Tsikuɖiɖi, Vidzĩ Yeyewo ƒe Tsikuxiwo (Bilirubin), Kple Kwasiɖa Gbãtɔ ƒe Aflaga Dzĩwo¶

Amegbetɔ ƒe agbenɔnɔ ƒe ŋkeke 7 gbãtɔwo, vevietɔ Ŋkeke 2 vaseɖe 5, le vidzĩ ƒe dodo le kɔdzi ƒe vidzidzixɔ me le aƒeme megbe teti, tsi tre ɖi na ŋutilã ƒe tɔtrɔ si me woate ŋu adze afɔku le ŋutɔ. Le fesre sia me la, vidada ƒe ayiku gakpɔtɔ le tɔtrɔm zua notsi tsitsi (lactogenesis II, si dzɔna zi geɖe le gaƒoƒo 72 va ɖo 96 le edzidzi megbe), vidzĩ yeyea ƒe aklã si metsi o le agbagba dzem be yeatsɔ fugboe ƒe ʋumenugbagbevi dzĩ siwo gbã ƒe dzidziɖedzi gã aɖe (bilirubin) aƒo ƒui, eye vidzĩa ƒe ayikuwo le tɔtrɔm ɖe tsi si le vidzidɔa godo ŋu dadasɔ. Esi wònye be hyperbilirubinemia sesẽ kple hypernatremic dehydration doa ŋusẽ wo nɔewo le tsatsam vɔ̃ɖi aɖe me ta la, tsi vɔ le vidzĩ yeye si meɖua nu nyuie o la va nɔa alɔ̃ dɔm akpa be wòana no, si wɔnɛ be aɖuɖɔ ƒe dodo nu tsona eye wòzia bilirubin dzi be wòagaxɔ bilirubin tso dɔgboa me atrɔ ayi ʋua me ta la, dɔdamɔnu ƒe dzesi siwo menya kpɔna dzea sii bɔbɔe o ate ŋu adzi ɖe edzi ava zu ahɔhɔ̃ me abi si nɔa anyi ɖaa (kernicterus) alo ʋu ƒe sisi ƒe dzidziɖedzi le eme gaƒoƒo 12 va ɖo 24.

Zi geɖe la, dzila yeyewo bua vodadatɔe be dɔléle ƒe kuviawɔwɔ (vidzĩ si me aɖi le, si me tsi mele o, alo si me tsi le si mate ŋu anɔ ŋudzɔ aɖu nu o) be enye "alɔ̃dɔla nyui si nɔa anyi kpoo." Ne dzilawo lé ŋku ɖe dɔdamɔnu ƒe xexlẽdzesi siwo sɔ pɛpɛpɛ, siwo ŋu woate ŋu aɖo taɖodzinu ɖo, gbesiagbe aŋekotoku siwo me tsi le eye woƒo ɖi ƒe xexlẽme, Kramer ƒe ŋgɔyiyi tso ta vaseɖe afɔ gbɔ le ŋutigbalẽ ƒe ʋuʋudedi ɣi me, ʋuʋudedi kple aɖuɖɔ ƒe amadede, kple dɔgbo ƒe dzoxɔxɔ ŋu la, dzilawo ate ŋu ade dzesi vidzĩ yeyewo ƒe nɔnɔme kpata siwo ate ŋu ade woƒe agbe afɔku me gaƒoƒo geɖe hafi nusiwo womate ŋu atrɔ o la nadzɔ.

Wɔ esia fifia¶

1. Ƒo ka na wò nutoa me ƒe xexlẽdzesi kpata enumake ne viwò yeyea ɖe ahɔhɔ̃mekawo, gbɔgbɔtsixe, alo bilirubin ƒe kuxi sesẽ ƒe dzesi aɖe fia: Ƒo ka na 911 le United States kple Canada, 112 le Europa Dukɔwo ƒe Habɔbɔ bliboa me, 999 le United Kingdom, alo 000 le Australia (kpɔ xexlẽdzesi siwo wozãna kpata) ne viwò yeyea mate ŋu anyɔ hena nuɖuɖu o, ese le eɖokui me fɔku abe ragdoll ene alo akɔ woƒe kɔ kple akɔta sesĩe yi megbe (opisthotonos), ɣlidodo si kɔkɔ, si womate ŋu afa akɔ na o le eŋu, dɔdzẽ ɣi le eŋu le edziɣi gaƒoƒo 24 gbãtɔwo me alo wòɖo asibidɛwo kple afɔkpodziwo gbɔ afɔ, alo le gbɔgbɔ kabakaba wu gbɔgbɔ 60 le miniti ɖeka me kple akɔta ƒe megbedede alo nuyi blɔ.
2. Yi Kɔdzi ƒe Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ enumake ne viwò yeyea ʋu tsi si ƒe amadede nye amadede dama alo neon yellow-green (bilious emesis): Mègalala be ɖeviwo nayɔ ɖeviwo ƒe yɔyɔ ne vidzĩ yeye aɖe ɖe ta alo ʋu tsi si ƒe amadede nye aŋutiɖiɖi vivi alo gbe/neon-amadede dzẽ si klẽna (abe dzesidenu dama ene o). To vovo na no me notsi alo notsi kplu ƒe ʋuʋudedi ɣi siwo megblẽa nu le ame ŋu o la, ʋuʋudedi dama si le vidzĩ yeye me fia be amekoko ƒe dɔgbo xe mɔ (malrotation with midgut volvulus), afisi dɔgbo si wotro ate ŋu aku le gaƒoƒo ʋɛ aɖewo me ɖeviwo ƒe dɔwɔwɔ kpata manɔmee.
3. Tsɔ dijitaal dɔgbo ƒe dzoxɔxɔ na vidzĩ yeye ɖesiaɖe si le alɔ̃ dɔm, le fu ɖem na, le dzo dam, alo le fafɛm: Le vidzĩ ɖesiaɖe si mexɔ ŋkeke 28 haɖe o (kple esi xɔ vaseɖe ŋkeke 60) gome la, akɔta ƒe dzoxɔxɔ si nye Celsius degree 38.0 (100.4 degrees Fahrenheit) alo esi wu nenema, alo akɔta ƒe dzoxɔxɔ si bɔbɔ si mede Celsius degree 36.0 (degree 96.8 o Fahrenheit) (dzoxɔxɔ si nu sẽ nye alesi vidzĩ yeye geɖe ɖea dɔlékuiwutike fiana), bia be woazɔ mɔ enumake ayi Kɔdzi ƒe Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ**. Mègana acetaminophen (Tylenol/paracetamol) alo ibuprofen vidzĩ hafi ɖɔkta nado vidzĩa kpɔ gbeɖe o.
4. Zi viwòa ƒe ŋutigbalẽ dzi blewuu le dzɔdzɔmeŋkeke me be nàkpɔ afisi lãmetutudɔ ɣi kaka ɖo le ŋutilãa me: Ðe awu na viwò yeye si te ɖe fesre ŋu le dzɔdzɔmeŋkeke me (xɔme akaɖi ɣi siwo wowɔ kple asi ɣlaa ʋuʋudedi). Mia asibidɛ ɖeka blewuu sɛkɛnd 2 ɖe ŋgonu, akɔta, ƒodo, ata, kple afɔwo ƒe afɔkpodzi dzi, emegbe nàkɔ wò asibidɛ ɖe dzi be nàlé ŋku ɖe ŋutigbalẽ si wofa la ŋu hafi ʋu pink nagatrɔ ava. Ne amadede ɣi dze afisiafi le Ŋkeke 1 lia dzi (mexɔ gaƒoƒo 24 haɖe o), alo kaka ɖe anyi to ƒodoa ŋu va ɖo afɔ siwo le ete, asibidɛwo, alo afɔkpodziwo la, yi ɖado bilirubin ʋu dodokpɔ kpata enumake.
5. Dzro gaƒoƒo 24 ƒe aklala xɔdzo kple ƒoɖi ƒe xexlẽme ɖe viwòa ƒe agbegbegbe tututu: Kpɔe ɖa be viwòa le gbesiagbe aklala xɔdzo ƒe se suetɔ kekeake dzi wɔm hã (** aklala xɔdzo 1 le Ŋkeke 1, 2 le Ŋkeke 2, 3 le Ŋkeke 3, 4 le Ŋkeke 4, kple aklala xɔdzo 6+ gbesiagbe tso Ŋkeke 5 dzi**). Ne viwò yeyea yi wu gaƒoƒo 8 va ɖo 12 aŋekotoku xɔdzo manɔmee le Ŋkeke 3 megbe, alo chalky orange-pink "brick dust" urate crystals gakpɔtɔ le aklala me le Ŋkeke 5 alo emegbe la, te ɖe wò ɖeviwo ƒe dɔdala ŋu egbea eye nàtsɔ nuɖuɖu akpe ɖe eŋu enumake abe alesi wogblɔe ene.
6. Mègana tsi dzro, suklitsi, alo notsi kplu na vidzĩ yeye gbeɖe o, eye mègatsɔ vidzĩ si ŋu aŋɔ le la de fesre ƒe ɣe ƒe keklẽ tẽ me gbeɖe be wòanye atikewɔwɔ ƒe fotodamɔnu teƒe o: Tsi dzro nana vidzĩ yeyea nana ʋu me sodium dzi ɖena kpɔtɔna eye wòhea tsi ƒe ahamumu ƒe alɔ̃madɔmadɔ vɛ. Ne tsi vɔ le vidzĩ aɖe ŋu alo eƒe lãme gbã eye wòle agbagba dzem be yeatsɔ notsi ayi teƒe bubu la, na colostrum/notsi si woɖe tso eme alo vidzĩ ƒe notsi si wozãna ɖaa si wotsaka nyuie to atikekui, gavi, alo aŋetu dzi esime nèle atike dim.

Kwasiɖa gbãtɔ me vidzĩ yeyewo ƒe vovototodedeameme kpata ƒe sisi¶

flowchart TD
    Newborn["Vidzĩ Si Wodzi Yeye (Agbemeŋkeke 1 vaseɖe 28) ƒe Dzodzro"] --> RedFlags{"1. Dzesi aɖewo Li Si Dze Agbe Afɔku Enumake?"}
    RedFlags -->|"Mate ŋu Anyɔ Be Nàɖu Nu, Afɔ/Akɔ Akɔ, Rectal Temp >= 38.0C alo < 36.0C, alo Gbɔgbɔ > 60/min"| ERNow["YI DƆDZIKPƆƑE ƑE NUKPƆKPƆ KPƆKPƆ KPƆKPƆ ƑE DƆDZIKPƆƑE ENUMAME (Ƒo ka na 911 / 112 / 999 ne Cyanotic alo Apneic)"]
    RedFlags -->|"Tsi Dama si Klẽna alo Gbe Dama Dzĩ (Bilious Emesis) ƒe Ʋuʋu ."| Volvulus["Amekoko Kpata (Midgut Volvulus Risk): Dzudzɔ Nuɖuɖu Nana Eye Yi Kɔdzi Tsã ER Fifia"]
    RedFlags -->|"Sepsis Sesẽ alo Amekoko ƒe Dzesi aɖeke Meli O"| JaundiceCheck{"2. Kpɔ Ŋutilã Kple Ŋkuwo Le Dzɔdzɔme Ŋkeke Me: Ðe Vidzĩa Le Dzĩa?"}
    JaundiceCheck -->|"Dzĩ Le Gaƒoƒo 24 Gbãtɔ Me tso Vidzidzi ALOO Dzĩ le Asibidɛwo/Afɔkpodziwo Dzi ALOO Kple Alɔ̃dɔdɔ"| BilirubinER["BILIRUBIN ƑE XAXƐ Kpata: Yi Kɔdzi ER Fifia hena Stat TSB Ʋudodokpɔ kple Fotodɔdada"]
    JaundiceCheck -->|"Dzĩ Fafɛ le Mo/Akɔta Ko (Ŋkeke 3 va ɖo 5) kple Nuɖuɖu Nana Dzodzro"| DiaperCheck{"3. Kpɔ Diaper Tsi Kple Ƒoɖiwo ƒe Xexlẽme ɖa be Agbeŋkeke Si Te Ðe Eŋu hã"}
    JaundiceCheck -->|"Jaundice aɖeke meli o"| DiaperCheck
    DiaperCheck -->|"Diapers Tsi Mesɔ gbɔ Wu Agbegbe, Brick-Dust Crystals Le Ŋkeke 4 megbe, alo Aɖuɖɔ Siwo Gakpɔtɔ Le Yevute Le Ŋkeke 5 lia Dzi"| Dehydrated["DEHYDRATION / UNDERFEEDING RED FLAG: Notsi/Notsi Kpekpeɖeŋu Fifia Kple Ðeviwo ƒe Ŋkeke Ma ke ƒe Dodokpɔ"]
    DiaperCheck -->|"Aɖuɖɔ Siwo Le Tsi Kple Dzĩ Siwo Katã Ƒe Taɖodzinuwo Dzi Kpɔkpɔ; Nyɔnyrɔxɔxɔ Le Gaƒoƒo 2 Vaseɖe 3 Ðesiaɖe Me"| Normal["Yi edzi Nàna Nuɖuɖu Zi 8 Va ɖo 12 Le Gaƒoƒo 24 Me eye Nàwɔ Ðoɖo Ŋkeke 3 Vaseɖe 5 Ðeviwo ƒe Dɔdala Sasrãkpɔ"]

1. Gbesiagbe Vidzĩ Yeyewo ƒe Aŋekotoku Xexlẽme, Aɖuɖɔ ƒe Tɔtrɔ, Kple Lolome Dzi Ðeɖe Akpɔtɔ ƒe Nɔnɔmetata (Ŋkeke 1 vaseɖe 7) .¶

Esi wònye be màte ŋu akpɔ colostrum alo notsi mililita nenie vidzĩ yeye si wona noe ɖuna le no nana ɖesiaɖe me o ta la, nusi dona le aklala me ye nye dɔdamɔnu ƒe dzidzenu ɖeka kolia si sɔ pɛpɛpɛ wu le nusi le gegem ɖe eme ŋu. Le ɣeyiɣi ma ke me la, ele be vidzĩ ɖesiaɖe ƒe aɖuɖɔ nato amadede ƒe tɔtrɔ si woate ŋu agblɔ ɖi tso aŋɔ yibɔ si léna ɖe nu ŋu (meconium) dzi ayi tɔtrɔ ƒe aɖuɖɔ si ƒe amadede nye aŋutiɖiɖi, eye mlɔeba wòava zu aɖuɖɔ si me nukuwo le abe sinapi-yibɔ ene le Ŋkeke 4 va ɖo 5 lia dzi, si nye tɔtrɔ si tsɔa bilirubin si wotsɔ ƒo ƒui doa goe le ŋutilãa me ŋutɔŋutɔ.

Alesi woawɔ anya ne egbegbe aklala si wotsɔna ƒua gbe si xɔa tsi ŋutɔ la tsi ŋutɔŋutɔ¶

Egbegbe aklala siwo wotsɔna ƒua gbe la me sodium polyacrylate gel polymers siwo tsɔa tsi ƒua gbe kabakaba ale gbegbe be ememe la sena le eɖokui me be eƒu ne woka asi eŋu ne vidzĩa ɖe aɖuɖɔ vɔ gɔ̃ hã:

• The Blue Wetness Indicator Line: Vidzĩ yeye ƒe aklala akpa gãtɔ ƒe fli ɣi aɖe le ŋgɔgbe gota nutsyɔnu si trɔna blɔ alo amadede dzẽ ne wodo ka kple aɖuɖɔ.
• Akplu 3 ƒe Kpekpeme Dodokpɔ: Klɔ tsi mililita 45 (aɖabaƒoƒo 3 / ounces 1.5) ɖe vidzĩ yeye ƒe aklala ƒuƒu dzadzɛ aɖe me eye nàlée ɖe asi; be squishy kpekpeme si dzena lae nye alesi "full wet diaper" ɖeka sena le eɖokui me tso Ŋkeke 5 lia dzi.
• Tissue Paper Trick (na Avɔ alo Non-Indicator Diapers): De mo ƒe lãkusi ɣi gbadzaa alo nugododeƒegbalẽ ƒe dzogoe ene me si woxatsa ɖe aŋekotokua ƒe ŋgɔgbe; ne èʋu aklala la, lãkusi si me tsi le la nana ɖikeke mele aɖuɖɔ sue aɖe gɔ̃ hã me o eye wòɖea urate-kristali ɖesiaɖe si le abe aŋutiɖiɖi-pink si le abe chalky ene la fiana kɔte.

Vovototo "Brick Dust" Urate Crystals kple Vidzĩ Yeyewo ƒe Pseudomenstruation kple Dɔléle ƒe Ʋudodo¶

Ne wokpɔ ɖi aɖe si ƒe amadede nye aŋutiɖiɖi, pink, alo dzĩ le vidzĩ yeye ƒe aklala me la, evɔ̃na na dzilawo. Zã dɔdamɔnu ƒe mama sia nàtsɔ ama vidzĩ yeye ƒe ŋutilã ƒe dɔwɔwɔ si menyo o kple tsikuɖiɖi alo ʋu si dona le GI me:

1. "Brick Dust" Uric Acid Crystals (Aŋutiɖiɖi, Gbeɖuɖɔ, alo Salmon-Pink Chalky Stain):
2. Nusi wònye: Vidzĩ yeyewo ɖea uric acid si sɔ gbɔ ɖe woƒe aɖuɖɔ me. Ne aɖuɖɔ ƒo ƒu ɖe aɖuɖɔtoe ƒe ŋkeke siwo me ʋu ƒe sisi mesɔ gbɔ o (Ŋkeke 1 va ɖo 3) la, uric acid ƒuna zua kristalo suesuesue siwo gblẽa akɔɖu-pink alo gbeɖuɖɔ-dzẽ si le abe chalky, powdery orange-pink alo rust-red ɖi ɖe aklala ƒe aŋekotokua dzi ene (edze abe ame aɖe tsɔ anyikpe dzĩ aɖe ƒo ɖe aklala ŋu ene pɛpɛpɛ).
3. Ne esɔ vs. nusi dzɔ kpata: Esɔ le Ŋkeke 1, 2, kple 3. Ne èkpɔ brick-dust urate crystals le Ŋkeke 4 (tsi megbe) alo Ŋkeke 5 kple emegbe la, menye ʋue o, enye dzesi si wonya nyuie be vidzĩa ƒe aɖuɖɔ ƒo ƒu le afɔku me tso nuɖuɖu si mesɔ gbɔ o kple tsikuɖiɖi gbɔ. Ƒo ka na wò ɖeviwo ƒe dɔdala egbea eye nàdzi notsi si nèɖuna ɖe edzi enumake.
4. Nyɔnu ƒe Vidzĩ Yeye ƒe Pseudomenstruation (Mucoid White Discharge si me Ʋu Pink/Dzĩ ƒe Ʋuʋu le):
5. Nusi wònye: Le nyɔnu vidzĩ yeyewo gome le Ŋkeke 2 va ɖo 7 me la, vidadaa ƒe fufɔfɔ me estrogen ƒe agbɔsɔsɔ si sɔ gbɔ le vidzidzi megbe ƒe ɖiɖi kpata nana vidzĩa ƒe vidzidɔ ƒe akpa suea tsia ɣeyiɣi sue aɖe, eye wòdzena abe nyɔnu ƒe vidzidɔ me ʋuʋudedi ɣi si le abe notsi ene si me ʋu dzĩ si le keklẽm alo pink dzẽ ʋee aɖewo le.
6. Nusi woawɔ: 100 le alafa me si sɔ eye megblẽa nu le ame ŋu o; tutu blewuu tso ŋgɔgbe yi megbe eye mègadze agbagba gbeɖe be yeatutu vernix/mucus ɣi siwo katã kpɔa ame ta la ɖa le lãkusiawo dome o.
7. Dɔléle ƒe Aɖuɖɔ ƒe Amadede Siwo Bia Atikewɔwɔ Enumake (Dzĩ, Yevu Le Ŋkeke 5 megbe, alo Chalky White):
8. Ʋu dzĩ si klẽna tẽ le aɖuɖɔ me alo aɖuɖɔ yibɔ si me aŋɔ le si gadzena le aɖuɖɔa ƒe ɣie xoxo vɔ megbe: Ebia be woada atikewo kpɔ kpata be ʋu si dona le Vitamin K ƒe anyimanɔmanɔ ta (ʋu si dona le vidzĩ yeyea ŋu, vevietɔ ne wogbe Vitamin K ƒe vidzidzitikea), notsi protein proctocolitis, akɔta ƒe gbagbã, alo necrotizing enterocolitis hã.
9. Aɖuɖɔ si le ɣie si le abe chalky ene, si ƒe amadede nye anyi dzẽ, alo putty-gray (Acholic Stools): MELE dzɔdzɔe GBEÐE le ƒe ɖesiaɖe me o. Aɖuɖɔ ɣi alo aŋutiɖiɖi si le yellow jaundice xa si nɔa anyi le kwasiɖa 2 megbe la fia be biliary atresia (bloked bile ducts in the liver), si nye amekoko ƒe ɣeyiɣi-bɔmb si wòle be woawɔ dɔ na (Kasai portoenterostomy) do ŋgɔ na eƒe agbenɔƒe ŋkeke 30 va ɖo 60 be woaxe mɔ ɖe aklãdɔ si wua ame nu.

2. Vidzĩ Yeyewo ƒe Ʋuʋudedi (Hyperbilirubinemia) kple Kernicterus Mɔxexe Ðe Enu¶

Jaundice nye ŋutigbalẽ kple ŋku ɣiwo ƒe amadede ɣi (scleral icterus) si tso unconjugated (indirect) bilirubin, si nye amadede ɣi-aŋutiɖiɖi si wowɔna ne ŋutilãa ma ʋumenugbagbevi dzĩ xoxowo me ƒe agbɔsɔsɔ si dzi ɖe edzi le ʋu me gbɔ. Esi wònye be fugboe si le vidzidɔa me hiã ʋumenugbagbevi dzĩ bubuwo be wòatsɔ oxygen eye ʋumenugbagbevi dzĩwo ƒe agbenɔƒe le kpuie wu (ŋkeke 70 va ɖo 90 tsɔ wu ŋkeke 120 le ame tsitsiwo gome) ta la, wodzia vidzĩ yeye ɖesiaɖe wògbãa ʋumenugbagbevi dzĩ gbogbo aɖewo esime woƒe aklã me enzyme si metsi o (UDP-glucurosyltransferase 1A1 / UGT1A1) wɔa dɔ le ame tsitsi ƒe ŋutete ƒe alafa memama **1 ko ** le ɣeyiɣia me agbemeŋkeke gbãtɔwo.

Esia wɔe be vi yeye siwo wodzi bliboe ƒe alafa memama 60 kple vidzĩ siwo wodzi do ŋgɔ na ɣeyiɣi si woɖo ɖi alo esiwo wodzi do ŋgɔ na ɣeyiɣi si tsi megbe ƒe alafa memama 80 (kwasiɖa 34 va ɖo 37) xɔa ŋutilã me ʋuʋudedi si woate ŋu akpɔ le Ŋkeke 2 kple 5. Gake ne bilirubin si wometsɔ ƒo ƒui o dzi ɖe edzi wu dzidzenu veviwo la, zi geɖe la, wu 20 va ɖo 25 mg/dL (340 va ɖo 425 \(\mu\text{mol/L}\)) le vidzĩ si wodzi bliboe me, alo le agbɔsɔsɔ si bɔbɔ wu gɔ̃ hã me le vidzĩ siwo wodzi do ŋgɔ, siwo dze dɔ, alo esiwo mewɔ ɖeka kple ABO/Rh ʋu ƒe hatsotso o me la, bilirubin si me ami me mebla o la tsoa vidzĩ yeyea ƒe ʋu-ahɔhɔ̃ ƒe mɔxenu si metsi o** eye wòƒoa ɖi hegblẽa ahɔhɔ̃a ƒe nuclei goglo siwo nye gray matter nuclei (the basal ganglia, globus pallidus, hippocampus, kple ahɔhɔ̃meka siwo sea nu ƒe nuclei).

Bilirubin Tagbɔdɔléle Sesẽ (ABE) kple Kernicterus: Dzesi Siwo Ðea Ahɔhɔ̃mekawo ƒe Dɔléle Kpata¶

Ahɔhɔ̃ me aɖi si tso bilirubin si sɔ gbɔ me dzɔna le akpa eve me: Acute Bilirubin Encephalopathy (ABE) (si woate ŋu atrɔ kokoko ne wodae enumake le kɔdzi kple fototherapy sesẽ kple ʋudodo na ame bubuwo) kple Kernicterus (choreoathetoid cerebral palsy si nɔa anyi didi, si nɔa anyi ɖaa, sensorineural deafness, dzimekpɔkpɔ lãmetutudɔ, kple aɖu ƒe lãkusi ƒe dɔmawɔmawɔ nyuie).

Alesi woada jaundice ƒe ŋgɔyiyi kpɔ le aƒeme: Kramer ƒe Cephalocaudal (Ta vaseɖe Afɔbidɛ) Zones¶

Ɣesiaɣi kloe la, vidzĩ yeyewo ƒe ʋusɔgbɔdɔ kakana tso ta dzi yi anyime yi afɔwo gbɔ (cephalocaudal progression) ne bilirubin ƒe agbɔsɔsɔ le ʋu me le dzi yim. Togbɔ be ŋkuléle ɖe nu ŋu mate ŋu axɔ ɖe kɔdzi Transcutaneous Bilirubinometer (TcB) scan alo Total Serum Bilirubin (TSB) afɔkpodzi-ti ƒe ʋudodokpɔ teƒe gbeɖe o (vevietɔ le vidzĩ siwo ƒe ŋutigbalẽ ƒe amadede do viviti wu, afisi wòle be nàlé ŋku ɖe ŋku ɣiwo [sclerae], aɖuwo, kple asibidɛ kple afɔkpodzi siwo wofa), Kramer ƒe Se na abadzivɔ ƒe akɔntabubu vevi aɖe:

Nu 5 siwo me afɔku le ŋutɔ siwo nana vidzĩ yeyewo ƒe ʋuʋudedi dzina kabakaba zi gbɔ zi eve¶

Na atikewɔla alo ɖeviwo ƒe dɔdala si kpɔa nudzɔdzɔ kpatawo gbɔ nanya enumake ne ahɔhɔ̃mekawo ƒe aɖi alo ʋumenugbagbeviɣidɔ ƒe afɔku siawo dometɔ aɖe le viwò yeyea ŋu (si woɖe fia le 2022 American Academy of Pediatrics [AAP] Hyperbilirubinemia Clinical Practice Guideline me):

1. Aɖuɖɔtoe si dzena le agbenɔƒe ƒe gaƒoƒo 24 gbãtɔwo me: Dɔléle vaseɖe esime woaɖo kpe edzi be menye nenemae o. Ɣesiaɣi kloe la, ʋumenugbagbevi dzĩwo ƒe tsɔtsrɔ̃ kabakaba (hemolysis) tso ABO ʋu ƒe hatsotso ƒe masɔmasɔ (dada nye Ʋu Ƒomevi O eye vidzĩ nye Ƒomevi A alo B), Rh factor dɔléle, alo G6PD ƒe anyimanɔmanɔ gbɔe wòtsona.
2. Fɔfɔ ƒe Ƒe si Woxɔ Do Ŋgɔ alo Fufɔfɔ ƒe Ɣeyiɣi Gbãtɔ (kwasiɖa 34 va ɖo 38): Vidzĩ si wodzi le kwasiɖa 35, 36, alo 37 ("late preterm / early term") ƒe aklã metsi o KPLE ŋgonu/aɖu nono si gbɔdzɔ wu si ɖeɖi tea eŋu le no me hafi xɔa nuɖuɖu blibo, si naa wo 4 va ɖo 8 ƒe afɔku si le hyperbilirubinemia sesẽ kple tsikuɖiɖi ne wotsɔe sɔ kple vidzĩ si xɔ kwasiɖa 40.
3. Cephalohematoma alo Vidzidzi ƒe Abi Vevie: Ne vacuum ɖeɖe, forceps, alo vidzidzi sesẽ na ʋu falɛfalɛ gã aɖe vuvu ɖe vidzĩa ƒe ta ŋu (cephalohematoma) alo mo/ŋutilã ƒe abi la, ele be vidzĩa ƒe ŋutilã nagbã ʋu mawo katã si xaxa le Ŋkeke 2 va ɖo 6 me, eye wòatsɔ bilirubin ƒe agba gã bubu aɖe aƒu gbe ɖe ʋua me.
4. G6PD (Glucose-6-Phosphate Dehydrogenase) ƒe anyimanɔmanɔ: Domenyiŋusẽfianu ƒe dɔmawɔmawɔ nyuie si do ƒome kple X (si bɔ wu le ƒome siwo tso Afrika, Mediterranea, Titina Ɣedzeƒe, kple Anyieheɣedzeƒe Asia me) afisi ʋumenugbagbevi dzĩwo gbagbã zi ɖeka zua ʋumenugbagbeviɣidɔ si gblẽa nu le wo ŋu ne wodo go oxidative triggers (neverse doa go vidzĩ yeye ƒe awuwo va ɖo mothballs [naphthalene], henna ƒe amadede, alo fava beans).
5. Suboptimal Breastfeeding Intake ("Starvation / Breastfeeding Failure Jaundice"): Ne vidzĩ yeye mekpɔ notsi si sɔ le ŋkeke 3 va ɖo 5 gbãtɔwo me o la, aɖuɖɔtoe me yiyi dzi ɖena kpɔtɔna. Le dɔgbo si tsi anyi la me la, enzyme aɖe si woyɔna be \(\beta\)-glucuronidase ɖea bilirubin le meconium la me eye wòɖonɛ ɖe vidzĩa ƒe ʋukawo me enumake (enterohepatic circulation).

Nusita MELE be nàtsɔ vidzĩ yeye si ŋu aŋɔ le la ade ɣe ƒe keklẽ me tẽ GBEÐE o¶

Wogblɔ na tɔgbuiwo kple mamawo ƒe dzidzimewo be woatsɔ vidzĩ si ƒe amadede nye ɣie vie la aɖo avɔ aɖe dzi le fesre si dzi ŋdɔ ʋuna le ŋgɔ. Amerika Ðeviwo ƒe Dɔlélewo Ŋuti Nusrɔ̃ƒe (AAP) kple UK NICE ƒe mɔfiamewo xlɔ̃ nu tẽ be woagazã aƒeme ɣe ƒe keklẽ tẽ na vidzĩ yeyewo ƒe ʋusɔgbɔdɔ o:

• Ɣe ƒe keklẽ tẽ alo esi woɖe le fesre nu nana vidzĩ yeye si le amama la kpɔa dzoxɔxɔ si nu sẽ (le xɔ si me ya ƒona le me) alo dzoxɔxɔ si gbɔ eme kple UV ɣe ƒe dzoxɔxɔ sesẽ si ate ŋu awui le miniti 15 me.
• Ŋuɖoɖo ɖe fesre ŋu hea dzilawo ɖe megbe le ʋudodokpɔ si ŋu taɖodzinu le Total Serum Bilirubin (TSB) wɔwɔ me esime bilirubin ya dzina ɖe edzi wu 20 mg/dL.
• Alesi atikewɔwɔ ƒe fotodamɔnu ŋutɔŋutɔ wɔa dɔe: Kɔdziwo (kple aƒeme fiberoptic Biliblanket pads siwo woŋlɔ na) zãa calibrated narrow-spectrum blue LED light si ƒe didime nye 460 va ɖo 490 nanometers, si gena ɖe ŋutigbalẽa me eye wòtsɔa foto-isomerizes fat-soluble unconjugated bilirubin into lumirubin, a water-soluble molecule that the vidzĩ ƒe ayiku kple aklã ate ŋu ado go ayi aɖuɖɔ kple aɖuɖɔ me tẽ evɔ mahiã aklã me dɔlékuiwutikewo o.

3. Vidzĩ Yeyewo ƒe Kuviawɔwɔ Kple Alɔ̃dɔdɔ Si Sɔ (kple Alesi Nànyɔ Vidzĩ Si Le Alɔ̃ dɔm Be wòana Nuɖuɖu) .¶

Zi geɖe la, vidzĩ yeyewo mlɔa anyi gaƒoƒo 16 va ɖo 18 gbesiagbe le gaƒoƒo 2 va ɖo 3 ƒe tsatsam kpuiwo me. Ke hã, esi wònye be tsikuɖiɖi (ʋume me sodium sɔ gbɔ) kple bilirubin si sɔ gbɔ siaa wɔa dɔ abe dzɔdzɔme atike siwo naa vidzĩa ƒe ahɔhɔ̃ dzea akɔ anyi ene ta la, vidzĩ si dɔ le wuwum alo si ŋu afɔku le la mafa avi le dɔwuame ta o, ke boŋ wova nɔa ɖoɖoezizi me, wodɔa alɔ̃ wu, eye nyɔnyrɔ̃ sesẽna wu ("vidzĩ si le alɔ̃ dɔm ƒe mɔ̃").

Afɔɖeɖe ɖesiaɖe ƒe ɖoɖowɔɖi si wotsɔ nyɔ vidzĩ yeye si le alɔ̃ dɔm (gake mekuvia o) be woana nuɖuɖu gaƒoƒo 2 va ɖo 3 ɖesiaɖe¶

Le viwòa ƒe agbemeŋkeke 10 va ɖo 14 gbãtɔwo me, vaseɖe esime viwòa ƒe kpekpeme gaɖo eƒe dzidziɣi ƒe alafa memama 100 eye ʋuʋudedia nu nayi la, mègana vidzĩ yeye nadɔ alɔ̃ wu gaƒoƒo 3 le ŋkeke me alo gaƒoƒo 3.5 va ɖo 4 zi ɖeka le zã me nuɖuɖu manɔmee o (nyinyi 8 va ɖo 12 le gaƒoƒo 24 ɖesiaɖe me):

1. Lala Active (REM) Sleep phase: Kpɔ ŋkume ƒe ʋuʋu, asibidɛwo ƒe ʋuʋu, alo no mimi ƒe ʋuʋu hafi nàfɔ vidzĩa.
2. Ðe vidzĩa ɖa vaseɖe woƒe aklala ɖeɖeko dzi: Awu kple avɔ siwo me dzo le nana vidzĩ yeyewo dɔa alɔ̃ tẽ. Ðe vidzĩa ƒe awuwo eye nàtsɔ wo ŋutilã-ɖe-ŋutilã ɖe wò akɔta ƒuƒlu la ŋu.
3. Trɔ aklala eye nàzã asikaka ame ŋu tufafatɔe: Ne ètrɔ aklala la, nyɔa vidzĩ akpa gãtɔ. Mitutu vidzĩa ƒe akɔta, akɔta, kple woƒe afɔkpodziwo sesĩe, alo nàtsɔ avɔ fafɛ (menye vuvɔ o) si me tsi le tutu woƒe ŋgonu kple ŋgonu blewuu.
4. Tsɔ notsi/notsi ƒe dodo ɖe vidzĩa ƒe nuyiwo dzi eye nàwɔ no ƒe mimi esime nèle no nam: Ne ènya lé no la ko la, mimi noa blewuu le eƒe gɔme ɣesiaɣi si vidzĩa ƒe no nono ƒe ɣeyiɣi ƒe didime dzi ɖe kpɔtɔ be nàtsɔ notsi ƒe sisi aɖe aƒu gbe ɖe woƒe nu me eye wòana woanɔ emim vevie. (Ne vidzĩa mete ŋu nɔ ŋudzɔ aɖabaƒoƒo 5 o togbɔ be ewɔ afɔɖeɖe siawo hã la, tɔ nàyi kɔdzi).

4. Vidzĩwo ƒe Aflaga Dzĩ Bubuwo le Kwasiɖa Gbãtɔ me: Aɖuɖɔtoe Dama, Vidzidɔ ƒe Dɔléle, Kple Gbɔgbɔ¶

Le tsikuɖiɖi kple ʋuʋudedi godo la, ŋutilã me dzesi etɔ̃ bubu siwo dzena le kwasiɖa gbãtɔ me bia be woawɔ nu kpata:

1. Bilious (Bright Green alo Dark Grass-Green) Ʋuʋu: Amekoko ƒe Nɔnɔme Kpata:
2. Normal Spit-Up: Tsi ɣi si le abe notsi ene alo tsi ɣi si wotsɔ lãgbalẽ wɔe si sina tso nu ƒe dzogoe dzi agbagbadzedzemanɔmee le ʋuʋudedi megbe.
3. Pyloric Stenosis (Zi geɖe la, Kwasiɖa 2 va ɖo 8): notsi ɣi/notsi si wotsɔ lãgbalẽ wɔe ƒe ʋuʋu sesẽ "projectile" si woda ɖe xɔa me godoo le nuɖuɖu nana vɔ megbe (ehiã be woada asɔ kpata).
4. Malrotation with Midgut Volvulus (Bright Green / Neon Green Vomit at Any Day of Life): Ne vidzĩ yeye ƒo tsi si dze abe bright green, neon yellow-green, alo dark forest green (bile) la, ɖewohĩ dɔgbo suea trɔ ƒo xlã eƒe ʋuka vevitɔ (the superior mesenteric artery). Esia nye agbe alo ku ƒe amekoko ƒe nɔnɔme kpata: dzudzɔ nuɖuɖu nana enumake eye nàyi Ðeviwo ƒe Kɔdzi ƒe Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ tẽ hafi dɔgbo si tro la naku.
5. Omphalitis (Dɔlékuiwo ƒe Dɔléle le Vidzidɔ ƒe Ka ƒe Kpo me):
6. Togbɔ be vidzidɔ ƒe aŋgba si da gbe ate ŋu aɖe ʋu ƒuƒu sue aɖe alo ʋeʋẽ fafɛ aɖe afia esime wòle gegem le Ŋkeke 7 kple 14 dome hã la, abibi, dzoxɔxɔ, ʋeʋẽ, alo vuvu kaka ɖe ƒodo ƒe ŋutigbalẽ dzi ƒo xlã ka ƒe alɔnu, alo ʋuʋudedi ɣi si ʋẽna lilili si le dodom tso akɔta, nye aɖuɖɔtoedɔ. Esi wònye be vidzidɔa ƒe ʋukawo doa ka kple vidzĩa ƒe aklã kple eƒe dɔgbo tẽ ta la, ŋkudɔ ate ŋu ahe vidzĩwo ƒe ʋumenugbagbeviɣidɔ si wua ame kple necrotizing fasciitis vɛ le gaƒoƒo ʋɛ aɖewo ko me eye wòhiã be woatsɔ dɔlékuiwutike siwo wodona ɖe ʋuka me enumake le ER me.
7. Yagbɔgbɔ ƒe fuɖename kple gbɔgbɔtsixetsixe:
8. Xlẽ viwòa ƒe gbɔgbɔ sɛkɛnd 60 blibo esime nèfa (vidzidzi yeyewo gbɔa ya le "gbɔgbɔ ɣeaɖewoɣi" si mesɔ o me eye wotɔa te sɛkɛnd 5 va ɖo 10 kpuie). Ƒo ka na 911 / 112 / 999 enumake hena gbɔgbɔ si nɔa anyi ɖaa kabakaba wu gbɔgbɔ 60 le miniti ɖeka me, yagbɔgbɔ ƒe ɖiɖiɖeme si xɔa sɛkɛnd 20 alo esi wu nenema, akɔta dome alo akɔta te ƒe megbedede (ŋutilã si noa nu goglo le akɔta alo no ƒe ƒu te), gbɔgbɔ ƒe ɣlidodo, no ƒe ʋuʋu, alo aɖe kple nuyi ƒe amadede blɔ/dzẽ.

Nya siwo wobiaa amewo enuenu¶

Nukatae nye vidzĩ yeye si xɔ ŋkeke 2 la gblẽ ɖi aɖe si ƒe amadede nye aŋutiɖiɖi alo pink-dzẽ ɖe aklala me? Ʋue wònyea?¶

Le agbe ƒe Ŋkeke 1, 2, kple 3 lia dzi la, ɖi si le abe chalky orange, rust, alo salmon-pink ene le vidzĩ yeye ƒe aklala me nyea "brick dust" urate crystals ɣesiaɣi kloe, uric acid kristalo siwo megblẽa nu le ame ŋu o siwo dona tso vidzĩ yeye ƒe aɖuɖɔ si me wode nu me esime wole lalam be vidadaa ƒe notsi tsitsi ƒe agbɔsɔsɔ si lolo wu nava le Ŋkeke 3 va ɖo 4 lɔƒo.(Le vidzĩ yeye ƒe aɖuɖɔ me nyɔnuviwo, ʋu dzĩ sue aɖe si le nyɔnu ƒe vidzidɔ me ʋuʋudedi ɣi ɣiwo me le kwasiɖa gbãtɔ me hã nye "aʋatsodzinukpɔkpɔ" si sɔ tso vidada ƒe lãmetsiŋusẽ ƒe asiɖeɖe le eŋu me). Gake ne èkpɔ orange brick-dust urate crystals le Ŋkeke 5 lia dzi alo emegbe la, efia be afɔku le vidzĩa ƒe aɖuɖɔ me le tsikuɖiɖi kple nuɖuɖu si mesɔ gbɔ o ta, si abia be woada ɖeviwo kpɔ gbemagbe ke eye woana nuɖuɖu kpeɖeŋutɔ enumake.

Aleke mawɔ ade dzesi vovototo si le vidzĩ yeyewo ƒe ʋuʋudedi si sɔ kple ʋuʋudedi si me afɔku le dome?¶

Ɣeyiɣi, ŋutilã ƒe ŋgɔyiyi, kple vidzĩa ƒe ŋudzɔnɔnɔ ma wo ame evea dome. Lãmetsiŋusẽ ƒe ʋuʋudedi si sɔ medzena gbeɖe le eƒe agbenɔƒe ƒe gaƒoƒo 24 gbãtɔwo me o; edzea egɔme le Ŋkeke 2 alo 3 lia lɔƒo le mo kple akɔta ƒe akpa si le etame, eɖoa eƒe kɔkɔƒe le Ŋkeke 3 va ɖo 5 lia dzi, eye vidzĩa nyɔna kple didi vevie le gaƒoƒo 2 va ɖo 3 ɖesiaɖe me be yeana nuɖuɖu eye wòwɔa aŋekotoku siwo me tsi le eye woƒe amadede nye ɣie la sɔ gbɔ. Aɖuɖɔtoe nye atikewɔwɔ kpata ne (1) ŋutigbalẽ alo ŋku ɣiwo do le gaƒoƒo 24 gbãtɔ siwo kplɔ vidzidzi megbe, (2) amadede ɣia kaka to ƒodoa ŋu va ɖo afɔ te, asiwo ƒe asibidɛwo, alo afɔkpodziwo, (3) vidzĩa le kuvia wɔm, manya wɔ be wòanyɔ hena nuɖuɖu o, alo eƒe avifafa sesẽ alo akɔta le akɔta, alo (4) aɖuɖɔtoe enɔa anyi didi wu kwasiɖa 2 kple aɖuɖɔ ɣi/ɣi si me kɔ o.

Ðe mate ŋu atsɔ nye vidzĩ yeye si ŋu ʋuʋudedi le la ade fesre si dzi ŋdɔ ʋuna le la xa alo mana tsigoewo wo be woatsɔ akɔ bilirubin la ado goea?¶

Mègawɔ wo dometɔ aɖeke gbeɖe o. Tsi dzro alo suklitsi nana vidzĩ yeye meɖea bilirubin ɖa o (bilirubin ƒe aŋgba akpa gãtɔ dona le aɖuɖɔ me to notsi si me calorie sɔ gbɔ ɖo me, ke menye tsi me o) eye ate ŋu ana sodium si mebɔ o si wua ame le ʋu me (tsi ƒe ahamumu ƒe alɔ̃madɔmadɔ) esime wòtsɔa nuɖuɖumeŋusẽ zero yɔa vidzĩa ƒe dɔgbo suea me fũ. Nenema ke Amerika Ðeviwo ƒe Dɔlélewo Ŋuti Nusrɔ̃ƒe xlɔ̃ nu be woagatsɔ vidzĩ yeye si le amama ade ɣe ƒe keklẽ tẽ alo fesre nu o le afɔku gã si le dzoxɔxɔ si nu sẽ, dzoxɔxɔ si gbɔ eme, ŋdɔkutsu dzatsɛ, kple afɔku ƒe megbetsitsi le kɔdzi bilirubin ʋudodokpɔ si sɔ pɛpɛpɛ kple fotoɖemɔ̃ si nye blue LED si sɔ na atikewɔwɔ me ta.

Nukatae ʋuʋudedi dama le vidzĩ yeye me nye nɔnɔme kpata sesẽ alea gbegbe ne wotsɔe sɔ kple yevuwo ƒe ʋuʋudedi?¶

Vidzĩ yeyewo katã kloe ɖea notsi ɣi alo notsi si wotsɔ lãgbalẽ wɔe sue aɖe ɖe wo me le nuɖuɖu vɔ megbe elabena lãmeka si le woƒe dɔgbo tame la metsi o. Gake ne vidzĩ yeye ƒo tsi si ƒe amadede nye amadede dzẽ si le keklẽm, neon yellow-green, alo gbe dama viviti (bilious vomiting) la, efia be ʋumenugbagbeviɣi si tso duodenum me le megbe yim ɖe dɔgboa me le esi ʋuka si le ʋukaa te xe ta. Le vidzĩ yeye gome la, ʋuʋudedi damae nye dzesi si wonya nyuie le dɔgbo ƒe tɔtrɔ gbegblẽ kple midgut volvulus, si nye amekoko ƒe nɔnɔme kpata si me wotsoa dɔgbo si tro la ɖa le eƒe ʋu me eye ate ŋu aku le gaƒoƒo ʋɛ aɖewo ko me negbe ɖe ɖeviwo ƒe amekola metrɔe o.

Wolé ŋku ɖe dzɔtsoƒewo ŋu¶

• Amerika Ðeviwo ƒe Dɔlélewo Ŋuti Nusrɔ̃ƒe (AAP, United States): Dɔdaƒe ƒe Dɔwɔwɔ Ŋuti Mɔfiamewo Me Toto: Hyperbilirubinemia Dzikpɔkpɔ le Vidzĩ Si Wodzi Yeye si xɔ Fufɔfɔ ƒe Kwasiɖa 35 alo esi wu nenema (Kemper et al., Pediatrics, 2022).
• Dukɔa ƒe Lãmesẽ Kple Belélename Ŋuti Nusrɔ̃ƒe (NICE ƒe Mɔfiame CG98 & NG194, United Kingdom): Aɖuɖɔtoedɔ le Vidzĩ Siwo Wodzi Yeye Si Mexɔ Ŋkeke 28 Haɖe O Ŋu: Woƒe Dzesidede, Totome Bilirubinometry, Kple Fotodamɔnu ƒe Dzidzenuwo kple Vidzidzi megbe Beléle.
• Xexeame ƒe Lãmesẽ Habɔbɔ (WHO): Pocket Book of Hospital Care for Children: Mɔfiamewo le Ðeviwo ƒe Dɔléle Siwo Bɔ Ŋu Dzi Kpɔkpɔ Ŋu: Vidzĩwo ƒe Ʋuʋudedi, Tsikuɖiɖi, Kple Afɔku Dzesiwo.
• Academy of Breastfeeding Medicine (ABM Clinical Protocol #3 & #22): Nuɖuɖu Kpekpeɖeŋunana le Vidzĩ Si Wona No Le Lãmesẽ Me, Kpekpeme Dzi Ðeɖe Akpɔtɔ, Kple Vidzĩwo ƒe Hyperbilirubinemia Dzi Kpɔkpɔ.
• Canada Ðeviwo ƒe Dɔléle Habɔbɔ (CPS): Mɔfiamewo ku ɖe Hyperbilirubinemia ƒe Detekpɔ, Edzikpɔkpɔ, Kple Mɔxexe Ðe Enu Ŋu le Vidzĩ Yeye Siwo Wodzi Do Ŋgɔ Na Ɣeyiɣi Si Wodzi Kple Le Ɣeyiɣi Siwo Megbe.

Mɔfiame siwo do ƒome kplii¶

• Vidzidzi megbe atikewɔwɔ kpata kple vidzĩ yeyewo ƒe afɔku ƒe dzesiwo
• Vidzidzi megbe tagbɔdɔléle vs. vidzidzi megbe blanuiléle: vidzidzi megbe tagbɔdɔléle kpatawo
• Vidzĩwo ƒe dzoxɔxɔ sesẽ kple dzoxɔxɔ ƒe alɔ̃madɔmadɔ
• Gbɔgbɔtsixe ƒe afakaka (blɔ vs. pale syncope) kple vidzĩ ƒe gbɔgbɔtsixetsixe ƒe vovototodedeameme
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