adi), hwehwɛ sɛ tu kwan ntɛm ara kɔ Ayaresabea Dwumadibea a Ɛho Hia Ntɛmntɛm. Mfa acetaminophen (Tylenol/paracetamol) anaa ibuprofen mma nkokoaa da ansa na oduruyɛfo ahwɛ akokoaa no.
4. Mia wo ba no honam ani brɛoo wɔ abɔde mu awia hann mu na hwɛ baabi a nipadua no mu jaundice kɔkɔɔ atrɛw akɔ fam: Yi wo ba a wɔawo no foforo no ntade wɔ baabi a ɛbɛn mfɛnsere wɔ abɔde mu awia hann mu (artificial yellow indoor bulbs de jaundice sie). Mia nsateaa biako brɛoo simma 2 wɔ moma so, moma so, yafunu, asen, ne nan ase so, afei ma wo nsateaa so hwɛ honam ani a ayɛ bruu no ansa na mogya a ɛyɛ pink asan aba. Sɛ kɔla kɔkɔɔ pue baabiara wɔ Da a edi kan (a enni nnɔnhwerew 24), anaasɛ atrɛw akɔ fam atwa yafunu no ho akɔ nan ase, nsateaa, anaa nan ase a, kɔ bilirubin mogya mu nhwehwɛmu a egye ntɛmpɛ ntɛm ara.
5. Hwɛ nnɔnhwerew 24 mpaboa a ɛyɛ nsu ne nea ɛho ntew dodow no ho akontaa de toto wo ba no nkwa da pɔtee ho: Hwɛ sɛ wo ba no redu mpaboa a ɛyɛ nsu a ɛba fam da biara da ho mmara a ɛba fam koraa no so anaa (** mpaboa a ɛyɛ nsu 1 wɔ Da 1, 2 wɔ Da 2, 3 wɔ Da 3, 4 wɔ Da 4, ne diapers a emu yɛ duru 6+ da biara fi Da 5 rekɔ**). Sɛ wo ba a wɔawo no foforo no kɔ bɛboro nnɔnhwerew 8 kosi 12 a onni mpaboa a ɛyɛ nsu wɔ Da a ɛto so 3 akyi, anaasɛ ɔda so ara wɔ chalky orange-pink "brick dust" urate crystals wɔ mpaboa no mu wɔ Da 5 anaa akyiri yi a, kɔ wo mmofra oduruyɛfo nkyɛn nnɛ na fa aduan foforo ma ntɛm ara sɛnea wɔakyerɛ no.
6. Mma akokoaa a wɔawo no foforo nsuo a ɛnyɛ den, asikre nsuo, anaa aduane a wɔayam no da, na fa akokoaa a ne ho ayɛ no yaw nhyɛ mfɛnsere mu owia hann tẽẽ mu da sɛ aduru a wɔde si aduruyɛ mu phototherapy ananmu: Sɛ wode nsuo a ɛnyɛ den ma abofra a wɔawo no foforɔ a, ɛma mogya mu sodium yɛ mmerɛw na ɛkanyan nsuo a ɔbow akisikuru. Sɛ akokoaa bi nsu nnim anaasɛ ne ho ayɛ no yaw na ɔrepere sɛ ɔbɛma nufusu akɔ baabi foforo a, fa syringe, nsenia, anaa toa so ma nkokoaa a wɔayiyi/nufusu a wɔayiyi mu anaasɛ nkokoaa aduan a wɔahyɛ da ayɛ a wɔde afra yiye bere a worehwehwɛ ayaresa no.

Nnawɔtwe a edi kan mu mmofra a wɔawo wɔn foforo ntɛm ara triage flow¶

flowchart TD
    Newborn["Nkokoaa a Wɔawo No Foforo (Nnafua 1 kosi 28 wɔ Nkwa mu) Nhwehwɛmu"] --> RedFlags{"1. Nsɛnkyerɛnne Bi Biara a Ɛde Nkwa To asiane mu Ntɛm ara?"}
    RedFlags -->|"Wontumi Nsɔre nkɔma Aduan, Limp/Arching Back, Rectal Temp >= 38.0C anaa < 36.0C, anaasɛ Ɔhome > 60/min"| ERNow["KƆ AYARESABEA HO NSƐM A ƐYƐ NTƐM NTAM (Frɛ 911 / 112 / 999 sɛ Cyanotic anaa Apneic a)"]
    RedFlags -->|"Nsu a Ɛyɛ ahabammono a Ɛyɛ Hyerɛn anaa Tum a Ɛyɛ Sare a Ɛyɛ ahabammono (Bilious Emesis) a Wofe ."| Volvulus["OPIRO A NTƐM (Midgut Volvulus Asiane): Gyae Aduan a Woma na Kɔ Ayaresabea ER Tẽẽ Seesei"]
    RedFlags -->|"Sepsis a Ɛyɛ Hu anaa Oprehyɛn Ho Nsɛnkyerɛnne biara nni hɔ"| JaundiceCheck{"2. Hwɛ Wora ne Aniwa wɔ Abɔde mu awia hann mu: So Akokoaa Yɛ Kɔkɔɔ?"}
    JaundiceCheck -->|"Yellow Wɔ Nnɔnhwerew 24 a Edi Kan wɔ Awo Mu ANAA Yellow wɔ Nsa/Nsateaa So ANAA Ɛwɔ Dae"| BilirubinER["BILIRUBIN AHOHYEHYƐE A ƐYƐ Ntɛmpɛ: Kɔ Ayaresabea ER Seesei kɔyɛ Stat TSB Mogya Nhwehwɛmu ne Phototherapy"]
    JaundiceCheck -->|"Mild Yellow on Face/Chest Only (Nnafua 3 kosi 5) ne Aduan a Wɔde Hopere Ma"| DiaperCheck{"3. Hwɛ Wet ne Dirty Diaper Count na woahu Nkwa Da Pɛpɛɛpɛ"}
    JaundiceCheck -->|"Jaundice biara nni hɔ"| DiaperCheck
    DiaperCheck -->|"Diapers a Ɛyɛ Nsu Kakraa Sen Nkwa Da, Biriki-Mfutuma Ahwehwɛ wɔ Da a Ɛto so 4 Akyi, anaa Nsuo a Ɛda so Yɛ Tuntum wɔ Da a Ɛto so 5 no"| Dehydrated["DEHYDRATION / UNDERFEEDING RED FLAG: Supplement Nufusu/Nnuru a Wɔde Ma Mprempren ne Da Koro Mmofra Nhwehwɛmu"]
    DiaperCheck -->|"Wet ne Yellow Seedy Stool Botae Ahorow Nyinaa a Wobehyia; Ɔsɔre Nnɔnhwerew 2 kosi 3 Biara"| Normal["Kɔ so Ma Aduan Mpɛn 8 kosi 12 Nnɔnhwerew 24 Biara na Yɛ Nhyehyɛe Da a Ɛto so 3 kosi 5 Mmofra Oduruyɛfo Nsrahwɛ"]

1. Da biara da Akokoaa a Wɔawo No Foforo Diaper Dodow, Nsu mu Nsakrae, ne Mu duru a Wɔtew So Ho Nhyehyɛe (Nna 1 kosi 7) .¶

Esiane sɛ wuntumi nhu colostrum anaa nufusu mililita dodow a abofra a wɔama no nufu no mene wɔ ayarehwɛ biara mu nti, nea epue wɔ diaper no mu no ne ayaresabea kyerɛwtohɔ biako pɛ a edi mu sen biara a ɛkyerɛ nea ɛrekɔ mu. Bere koro no ara mu no, ɛsɛ sɛ abofra biara a wɔawo no foforo nsu a ɛwɔ ne mu no nya kɔla nsakrae a wotumi hyɛ ho nkɔm fi tar tuntum a ɛyɛ nnam (meconium) so kɔ nsakrae nsu a ɛyɛ ahabammono-biribiri mu, na awiei koraa no ɛkɔ nsu a ɛyɛ aba a ɛyɛ sinapi-kɔla kɔkɔɔ mu ansa na Da a ɛto so 4 kosi 5 adu, nsakrae a ɛde bilirubin a wɔde afrafra fi nipadua no mu wɔ honam fam.

Sɛnea wubehu sɛ ebia nnɛyi mpaboa a wɔtow gu a ɛtwetwe nsu kɛse no yɛ nsu ankasa anaa¶

Nnɛyi mpaboa a wɔtow gu no kura sodium polyacrylate gel polymers a ɛma nsu no kɔ ntɛmntɛm araa ma sɛ obi ka a, ɛte nka sɛ emu ntama no ayow bere a akokoaa no ato nsu mpo akyi:

• The Blue Wetness Indicator Line: Nkokoaa a wɔawo wɔn foforo mpaboa dodow no ara wɔ nsensanee kɔkɔɔ bi a ɛba fam wɔ anim akyi kataso no so a ɛdan blue anaa ahabammono bere a ɛne nsu no di nkitaho no.
• The 3-Tablespoon Weight Test: Hwie nsuo 45 mililita (3 tablespoons / 1.5 ounces) gu akokoaa a wɔawo no foforo a ɛho tew a ɛyɛ dry mu na fa kura wo nsa mu; saa squishy heaviness a ɛda nsow no ne sɛnea "full wet diaper" biako te nka fi Da 5 rekɔ.
• Tissue Paper Trick (ma Ntama anaa Non-Indicator Diapers): Fa anim ntini fitaa a ɛnyɛ den anaa tiafi krataa a wɔabobɔw ahinanan gu diaper no anim; sɛ wubue mpaboa no mu a, ntini a ɛyɛ nsu no ma nsu ketewaa bi mpo yɛ nea akyinnye biara nni ho na ɛda urate ahwehwɛ biara a ɛyɛ borɔdɔma-pink a ɛyɛ chalky adi pefee.

Nsonsonoe a ɛda "Brick Dust" Urate Crystals ne Neonatal Pseudomenstruation ne Pathological Bleeding ntam¶

Sɛ wohu nkekae bi a ɛyɛ borɔdɔma, pink, anaa kɔkɔɔ wɔ abofra a wɔawo no foforo mpaboa mu a, ɛma ehu ka awofo. Fa saa ayaresabea mu mpaapaemu yi yiyi mmofra a wɔawo wɔn foforo nipadua a ɛnyɛ hu fi nsu a ɛho nhia anaa GI mogya a ɛtɔ no mu:

1. "Briki Mfutuma" Uric Acid Ahwehwɛ (Orange, Rust, anaa Salmon-Pink Chalky Stain):
2. Nea ɛyɛ: Nkokoaa a wɔawo wɔn foforo yi uric acid a ɛdɔɔso fi wɔn nsu mu. Sɛ nsuo no yɛ kɛseɛ wɔ colostrum nna a ɛnnɔɔso (Nnafua 1 kɔsi 3) a, uric acid no tɔ gu ahwehwɛ nketenkete mu a ɛgya chalky, powdery orange-pink anaa rust-red stain wɔ diaper pad no so (ɛte sɛ nea obi de dɔteɛ birikisi kɔkɔɔ petepete diaper no so pɛpɛɛpɛ).
3. Sɛ ɛyɛ daa vs. ntɛmpɛ: Ɛyɛ daa wɔ Nna 1, 2, ne 3. Sɛ wuhu birikisi-mfutuma urate ahwehwɛ wɔ Da a ɛto so 4 (akyi) anaa Da a ɛto so 5 ne nea ɛboro saa a, ɛnyɛ mogya, ɛyɛ sɛnkyerɛnne a wɔtaa de kyerɛ sɛ akokoaa no nsu ayɛ nea asiane wom fi aduan a wonnya nni ne nsu a ɛho nhia. Frɛ wo mmofra oduruyɛfo nnɛ na ma nufusu a wudi no nkɔ soro ntɛm ara.
4. Mmea Neonatal Pseudomenstruation (Mucoid White Discharge a Mogya Pink/Kɔkɔbɔ a Ɛkɔ So):
5. Nea ɛyɛ: Wɔ mmea a wɔawo wɔn foforo wɔ Nna a ɛto so 2 kosi 7 mu no, ɛna no nyinsɛn mu estrogen dodow a ɛkɔ soro a ɛkɔ fam mpofirim wɔ awo akyi no ma akokoaa no awotwaa mu ntini ketewaa no hwie bere tiaa bi, na ɛda adi sɛ ɔbea no awotwaa mu nsu a ɛyɛ den te sɛ nufusu fitaa a mogya kɔkɔɔ a ɛhyerɛn anaa pink tuntum kakraa bi a ɛtɔ so ayɛ no nsensanee.
6. Nea ɛsɛ sɛ woyɛ: Ɔha biara mu nkyem 100 a ɛyɛ nea ɛfata na asiane biara nni ho; popa brɛoo fi anim kɔ akyi na mmɔ mmɔden da sɛ wobɛpopa vernix fitaa/mucus fitaa a ɛbɔ ho ban no nyinaa afi labia ntam.
7. Pathological Stool Colors a Ɛhia sɛ Wɔhwɛ Aduruyɛ Ntɛm ara (Kɔkɔbɔ, Tuntum Wɔ Da 5 Akyi, anaa Chalky White):
8. Frank mogya kɔkɔɔ a ɛhyerɛn wɔ nsu mu anaa black tarry stools a ɛsan pue bere a nsu a ɛwɔ nsu mu no adan kɔkɔɔ dedaw akyi: Ɛhwehwɛ sɛ wɔyɛ aduruyɛ mu nhwehwɛmu ntɛm ara wɔ Vitamin K a enni mogya mu (mogya a ɛtɔ wɔ abofra a wɔawo no foforo mu, titiriw sɛ wɔpow Vitamin K awo aduru no), nufusu mu protein proctocolitis, anal fissure, anaasɛ necrotizing enterocolitis.
9. Nsu a ɛyɛ fitaa a ɛyɛ chalky, dɔte kɔla a ɛyɛ mmerɛw, anaa putty-gray (Acholic Stools): ENNYƐ sɛnea ɛte da wɔ mfe biara mu. Nsu fitaa anaa fitaa a ɛyɛ mmerɛw a ɛka jaundice kɔkɔɔ ho a ɛkɔ so tra hɔ akyɛ adapɛn 2 no kyerɛ biliary atresia (bile ducts a asiw wɔ mmerɛbo mu), oprehyɛn bere-topae a ɛsɛ sɛ wɔyɛ no oprehyɛn (Kasai portoenterostomy) ansa na wadi nnafua 30 kosi 60 na wɔasiw mmerɛbo mu yare a edi awu ano.

2. Nkokoaa a Wɔawo Wɔn Foforo Ayare (Hyperbilirubinemia) ne Kernicterus a Wɔde Siw Ano¶

Jaundice yɛ kɔla kɔkɔɔ a ɛsakra wɔ honam ani ne aniwa fitaa (scleral icterus) a efi mogya mu unconjugated (indirect) bilirubin, aduru a ɛyɛ kɔkɔɔ-akutu a ɛba bere a nipadua no bubu hemoglobin a efi mogya mu nkwammoaa kɔkɔɔ dedaw mu no mu. Esiane sɛ akokoaa a ɔwɔ awotwaa no mu hia mogya mu nkwammoaa kɔkɔɔ foforo na ama watumi de oxygen akɔ na ne nkwa nna yɛ tiaa (nnafua 70 kosi 90 sen nnafua 120 wɔ mpanyimfo mu) nti, wɔwo abofra biara a wɔawo no foforo a ɔrebubu mogya mu nkwammoaa kɔkɔɔ pii bere a wɔn mmerɛbo mu enzyme a ennyinii (UDP-glucurnosyltransferase 1A1 / UGT1A1) yɛ adwuma wɔ mpanyimfo tumi mu ɔha biara mu nkyem 1 pɛ** wɔ bere no mu nkwa nna a edi kan no.

Nea afi mu aba ne sɛ, nkokoaa a wɔawo wɔn foforo a wɔawo wɔn bere nyinaa ɔha biara mu nkyem 60 ne mmofra a wɔawo wɔn foforo a wɔn bere nnɔɔso anaa akyiri yi ɔha biara mu nkyem 80 (adapɛn 34 kosi 37) nya physiologic jaundice a wotumi hu wɔ Nnafua 2 ne 5. Nanso, sɛ bilirubin a wɔamfa anhyɛ mu no kɔ soro boro ahwehwɛde a ɛho hia so a, mpɛn pii no boro 20 kosi 25 mg/dL (340 kosi 425 \(\mu\text{mol/L}\)) wɔ akokoaa a wadi mũ mu, anaasɛ wɔ dodow a ɛba fam mpo mu wɔ nkokoaa a wɔawo wɔn ntɛm, wɔyare, anaa ABO/Rh mogya kuw a wɔne no nhyia mu no, bilirubin a entumi nkyekyere srade mu no twa akokoaa a wɔawo no foforo no mogya-amemene akwanside a ennyinii** no na ɛde nkekae na ɛsɛe amemene no mu nneɛma a ɛyɛ fitaa a emu dɔ no (the basal ganglia, globus pallidus, hippocampus, ne amemene no ntini a ɛte aso).

Bilirubin Encephalopathy (ABE) ne Kernicterus: Nsɛnkyerɛnne a Ɛkyerɛ sɛ Ntini mu Ayaresa a Egye Ntɛmntɛm¶

Amemene mu awuduru a efi bilirubin a ɛdɔɔso mu ba no ba wɔ akwan abien so: Acute Bilirubin Encephalopathy (ABE) (a sɛ wɔsa no ntɛm ara wɔ ayaresabea a wɔde mfonini ayaresa a emu yɛ den na wɔde sesa mogya) ne Kernicterus (amemene mu yare a enni sabea, daa choreoathetoid, sensorineural deafness, ɔsoro hwɛ obubuafo, ne nsensan mu ntini a ɛyɛ mmerɛw).

Sɛnea wɔhwɛ sɛnea jaundice kɔ so wɔ fie: Kramer’s Cephalocaudal (Head-to-Toe) Zones¶

Ɛkame ayɛ sɛ bere nyinaa na mmofra a wɔawo wɔn foforo jaundice trɛw fi ti so kɔ fam kɔ nan no so (cephalocaudal progression) bere a mogya mu bilirubin dodow kɔ soro no. Bere a aniwa mu nhwehwɛmu ntumi nsi ayaresabea Transcutaneous Bilirubinometer (TcB) scan anaa Total Serum Bilirubin (TSB) heel-stick mogya mu nhwehwɛmu ananmu da (titiriw wɔ nkokoaa a wɔn honam ani yɛ tuntum mu, baabi a ɛsɛ sɛ wohwɛ aniwa fitaa [sclerae], anom, ne nsateaa ne nan ase a ayɛ fitaa), Kramer’s Mmara de mpa ho akontaabu a ɛho hia ma:

Nneɛma 5 a asiane kɛse wom a ɛma mmofra a wɔawo wɔn foforo no nya jaundice kɔ soro ntɛmntɛm mmɔho abien¶

Sɛ wo ba a wɔawo no foforo no wɔ saa neurotoxicity anaa hemolysis risk factors yi bi (a wɔakyerɛkyerɛ mu wɔ 2022 American Academy of Pediatrics [AAP] Hyperbilirubinemia Clinical Practice Guideline mu) a, ka kyerɛ oduruyɛfo a ɔhwɛ ntɛmpɛ anaa mmofra oduruyɛfo no ntɛm ara:

1. Jaundice a ɛda adi wɔ nkwa nna nnɔnhwerew 24 a edi kan no mu: Ɔyare kosi sɛ wɔbɛda no adi sɛ ɛnte saa. Ɛkame ayɛ sɛ bere nyinaa efi mogya mu nkwammoaa kɔkɔɔ a wɔsɛe no ntɛmntɛm (hemolysis) fi ABO mogya mu su a ɛne ne ho nhyia (ɛna yɛ Mogya Type O na akokoaa yɛ Type A anaa B), Rh factor yare, anaa G6PD a enni hɔ.
2. Late-Preterm anaa Early-Term Gestational Age (34 to 38 weeks): Akokoaa a wɔwoo no wɔ 35, 36, anaa 37 weeks ("late preterm / early term") wɔ mmerɛbo a ennyinii NA ne hwene/anom nufu a ɛyɛ mmerɛw a ɛbrɛ wɔ nufu no mu ansa na wanya aduan a edi mũ, na ɛma wɔn 4 kosi 8 asiane a ɛwɔ hɔ hyperbilirubinemia a emu yɛ den ne nsu a ɛho ntew bere a wɔde toto akokoaa a wadi adapɛn 40 ho no.
3. Cephalohematoma anaa Awo mu Akuru a Ɛho Hia: Sɛ vacuum a wɔde yiyi mu, forceps, anaa awo a ɛyɛ den ma mogya a ɛyɛ mmerɛw kɛse bi a ɛho ahonhon wɔ akokoaa no ti nhwi so (cephalohematoma) anaasɛ n’anim/nipadua mu akisikuru a, ɛsɛ sɛ akokoaa no nipadua bubu mogya a ɛkyeree no nyinaa wɔ Nnafua 2 kosi 6 mu, na ɛtow bilirubin adesoa kɛse a ɛboro so gu mogya no mu.
4. G6PD (Glucose-6-Phosphate Dehydrogenase) Deficiency: Awosu mu enzyme a enni abusuabɔ a ɛne X wɔ abusuabɔ (ɛtaa ba mmusua a wofi Afrika, Mediterranea, Mfinimfini Apuei, ne Asia Kesee Fam Apuei abusua mu) a mogya mu nkwammoaa kɔkɔɔ no pae mpofirim kɔ mogya a ɛyɛ hu mu bere a wɔde wɔn ho hyɛ oxidative triggers mu (wɔmfa akokoaa a wɔawo no foforo ntama nhyɛ mu bere biara de kɔ nwansena [naphthalene], henna aduru, anaa fava bankye).
5. Suboptimal Breastfeeding Intake ("Starvation / Breastfeeding Failure Jaundice"): Sɛ abofra a wɔawo no foforo nnya nufusu a ɛdɔɔso wɔ nnafua 3 kosi 5 a edi kan no mu a, nsu a wɔde fa nsu mu no brɛ ase. Wɔ dwensɔtwaa a agyina hɔ no mu no, enzyme bi a wɔfrɛ no \(\beta\)-glucuronidase yi bilirubin fi meconium no mu na ɛsan kɔ akokoaa no mogya mu pɛɛ (enterohepatic circulation).

Nea enti a ɛnsɛ sɛ wode abofra a wɔawo no foforo a ne ho ayɛ no yaw to owia hann tẽẽ mu DA¶

Wɔka kyerɛɛ nananom awo ntoatoaso ahorow sɛ wɔmfa akokoaa a ne ho yɛ kɔkɔɔ kakra nsi ntama bi so wɔ mfɛnsere bi a owia bɔ kɛse anim. Amerika Mmofra Ayaresa Sukuu (AAP) ne UK NICE akwankyerɛ bɔ kɔkɔ pefee sɛ ɛnsɛ sɛ wɔde ofie owia hann tẽẽ nni dwuma mma mmofra a wɔawo wɔn foforo jaundice:

• Owia hann tẽẽ anaasɛ wɔde mfɛnsere mu yiyi no ma abofra a wɔawo no foforo a ɔda adagyaw no nya ɔhyew a ɛba fam (wɔ dan a mframa bɔ kɛse mu) anaa ɔhyew a ɛboro so ne UV owia hyew kɛse a ɛde ne nkwa to asiane mu wɔ simma 15 mu.
• Mfɛnsere a wɔde wɔn ho to so no twentwɛn awofo ase sɛ wobenya botae Total Serum Bilirubin (TSB) mogya mu nhwehwɛmu bere a bilirubin foro kɔ soro boro 20 mg/dL.
• Sɛnea aduruyɛ mu phototherapy ankasa yɛ adwuma: Ayaresabea ahorow (ne ofie fiberoptic Biliblanket pads a wɔakyerɛw ama wɔn) de calibrated narrow-spectrum blue LED kanea a ɛyɛ 460 kosi 490 nanometers di dwuma, a ɛhyɛn honam ani na ɛma photo-isomerize srade-soluble unconjugated bilirubin kɔ lumirubin, a nsu-nwene molecule a the akokoaa asaabo ne mmerɛbo tumi fi mu kɔ nsu ne nsu mu tẽẽ a enhia mmerɛbo mu enzymes.

.¶

Mpɛn pii no, mmofra a wɔawo wɔn foforo da ** nnɔnhwerew 16 kosi 18 da biara** wɔ nnɔnhwerew 2 kosi 3 kyinhyia ntiantiaa mu. Nanso, esiane sɛ nsu a ɛho ayɛ fĩ (mogya mu sodium a ɛdɔɔso) ne bilirubin a ɛdɔɔso nyinaa yɛ adwuma sɛ abɔde mu nnuru a ɛma akokoaa amemene no dwo nti, akokoaa a ɔkɔm de no anaasɛ ne ho yɛ hu no rensu ɔkɔm mu, mmom no, wɔbɛyɛ komm, wɔada, na ɛyɛ den sɛ wɔbɛsɔre ("akokoaa a ɔda afiri").

Anamɔn biara nhyehyɛe a wɔde kanyan abofra a wɔawo no foforo a wada (nanso ɔnyɛ ɔbrɛ) ma wɔma no aduan nnɔnhwerew 2 kosi 3 biara¶

Wɔ nkwa nnafua 10 kosi 14 a edi kan no mu, kosi sɛ wo ba no bɛsan anya ne mu duru ɔha biara mu nkyem 100 wɔ awo mu na jaundice no afi hɔ no, mma abofra a wɔawo no foforo nna nkyɛ nsen nnɔnhwerew 3 awia anaa nnɔnhwerew 3.5 kosi 4 pɛnkoro anadwo a ɔmma no aduan da (ma no aduan 8 kosi 12 wɔ nnɔnhwerew 24 biara mu):

1. Twɛn Active (REM) Sleep phase: Hwɛ sɛ aniwa a ɛrehuruhuruw, nsateaa a ɛrewosow, anaasɛ ɛreyɛ nufu ansa na woafa akokoaa no.
2. Twe akokoaa no fi ne mpaboa nkutoo so: Ntama a ɛyɛ hyew ne ntama a wɔde kyekyere mmofra no ma mmofra a wɔawo wɔn foforo no da tẽẽ. Yi akokoaa no ntade na fa honam ani hwɛbea to wo moma so a ɛda hɔ kwa no so.
3. Sesa diaper no na fa tactile stimulation a ɛyɛ brɛoo di dwuma: Diaper no a wobɛsesa no kanyan nkokoaa dodow no ara. Fa akokoaa no akyi, n’akyi berɛmo, ne ne nan ase denneennen, anaasɛ fa ntama a ɛyɛ nwini (ɛnyɛ nwini) a ɛyɛ nwini popa ne moma so ne ne hwene brɛoo.
4. Fa colostrum/nufusu bi a ɛtɔ gu akokoaa no ano na yɛ nufu no mu nhyɛso bere a worenom nufu: Sɛ wokyekyere no wie a, pia nufu no brɛoo wɔ ne nnyinaso bere biara a akokoaa no nufu a ɛyɛ dɛ no bɛbrɛ ase na ama nufusu a ɛreworo so akɔ wɔn anom na ama wɔakɔ so amene no denneennen. (Sɛ akokoaa no ntumi nna simma 5 ɛmfa ho anammɔn yi a, gyae na kɔ ayaresabea).

4. Nnawɔtwe a Edi Kan no mu Frɛko Kɔkɔɔ Afoforo: Ɔfe a Ɛyɛ ahabammono, Awotwaa mu Nyarewa, ne Ɔhome¶

Wɔ nsu a ɛho ayɛ fĩ ne jaundice akyi no, nipadua mu sɛnkyerɛnne afoforo abiɛsa wɔ dapɛn a edi kan no mu hwehwɛ sɛ wɔde wɔn ho gye mu ntɛm ara:

1. Bilious (Bright Green anaa Dark Grass-Green) Ɔfe: Oprehyɛn a Ɛho Hia Ntɛmntɛm:
2. Normal Spit-Up: Nsu fitaa a ɛte sɛ nufusu anaa fitaa a wɔayam a ɛsen fi ano no ntwea so a ɛnyɛ mmɔdenbɔ bere a ayɛ burp akyi.
3. Pyloric Stenosis (Mpɛn pii no Adapɛn 2 kosi 8): "Projectile" a ɛyɛ den a ɛfe nufusu fitaa/a wɔayam a ɛtow tuo fa dan no mu bere a wɔama no aduan akyi (ɛho hia sɛ wɔyɛ nhwehwɛmu ntɛm ara).
4. Malrotation with Midgut Volvulus (Bright Green / Neon Green Vomit at Any Day of Life): Sɛ abofra a wɔawo no foforo fe nsu a ɛte sɛ ahabammono a ɛhyerɛn, neon kɔkɔɔ-ahabammono, anaa kwae mu ahabammono tuntum (bile) a, ebia dwensɔtwaa ketewa no twitwaa ne mogya ntini titiriw (the superior mesenteric artery) ho. Eyi yɛ nkwa anaa owu oprehyɛn a egye ntɛmpɛ: gyae aduanma ntɛm ara na kɔ Mmofra Ayaresabea Dwumadibea a Ɛho Hia Ntɛmntɛm tẽẽ ansa na dwensɔtwaa a wɔakyinkyim no awu.
5. Omphalitis (Mmoawa a Wɔde Nya Awotwaa no Dua):
6. Bere a awotwaa mu dua a ɛsa yare betumi ada mogya a ayow ketewaa bi anaa hua ketewaa bi adi bere a ɛrehwe ase wɔ Nnafua 7 ne 14 ntam no, yafunu no honam ani kɔkɔɔ a ɛtrɛw, ɔhyew, ɛyɛ mmerɛw, anaasɛ ɛho ahonhon wɔ yafunu no honam ani a atwa hama dua no ase ho ahyia, anaasɛ akisikuru kɔkɔɔ a ɛyɛ fĩ a ɛyɛ den a ɛretu fi awotwaa no mu no yɛ omphalitis. Esiane sɛ awotwaa mu mogya ntini no ne akokoaa no mmerɛbo ne ne akyi berɛmo no di nkitaho tẽẽ nti, omphalitis betumi ama akokoaa a wɔawo no foforo sepsis a edi awu ne necrotizing fasciitis aba wɔ nnɔnhwerew kakraa bi mu na ɛhwehwɛ sɛ wɔde nnuru a ekum ɔyare mmoawa a wɔde fa IV mu ma ntɛm ara wɔ ER no mu.
7. Ɔhome mu Ahokyere ne Ahomegyeɛ:
8. Kan wo ba no home sikɔne 60 a edi mũ bere a wo ho adwo wo (nkokoaa a wɔawo wɔn foforo home wɔ "ahome a wɔhome bere ne bere mu" a ɛnkɔ so daa a wɔde sikɔne 5 kosi 10 gyina bere tiaa bi mu). Frɛ 911 / 112 / 999 ntɛm ara na home a ɛkɔ so ntɛmntɛm sen ahome 60 wɔ simma biara mu, ahome a ɛhome a ɛtra hɔ simma 20 anaa nea ɛboro saa, intercostal anaa subcostal retractions (honam ani a ɛnom kɔ akyiri wɔ mpampam anaa nufu dompe ase), expiratory grunting, nasal flaring, anaa tɛkrɛma ne anofafa kɔla bruu/akuturuku.

Nsɛm a wɔtaa bisa¶

Dɛn nti na me ba a wadi nnafua 2 a wɔawo no foforo no gyaw nkekae bi a ɛyɛ borɔdɔma anaa pinkish-red wɔ diaper no mu? So ɛyɛ mogya?¶

Wɔ nkwa nna Nnafua 1, 2, ne 3 mu no, ɛkame ayɛ sɛ bere nyinaa na nkekae a ɛyɛ chalky a ɛyɛ borɔdɔma, nkannare, anaa salmon-pink a ɛwɔ abofra a wɔawo no foforo mpaboa mu no yɛ "birikisi mfutuma" urate ahwehwɛ, uric acid ahwehwɛ a asiane biara nni ho a ɛtɔ fi akokoaa a wɔawo no foforo nsu a ɛyɛ den mu bere a ɛretwɛn sɛ ɛna no nufusu a ɛho akokwaw kɛse no bɛba bɛyɛ Da a ɛto so 3 kosi 4. (Wɔ akokoaa a wɔawo no foforo mu mmeawa, mogya kɔkɔɔ ketewaa bi a ɛwɔ ɔbea no awotwaa mu nsu fitaa a ɛyɛ den mu wɔ dapɛn a edi kan no mu nso yɛ "pseudomenstruation" a ɛfata a efi ɛna no hormone a wɔtwe fi nipadua no mu). Nanso, sɛ wuhu birikisi-mfutuma a ɛyɛ borɔdɔma urate ahwehwɛ wɔ Da a ɛto so 5 anaa akyiri yi a, ɛkyerɛ sɛ akokoaa no nsu ayɛ nea ɛyɛ hu esiane nsu a ɛho nhia ne aduan a onnya nni nti, na ɛhwehwɛ sɛ wɔyɛ mmofra nhwehwɛmu da koro no ara na wɔma no aduan foforo ntɛm ara.

Mɛyɛ dɛn ahu nsonsonoe a ɛda mmofra a wɔawo wɔn foforo jaundice a ɛfata ne jaundice a asiane wom ntam?¶

Bere, nipadua no nkɔso, ne sɛnea akokoaa no ani da hɔ no tetew abien no ntam. Nipadua mu jaundice a ɛyɛ daa no mpue da wɔ nnɔnhwerew 24 a edi kan wɔ nkwa mu; efi ase bɛyɛ Da a ɛto so 2 anaa 3 wɔ n’anim ne ne moma so atifi, ɛkɔ soro wɔ Nna a ɛto so 3 kosi 5, na akokoaa no nyane denneennen nnɔnhwerew 2 kosi 3 biara ma ɔma aduan na ɔyɛ mpaboa a ɛyɛ nsu na ɛyɛ kɔkɔɔ pii. Jaundice yɛ aduruyɛ mu tebea a egye ntɛmpɛ sɛ (1) honam ani anaa aniwa kɔkɔɔ pue wɔ awo akyi nnɔnhwerew 24 a edi kan no mu, (2) kɔla kɔkɔɔ no trɛw kɔ fam twa yafunu no mu kɔ anan ase, nsateaa, anaa nan ase, (3) akokoaa no ayɛ mmerɛw, ontumi nnyane mma aduan, anaasɛ ne su kɛse anaasɛ n’akyi yɛ kurukuruwa, anaasɛ (4) jaundice ɛkyɛ boro adapɛn 2 a ɛwɔ nsu a ɛyɛ fitaa/a ɛyɛ fitaa a ɛyɛ mmerɛw.

So metumi de me ba a wɔawo no foforo a ne ho ayɛ no yaw no ato mfɛnsere bi a owia bɔ kɛse nkyɛn anaasɛ mɛma wɔn nsu nkotoku a wɔde bɛhohoro bilirubin no afi mu?¶

Mma nnyɛ emu biara da. Nsu a ɛnyɛ den anaa asikre nsu a wɔde ma abofra a wɔawo no foforo no mma bilirubin mfi mu (bilirubin nhaban dodow no ara nam nufusu a calorie pii wom so, ɛnyɛ nsu) na ebetumi ama mogya mu sodium a ɛba fam a edi awu (nsu a ɛbow akisikuru) bere a ɛma akokoaa no yafunu ketewaa no mu ahoɔdennuru biara nni mu no. Saa ara nso na Amerika Mmofra Ayaresa Sukuu no bɔ kɔkɔ sɛ ɛnsɛ sɛ wɔde abofra a wɔda adagyaw bɛto owia hann tẽẽ anaa mfɛnsere mu esiane asiane kɛse a ɛwɔ hɔ sɛ ɔhyew a ɛba fam, ɔhyew a ɛboro so, owia hyew, ne akyɛde a asiane wom a ɛbɛkyɛ wɔ ayaresabea bilirubin mogya mu nhwehwɛmu a edi mu ne aduruyɛ mu grade blue LED phototherapy mu nti.

Dɛn nti na ɔfe a ɛyɛ ahabammono a ɛba abofra a wɔawo no foforo mu no yɛ tebea a egye ntɛmpɛ a emu yɛ den saa bere a wɔde toto ntasu fitaa a wɔteɛteɛm ho no?¶

Ɛkame ayɛ sɛ mmofra a wɔawo wɔn foforo nyinaa tew nufusu fitaa anaa a wɔayam no kakraa bi bere a wɔama wɔn aduan awie no efisɛ ntini a ɛwɔ wɔn yafunu atifi no nnyinii. Nanso, sɛ abofra a wɔawo no foforo fe nsu a ɛyɛ ahabammono a ɛyɛ hyew, neon kɔkɔɔ-ahabammono, anaa sare tuntum-ahabammono (bilious vomiting) a, ɛkyerɛ sɛ bile a efi duodenum no mu no resan akɔ yafunu no mu esiane bile duct no ase a asiw nti. Wɔ abofra a wɔawo no foforo mu no, ɔfe a ɛyɛ ahabammono ne ade titiriw a ɛkyerɛ sɛ dwensɔtwaa no nkyinkyin yiye a ɛwɔ mfinimfini awotwaa mu volvulus, oprehyɛn a egye ntɛmpɛ a wotwa dwensɔtwaa a wɔakyinkyim no fi ne mogya mu na ebetumi awu wɔ nnɔnhwerew kakraa bi mu gye sɛ mmofra oprehyɛn ankyinkyim no.

Sources a wɔhwɛɛ mu¶

• Amerika Mmofra Ayaresa Sukuu (AAP, United States): Ayaresa mu Adeyɛ Akwankyerɛ mu Nsakrae: Hyperbilirubinemia a Wɔde Di Dwuma wɔ Nkokoaa a Wɔawo No Foforo a Wɔadi Nyinsɛn Adapɛn 35 anaa Nea ɛboro saa mu (Kemper ne ne mfɛfo, Pediatrics, 2022).
• Ɔman Asoɛe a Ɛhwɛ Akwahosan ne Ɔhwɛ a Ɛyɛ Paara So (NICE Akwankyerɛ CG98 & NG194, United Kingdom): Jaundice wɔ Nkokoaa a Wɔawo Wɔn Foforo a wonnii Nnafua 28 mu: Wohu, Transcutaneous Bilirubinometry, ne Phototherapy Thresholds ne Postnatal Care.
• Wiase Nyinaa Akwahosan Ahyehyɛde (WHO): Pocket Book of Hospital Care for Children: Akwankyerɛ a Wɔde Di Mmofra Nyarewa a Ɛtaa Ba Ho: Neonatal Jaundice, Dehydration, ne Asiane Nsɛnkyerɛnne.
• Academy of Breastfeeding Medicine (ABM Clinical Protocol #3 & #22): Nnuan a Wɔde Ka Ho wɔ Akwahosan Bere mu Nufu a Wɔma no Foforo, Mu duru a Wɔtew So, ne Neonatal Hyperbilirubinemia a Wɔhwɛ So.
• Canada Mmofra Ayaresa Kuw (CPS): Akwankyerɛ a ɛfa Hyperbilirubinemia a Wɔbɛhu, Wɔadi Ho Adi, na Wɔasiw Ano wɔ Nkokoaa a Wɔawo Wɔn Foforo a Wɔawo Wɔn Bere Nnɔbae ne Wɔn a Wɔawo Wɔn Akyirikyiri Ho.

Akwankyerɛ ahorow a ɛfa ho¶

• Awo akyi aduruyɛ mu ntɛmpɛ ne asiane ho sɛnkyerɛnne a ɛkyerɛ sɛ mmofra a wɔawo wɔn foforo
• Awo akyi adwenemhaw vs. awo akyi adwenemhaw: awo akyi adwenemyare a egye ntɛmpɛ
• Nkokoaa atiridiinini a emu yɛ den ne atiridiinini a ɛma obi ho kyere no
• Nkɔmhyɛ a ɛma ɔhome (blue vs. pale syncope) ne nkokoaa ahomegye a wɔpaw
• Nkokoaa aduan a wɔde ma a wonnya, anyinam ahoɔden a ɛtɔ, nufusu a wɔde ma, ne aduan a ahobammɔ wom
• Nnɔmba a egye ntɛmpɛ sɛnea ɔman biara te