Umwuma ukivuka, Jaundice ikabije (Bilirubin), hamwe nicyumweru cya mbere Ibendera ritukura¶

Iminsi 7 yambere yubuzima bwabantu, cyane cyane ** Iminsi 2 kugeza 5 , ako kanya umwana amaze gusezererwa murugo avuye mubyaro by’ababyeyi, byerekana inzibacyuho y’umubiri. Muri iri dirishya, colostrum y'ababyeyi iracyahinduka mu mashereka akuze ( lactogenez II , ubusanzwe iba hagati yamasaha 72 na 96 nyuma yo kuvuka), umwijima utarakura urimo urwana no guhuza umubare munini wamaraso yamenetse yamenetse ( bilirubin ), kandi impyiko zuruhinja zirahinduka. Kuberako hyperbilirubinemia ikabije hamwe na hypernatremic dehydrasi ikomezanya muburyo bubi, uruhinja rudafite umwuma, rutaravuka ruba rusinziriye cyane ku buryo rwonsa, ruhagarika gusohora intebe kandi rugahatira bilirubin gusubira mu mara mu maraso, ibimenyetso by’amavuriro byoroshye bishobora kwiyongera bikomeretsa ubwonko buhoraho ( kernicterus **) cyangwa hypovolemic **.

Ababyeyi bashya bakunze kwibeshya kuri pathologiya ** ubunebwe ** (umwana ufite ubumara, umwuma, cyangwa septique udashobora gukomeza kuba maso ngo agaburire) kugirango "asinzire neza, atuje." Mugukurikirana ibipimo nyabyo, bifatika, ** umunsi-kuwundi ibara ryanduye kandi ryanduye **, ** umutwe-ku-Kramer gutera imbere kuruhu rwumuhondo **, ibara ryibyuka nigituba, hamwe nubushyuhe bwurukiramende, ababyeyi barashobora kumenya ibyihutirwa byangiza ubuzima bwamasaha make mbere yuko ibyangiritse bidasubirwaho.

Kora ubu¶

1. ** Hamagara nimero yawe yihutirwa ako kanya niba uruhinja rwawe rugaragaje ikimenyetso gikomeye cyubwonko, ubuhumekero, cyangwa bilirubin **: Hamagara 911 muri Amerika na Kanada, 112 hirya no hino mubumwe bw’ibihugu by’Uburayi, 999 mu Bwongereza, cyangwa 000 muri Ositaraliya (reba nimero yihutirwa) niba umwana wawe wavutse adashoboka ** kubyuka kugirango agaburwe **, yumva ** acumbagira nka ragdoll ** cyangwa ** yiziritse ijosi numugongo inyuma cyane (opisthotonos) **, afite ** urusaku rwinshi, induru idashobora kwihanganira **, afite ** umuhondo wumuhondo mumasaha 24 yambere avutse cyangwa kugera mumaboko yintoki cyangwa umunwa ** guhumeka ibirenge ** cyangwa 60.
2. ** Jya guhita ujya mubitaro byihutirwa byibitaro niba umwana wawe akivuka arutse icyatsi kibisi cyangwa neon yumuhondo-icyatsi kibisi (bilious emesis) : Ntutegereze umuhamagaro wabana niba umwana wavutse aciriye cyangwa aruka ** icyatsi kibisi cyangwa icyatsi kibisi / icyatsi kibisi / icyatsi kibisi ** (nka wino yicyatsi kibisi). Bitandukanye n'amata yera atagira icyo yonsa cyangwa amata ya spit-up, kuruka kwicyatsi kibisi mukivuka byerekana inzitizi yo kubaga amara ( malrotation hamwe na midgut volvulus **), aho amara yagoramye ashobora gupfa mumasaha atabanje kubagwa byihutirwa byabana.
3. ** Fata ubushyuhe bwa digitale kuri buri kintu cyose gisinziriye, giteye ubwoba, gishyushye, cyangwa cyumva gikonje **: Ku mwana uwo ari we wese uri munsi yiminsi 28 (no kugeza kumunsi wiminsi 60), ubushyuhe bwa ** buringaniye bwa dogere selisiyusi 38.0 (dogere 100.4 Fahrenheit) cyangwa hejuru ya **, cyangwa ubushyuhe buke bwurukiramende ** munsi ya dogere selisiyusi (96.8) ** urugendo rwihuse mubitaro byihutirwa byibitaro **. Ntuzigere utanga uruhinja acetaminofeni (Tylenol / paracetamol) cyangwa ibuprofen mbere yuko umuganga asuzuma umwana.
4. ** Kanda witonze kuruhu rwumwana wawe kumanywa yumunsi kugirango urebe aho umubiri wa jaundice wumuhondo wagwiriye **: Kwambura umwana wawe wavutse hafi yidirishya kumanywa yumucyo (amatara yumuhondo yo murugo ahisha jaundice). Kanda urutoki rumwe witonze kumasegonda 2 kuruhanga, igituza, inda, ikibero, na ** ibirenge **, hanyuma uzamure urutoki rwawe kugirango urebe uruhu rwumye mbere yuko amaraso yijimye agaruka. Niba ibara ry'umuhondo rigaragara ** ahantu hose kumunsi wa 1 (munsi yamasaha 24) **, cyangwa ryarakwirakwije hejuru yinda yinda kugeza kumaguru ** yo hepfo, imikindo, cyangwa ibirenge **, jya kwisuzumisha byihutirwa bya bilirubin.
5. ** Kugenzura amasaha 24 yumubare wanduye kandi wanduye ugereranije numunsi wubuzima bwumwana wawe : Reba niba umwana wawe yujuje amategeko ntarengwa ya buri munsi ( 1 igituba cyumunsi kumunsi wa 1, 2 kumunsi wa 2, 3 kumunsi wa 3, 4 kumunsi wa 4, na 6+ impapuro ziremereye kumunsi kuva kumunsi wa 5 gukomeza **). Niba uruhinja rwawe rugenda ** amasaha arenga 8 kugeza kuri 12 adafite ikariso itose ** nyuma yumunsi wa 3, cyangwa agifite ** chalky orange-pink "umukungugu wamatafari" urate kristaliste ** mumatako kumunsi wa ** Umunsi wa 5 cyangwa nyuma yaho **, hamagara umuganga wabana wawe uyumunsi hanyuma wuzuze kugaburira ako kanya nkuko byateganijwe.
6. ** Ntuzigere uha amazi asanzwe, amazi yisukari, cyangwa amata yahinduwe kumwana wavutse, kandi ntuzigere ushyira umwana wumuhondo mwizuba ryizuba ryizuba kugirango risimburwe nubuvuzi **: Guha amazi meza umwana wavutse bigabanya sodium yamaraso kandi bigatera ** gufata amazi **. Niba umwana adafite umwuma cyangwa umuhondo kandi arwana no kwimura amashereka, kugaburira ** yerekanaga colostrum / amashereka cyangwa ivanze neza ryuruhinja rusanzwe ** ukoresheje siringi, ikiyiko, cyangwa icupa mugihe ushaka ubuvuzi.

Icyumweru cya mbere cyavutse byihutirwa triage itemba¶

flowchart TD
    Newborn["Uruhinja rukivuka (Iminsi 1 kugeza 28 yubuzima) Isuzuma"] --> RedFlags{"1. Ibimenyetso byose byangiza ubuzima ako kanya?"}
    RedFlags -->|"Ntushobora gukanguka kugaburira, Limp / Arching Inyuma, Ubushuhe buringaniye> = 38.0C cyangwa <36.0C, cyangwa Guhumeka> 60 / min"| ERNow["JYA MU BITARO BYIHUTIRWA BYIHUTIRWA (Hamagara 911/112/999 niba Cyanotic cyangwa Apneic)"]
    RedFlags -->|"Kuruka Icyatsi kibisi cyangwa Icyatsi kibisi-Icyatsi kibisi (Bilious Emesis)"| Volvulus["BYIHUTIRWA BIKORESHEJWE (Midgut Volvulus Risk): Hagarika kugaburira hanyuma ujye mu bitaro ER Noneho"]
    RedFlags -->|"Nta Sepsis ikaze cyangwa ibimenyetso byo kubaga"| JaundiceCheck{"2. Reba uruhu n'amaso kumanywa yumunsi: Ese umwana ni umuhondo?"}
    JaundiceCheck -->|"Umuhondo Mugihe cyamasaha 24 yambere yo kuvuka CYANGWA Umuhondo kumikindo / Inkweto CYANGWA Ufite ibitotsi"| BilirubinER["CRISIS YIHUTIRWA BILIRUBIN: Jya mu bitaro ER Noneho kuri Stat TSB Ikizamini cyamaraso na Phototherapy"]
    JaundiceCheck -->|"Umuhondo woroshye ku Isura / Isanduku Yonyine (Iminsi 3 kugeza 5) no Kugaburira Byoroshye"| DiaperCheck{"3. Reba Umubare Wuzuye kandi Wanduye Kubara Umunsi wubuzima"}
    JaundiceCheck -->|"Nta Jaundice"| DiaperCheck
    DiaperCheck -->|"Impapuro nke zitose kurenza umunsi wubuzima, Crystal-Amatafari ya Kirisitu nyuma yumunsi wa 4, cyangwa intebe ziracyari umukara kumunsi wa 5"| Dehydrated["DEHYDRATION / BIDASOBANUWE URUPAPURO RW'UMUKARA: Ongeraho amata / Amata none hamwe no kugenzura abana umunsi umwe"]
    DiaperCheck -->|"Guhura Intego Zose Zitose n'Umuhondo Intebe Zintebe; Kubyuka buri masaha 2 kugeza kuri 3"| Normal["Komeza Kugaburira Inshuro 8 kugeza 12 Kumasaha 24 kandi Ukomeze Gahunda Yumunsi 3 kugeza 5 Gusura Abaganga Babana"]

1. Umunsi-ku-munsi Impinja Zivuka Impapuro, Inzibacyuho Yintebe, nimbonerahamwe yo gutakaza ibiro (Umunsi wa 1 kugeza 7)¶

Kuberako udashobora kubona mililitiro zingahe za colostrum cyangwa konsa umwana yonsa yamira buri somo ryabaforomo, ** ibiva mubitabo ni igipimo kimwe cyukuri cyamavuriro yibibera muri . Muri icyo gihe, intebe ya buri mwana wavutse igomba guhindurwa ** iteganijwe guhinduka ** kuva kumurongo wumukara wumukara ( meconium **) ukajya kuntebe yicyatsi kibisi-umukara, hanyuma amaherezo ukajya kuntebe yumuhondo wumuhondo kugeza kumunsi wa 4 kugeza 5, inzibacyuho itwara bilirubine ifatanye mumubiri.

Nigute ushobora kumenya niba ikigezweho cya super-absorbent ikoreshwa rimwe gusa¶

Impapuro zigezweho zikoreshwa zirimo sodium polyacrylate gel polymers itwike yubushyuhe bwihuse kuburyo umurongo wimbere wumva wumye kugirango ukoreho nubwo umwana amaze kwihagarika:

• ** Umurongo werekana ubururu bwubururu **: Impapuro nyinshi zavutse zifite umurongo wumuhondo munsi yimbere yimbere ihinduka ** ubururu cyangwa icyatsi ** iyo uhuye ninkari.
• ** Ikizamini cyibiro 3-Ibiyiko **: Suka ** mililitiro 45 (ibiyiko 3 / 1.5 ounci) yamazi ** mumashanyarazi yumye yumye kandi uyifate mumaboko yawe; ubwo buremere bugaragara uburemere nicyo umuntu "wuzuye wuzuye wuzuye" yumva kuva kumunsi wa 5 gukomeza.
• ** Impapuro zimpapuro za Tissue (kumyenda yimyenda cyangwa itari iyerekana) **: Shyira kare iringaniye yimyenda yera yo mumaso cyangwa impapuro zumusarani imbere yigitambaro; iyo ufunguye ikariso, tissue itose ituma ninkari ntoya idashidikanywaho kandi ikagaragaza neza kristu ya chalky orange-pink urate kristal.

Gutandukanya "Umukungugu w'amatafari" Urate Crystal na Neonatal Pseudomenstruation vs Amaraso ya Pathologiya¶

Kubona icunga, umutuku, cyangwa umutuku mu gitambaro cyavutse giteye ubwoba ababyeyi. Koresha uku gusenyuka kwa clinique kugirango utandukanye physiologie yavutse neza hamwe no kubura amaraso cyangwa GI:

1. ** "Umukungugu w'amatafari" Crystal ya Uric Acide (Orange, Rust, cyangwa Salmon-Pink Chalky Stain) **:
2. • Icyo aricyo : Abana bavutse basohora aside irike nyinshi mu nkari zabo. Iyo inkari zegeranijwe muminsi mike ya colostrum (* Iminsi 1 kugeza 3 **), aside irike igwa muri kristu ya microscopique isiga ** chalky, ifu ya orange-umutuku cyangwa ikizinga gitukura ** kuri paje (bisa nkumuntu wasize amatafari yibumba atukura kumpapuro).
3. • Iyo ari ibisanzwe va byihutirwa *: Bisanzwe kuri ** Umunsi wa 1, 2, na 3 **. ** Niba ubona amatafari-umukungugu urate kristaliste kumunsi wa 4 (utinze) cyangwa kumunsi wa 5 no kurenga **, ntabwo ari amaraso, nikimenyetso cyerekana ko inkari zumwana ziteje akaga kuva ** kugaburira no kubura amazi **. Hamagara umuganga wabana wawe uyumunsi kandi wongere amata ako kanya.
4. ** Umugore wa Neonatal Pseudomenstruation (Gusohora Mucoid Yera hamwe na Streak yijimye / Amaraso atukura) **:
5. .
6. • Icyo gukora *: ** 100 ku ijana bisanzwe kandi bitagira ingaruka **; guhanagura witonze uhereye imbere ujya inyuma kandi ntuzigere ugerageza gukuramo ibintu byose birinda vernix / mucus birinda hagati ya labia.
7. ** Amabara yintebe yintebe asaba ubuvuzi bwihuse (Umutuku, Umukara Nyuma yumunsi wa 5, cyangwa Chalky White) **:
8. ** Frank maraso yumutuku yuzuye mumyanya yigituba ** cyangwa ** igituba cyumukara cyongeye kugaragara nyuma yintebe zimaze guhinduka umuhondo **: Irasaba isuzumwa ryihutirwa ryubuvuzi bwo kubura amaraso ya Vitamine K (indwara ya hemorhagashi y’uruhinja ruvutse, cyane cyane niba ivuka rya Vitamine K ryaranze), poroteyine y’amata proctocolitis, fissure anal, cyangwa enterocolitis enterocolitis.
9. ** Chalky yera, ibara ryibumba ryijimye, cyangwa ibishishwa byijimye (Acholic Stools) **: ** NTIBIGEZE BISANZWE kumyaka iyo ari yo yose.

2. Jaundice yavutse (Hyperbilirubinemia) no kwirinda Kernicterus¶

** Jaundice ** ni ibara ry'umuhondo ryuruhu n'abazungu b'amaso (** scleral icterus **) biterwa no kuzamuka kwamaraso ya ** bilirubin (indirect) bilirubin , ibara ry'umuhondo-orange ryakozwe mugihe umubiri umennye hemoglobine kuva mumasemburo ashaje atukura. Kuberako uruhinja ruri munda rukenera uturemangingo twinshi twamaraso rutukura kugirango rutware ogisijeni kandi rufite igihe gito cyamaraso yumutuku (iminsi 70 kugeza 90 niminsi 120 mubantu bakuze), buri mwana wavutse avuka amenagura umubare munini wamaraso yumutuku mugihe enzyme yumwijima idakuze ( UDP-glucuronosyltransferase 1A1 / UGT1A1 **) ikora mubuzima bwa ** 1% gusa mubuzima bwabakuze **.

Kubera iyo mpamvu, ** 60 ku ijana by'abana bavutse igihe cyose na 80 ku ijana by'abana bavutse batagejeje igihe cyangwa batinze (ibyumweru 34 kugeza 37) ** barwara indwara ya jaundice igaragara ** hagati y'iminsi ya 2 n'iya 5. Icyakora, niba bilirubine idashyizwe hamwe yazamutse ikarenga inzitizi zikomeye, mubisanzwe ** hejuru ya 20 kugeza kuri 25 mg / dL (340 kugeza 425 $ mu inyandiko) imburagihe, irwaye, cyangwa ABO / Rh amaraso-matsinda-adahuye, impinja zidafite amavuta ya bilirubin zambuka inzitizi zidakuze ** inzitizi yubwonko bwamaraso ** ikananduza kandi ikangiza ibintu byimbitse byimyunyu ngugu byubwonko (** basal ganglia, globus pallidus, hippocampus, na auditori ya nuclei **).

Acir Bilirubin Encephalopathie (ABE) na Kernicterus: Ibimenyetso byihutirwa bya Neurologiya¶

Uburozi bwubwonko buturuka kuri bilirubine ndende bubaho mubyiciro bibiri: ** Acute Bilirubin Encephalopathie (ABE) ** (irashobora guhindurwa iyo ivuwe ako kanya mubitaro hamwe na ** ivura cyane ivura no guhererekanya amaraso **) na ** Kernicterus ** (karande, choreoathetoid cerebral palsy, ubumuga bwo kutumva no kutagira ubumuga bwo hejuru).

Nigute wasuzuma iterambere rya jaundice murugo: Cephalocaudal ya Kramer (Umutwe-Kuri-Amano)¶

Indwara ya jaundice hafi ya yose ikwirakwira ** kuva kumutwe kumanuka ugana ibirenge (cephalocaudal progress) ** uko bilirubin yamaraso izamuka. Mugihe ubugenzuzi bwamaso budashobora na rimwe gusimbuza ibitaro ** Transcutaneous Bilirubinometer (TcB) ** scan cyangwa ** Total Serum Bilirubin (TSB) ** isuzuma ryamaraso yinkoni yinkweto (cyane cyane kubana bato bafite uruhu rwijimye rwijimye, aho ugomba kugenzura abazungu ** b'amaso [sclerae], amenyo, hamwe n'imikindo yunamye **), ** Kramer's Rule **

Ibintu 5 bishobora guteza ibyago byinshi bituma jaundice ikivuka izamuka kabiri¶

Menyesha umuganga wihutirwa cyangwa umuganga w’abana vuba niba umwana wawe wavutse afite kimwe muri ibyo ** bitera indwara ya neurotoxicity cyangwa hemolysis ** (bisobanurwa muri ** 2022 Ishuri Rikuru ry’abana ry’Abanyamerika [AAP] Hyperbilirubinemia Clinical Practice Guideline **):

1. ** Indwara ya Jaundice igaragara mumasaha 24 yambere yubuzima **: ** Indwara ya Pathologiya kugeza igihe bigaragaye ukundi.
2. ** Gutinda-Gutegura cyangwa Igihe Cyambere cyo Gutwita (ibyumweru 34 kugeza 38) **: Umwana wavutse kuri ** 35, 36, cyangwa ibyumweru 37 ** ("gutinda igihe kitaragera / igihe cyambere") afite umwijima utarakura KANDI umusaya udakomeye / umusaya unaniza amabere mbere yo kubona ibiryo byuzuye, bikabaha ** inshuro 4 kugeza kuri 8 ibyago ** byindwara ya hyperbilirubinemia.
3. ** Cephalohematoma cyangwa kuvuka gukomeye gukomeretsa : Niba gukuramo vacuum, imbaraga, cyangwa kuvuka gukabije byasize ibibyimba binini byamaraso byabyimbye kumutwe wumwana ( cephalohematoma **) cyangwa gukomeretsa mumaso / umubiri, umubiri wumwana ugomba kumeneka amaraso yose yafashwe mumaraso muminsi ya bilirubine.
4. ** G6PD.
5. ** Kwifata byonsa cyane ("Inzara / Kwonsa Kunanirwa kwa Jaundice") : Iyo umwana wavutse atabonye amata ahagije muminsi 3 kugeza 5 yambere, inzira yintebe iratinda. Imbere y'amara adahagaze, enzyme yitwa ** $ beta $ -glucuronidase ** ifungura bilirubin ivuye muri meconium ikayohereza ako kanya mumaraso yumwana ( enterohepatic circulation **).

Impamvu utagomba na rimwe gushyira umwana wavutse ufite izuba ryinshi¶

Ibisekuru bya basogokuru basabwe gushyira umwana muto wumuhondo hejuru yigitambaro imbere yidirishya ryizuba. ** Ishuri Rikuru ry’Abanyamerika ryita ku bana (AAP) hamwe n’amabwiriza ya NICE yo mu Bwongereza biraburira mu buryo bweruye kwirinda gukoresha urumuri rw’izuba mu rugo rwa jaundice yavutse **:

• Imirasire y'izuba itaziguye cyangwa idirishya irerekana uruhinja rwambaye ubusa rwangiza ubuzima ** hypothermia ** (mucyumba cyateguwe) cyangwa ** hyperthermia hamwe nizuba rikabije rya UV ** muminota 15.
• Kwishingikiriza ku idirishya bidindiza ababyeyi kubona intego ** Igiteranyo cya Serumu Bilirubin (TSB) ** kwipimisha amaraso mugihe bilirubin yazamutse 20 mg / dL.
• ** Ukuntu imiti yubuvuzi nyayo ikora **: Ibitaro (kandi byanditseho fibreopique yo mu rugo ** Biliblanket ** padi) bifashisha kalibatifike yoroheje-itara ** itara ryubururu rya LED kuri 460 kugeza 490 nanometero **, ryinjira muruhu kandi ifoto-isomerize ibinure-ibishishwa bitarimo amavuta ya bilirubin muri ** lumirubin **, umwijima wumwijima utanga umwijima wumwijima hamwe numwijima wumwijima ukenera umwijima wumwijima hamwe numwijima wumwijima wumwijima wumwijima hamwe numwijima wumwijima wumwijima hamwe numwijima wumwijima wumwijima wumwijima hamwe numwijima wumwijima wumwijima. enzymes.

3.Gusuzuma ubunebwe bwavutse hamwe nubusinzira busanzwe (nuburyo bwo kubyutsa umwana usinziriye kugaburira)¶

Ubusanzwe impinja zirara ** amasaha 16 kugeza 18 kumunsi ** mugihe gito cyamasaha 2 kugeza kuri 3. Ariko, kubera ko ** dehydrasiyo (sodium yo mu maraso menshi) ** na ** bilirubin ** ikora nk'imiti itera ubwonko bw'uruhinja, umwana wicwa n'inzara cyangwa akaga ka jaundice ntashobora ** gutaka inzara **, ahubwo, bacecetse, basinziriye, kandi bigoye kubyuka ("umutego w'abana basinziriye").

Intambwe ku yindi protocole yo gukangura uruhinja rusinziriye (ariko rutari umunebwe) rwo kugaburira buri masaha 2 kugeza kuri 3¶

Mugihe cyiminsi 10 kugeza 14 yambere yubuzima, kugeza igihe umwana wawe yagaruye 100 kwijana ryibiro byavutse kandi jaundice irakemuka, ** ntuzigere ureka umwana wavutse asinzira amasaha arenze 3 kumanywa cyangwa amasaha 3.5 kugeza kuri 4 rimwe nijoro atagaburira ** (ibiryo 8 kugeza 12 kumasaha 24):

1. ** Tegereza icyiciro cyo gusinzira (REM) Icyiciro cyo gusinzira **: Reba amaso yijimye, guhina intoki, cyangwa kwonsa mbere yo gutoragura umwana.
2. ** Andika umwana kumpapuro zabo gusa **: Ibiringiti bishyushye hamwe nudupapuro dushyira impinja gusinzira neza. Kwambura umwana hanyuma ubishyire ** uruhu-ku-ruhu ** ku gituza cyambaye ubusa.
3. ** Hindura ikariso hanyuma ukoreshe ubwitonzi bwitondewe **: Guhindura ikariso ikangura abana benshi. Siga umugongo, uruti rw'umugongo, n'ibirenge by'ibirenge byabo, cyangwa uhanagure gahoro gahanga uruhanga no mumatama ukoresheje imyenda yo gukaraba (idakonje).
4. ** Erekana igitonyanga cya colostrum / amata kumunwa wumwana hanyuma ukore ibisebe byamabere mugihe wonsa **: Numara gufunga, kanda amabere witonze hasi mugihe cyose injyana yinjyana yumwana itinze kugirango yinjize amata mumunwa kandi ukomeze kumira cyane. * (Niba umwana adashobora gukomeza kuba maso muminota 5 nubwo izi ntambwe, hagarara ujye mubitaro). *

4.¶

Kurenga umwuma na jaundice, ibimenyetso bitatu byinyongera byumubiri mugihe cyicyumweru cya mbere bisaba gutabarwa byihuse:

1. ** Bilious (Icyatsi kibisi cyangwa Icyatsi kibisi-Icyatsi) Kuruka: Ibihe byihutirwa byo kubaga **:
2. ** Amacandwe asanzwe **: Amata yera cyangwa yuzuye amavuta yera atemba atemba ava mumfuruka yumunwa nyuma yo guturika.
3. ** Pyloric Stenosis (Mubisanzwe Icyumweru 2 kugeza 8) **: Kuruka "gukomeretsa" gukomeye kwamata ** yera / amata yamata ** kurasa mucyumba nyuma yo kugaburira (hakenewe isuzuma ryihutirwa).
4. ** Malrotation hamwe na Midgut Volvulus (Icyatsi kibisi / Neon Icyatsi kibisi kumunsi uwo ariwo wose wubuzima) **: Niba umwana wavutse arutse amazi asa ** icyatsi kibisi, neon umuhondo-icyatsi kibisi, cyangwa ishyamba ryijimye icyatsi kibisi (bile) , amara mato ashobora kuba yazindukiye mumitsi yingenzi yamaraso ( arteri ya mesenteric arteri **). ** Nibintu byihutirwa byubuzima-cyangwa-urupfu **: reka guhita ugaburira hanyuma uhite ujya mubitaro byihutirwa byibitaro byabana mbere yuko amara agoramye apfa.
5. ** Omphalitis (Indwara ya bagiteri yandurira mu mitsi) **:
6. Mugihe igifu gikiza gishobora kwerekana igitonyanga gito cyamaraso yumye cyangwa impumuro yoroheje neza kuko iguye hagati yumunsi wa 7 na 14, ** ikwirakwiza umutuku, ubushyuhe, ubwuzu, cyangwa kubyimba kuruhu rwinda ruzengurutse munsi yigitereko cyumugozi **, cyangwa ibinure byumuhondo binuka cyane biva mu nsi, ni ** omphalitis **. Kubera ko imiyoboro y'amaraso ihuza umwijima na peritoneum, omphalitis irashobora gutera sepsis yica na necrotizing fasciitis mu masaha kandi igasaba antibiyotike ya IV muri ER.
7. ** Akababaro k'ubuhumekero na Apnea **:
8. Bara umwuka wumwana wawe kumasegonda 60 yuzuye mugihe utuje (impinja zikivuka zihumeka muburyo budasanzwe "guhumeka burigihe" hamwe nikiruhuko gito 5-10-10). Hamagara 911/112/999 ako kanya kugirango ** ikomeze guhumeka byihuse kuruta guhumeka 60 kumunota **, ** apnea ihagarara kumara amasegonda 20 cyangwa arenga **, ** gukuramo intercostal cyangwa subcostal ** (uruhu rwonsa cyane munsi yimbavu cyangwa amabere), ** gutaka kwinshi **, ** izuru ryaka ururimi ** niminwa **.

Ibibazo bikunze kubazwa¶

Ni ukubera iki umwana wanjye w'iminsi 2 yavutse yasize icunga cyangwa umutuku-umutuku wijimye? Ni amaraso?¶

Ku munsi wa 1, 2, na 3 wubuzima, icyatsi cya orange, ingese, cyangwa salmon-pink yijimye mu gitambaro cyavutse ni hafi "umukungugu wamatafari" urate kristal, kristu ya aside irike itagira ingaruka ziva mu nkari zavutse mugihe utegereje ko umubyeyi munini w’amata akuze azaza mu munsi wa 3 kugeza ku wa 4. "pseudomenstruation" kuva gukuramo imisemburo y'ababyeyi). Ariko, niba ubonye amatafari ya orange-umukungugu urate kristaliste kumunsi wa 5 cyangwa nyuma yayo, bivuze ko inkari zumwana ziteranijwe cyane no kubura umwuma no kugaburira nabi, bisaba isuzumabumenyi ryabana kumunsi umwe no kugaburirwa byihuse.

Nigute nshobora kuvuga itandukaniro riri hagati ya jaundice isanzwe ivutse na jaundice iteje akaga?¶

Igihe, iterambere ryumubiri, hamwe no kuba maso kwabana bitandukanya byombi. Indwara ya physiologic isanzwe ntabwo igaragara mumasaha 24 yambere yubuzima; itangira hafi yumunsi wa 2 cyangwa 3 mumaso no mugituza cyo hejuru, impinga kumunsi wa 3 kugeza ku wa 5, kandi umwana akanguka ashishikaye buri masaha 2 kugeza kuri 3 yo kugaburira kandi akabyara imbuto nyinshi zitose kandi zumuhondo. Indwara ya Jaundice nihutirwa kwivuza niba (1) uruhu rwumuhondo cyangwa amaso bigaragara mumasaha 24 yambere nyuma yo kuvuka, (2) ibara ryumuhondo rikwirakwira hejuru yinda yinda kugeza kumaguru yo hepfo, imikindo yintoki, cyangwa ibirenge byamaguru, (3) umwana ni umunebwe, ntibishoboka gukanguka kubiryo, cyangwa afite amarira maremare cyane cyangwa yunamye inyuma yibyumweru 2.

Nshobora gushyira uruhinja rwanjye rwumuhondo iruhande rwidirishya ryizuba cyangwa nkabaha amacupa yamazi yo gusohora bilirubin?¶

Ntuzigere na rimwe ubikora. Guha amazi meza cyangwa isukari umwana wavutse ntibisohora bilirubin (amababi ya bilirubine menshi mumyanya yintebe binyuze mumata akungahaye kuri calorie, ntabwo ari amazi) kandi birashobora gutera sodium maraso yica (gufata uburozi bwamazi) mugihe wuzuza igifu gito cyumwana karori ya zeru. Mu buryo nk'ubwo, Ishuri Rikuru ry’Abanyamerika ryita ku bana riraburira kwirinda gushyira umwana wavutse wambaye ubusa ku zuba cyangwa mu idirishya bitewe n’impanuka nyinshi ziterwa na hypothermie, ubushyuhe bukabije, izuba ryinshi, n’ubukererwe bukabije bwo kubona ibizamini by’amaraso bya bilirubin hamwe n’ubuvuzi bw’ubuvuzi bwa LED.

Ni ukubera iki kuruka icyatsi mukivuka ari ibintu byihutirwa cyane ugereranije n'amacandwe yera?¶

Hafi yimpinja zose zaciriye amata yera cyangwa yuzuye amata nyuma yo kugaburira kuko valve yimitsi iri hejuru yinda yabo idakuze. Ariko, niba uruhinja ruvutse rwirutse rufite ibara ryatsi ryatsi, neon yumuhondo-icyatsi, cyangwa ibyatsi byijimye-icyatsi kibisi (kuruka bilious), bivuze ko umuyonga uva muri duodenum usubira mu gifu kubera kuziba munsi yumuyoboro. Mu kuvuka, kuruka icyatsi nicyo kintu cyambere kiranga malrotation yo munda hamwe na midgut volvulus, ibyihutirwa byo kubaga aho amara yagoramye yaciwe n'amaraso kandi ashobora gupfa mu masaha keretse iyo atabigambiriye kubaga umuganga w'abana.

Inkomoko yagenzuwe¶

• Ishuri ry’Abanyamerika ryita ku bana (AAP, Amerika): * Kuvugurura umurongo ngenderwaho wa Clinical Practice: Ubuyobozi bwa Hyperbilirubinemia mu ruhinja ruvutse ibyumweru 35 cyangwa birenga byo gutwita (Kemper et al., Pediatrics, 2022) *.
• Ikigo cy’igihugu gishinzwe ubuzima n’ubuvuzi bwiza (NICE Guideline CG98 & NG194, Ubwongereza): * Indwara ya Jaundice mu bana bavutse bari munsi yiminsi 28: Kumenyekana, Bilirubinometry ya Transcutaneous, hamwe na Phototherapy Thresholds * na * Kwitaho nyuma yo kubyara *.
• Ishami ry'Umuryango w'Abibumbye ryita ku Buzima (OMS): * Igitabo cyo mu mufuka cyo kwita ku bitaro byita ku bana: Amabwiriza yo gucunga indwara zisanzwe zo mu bwana: Indwara ya Neonatal Jaundice, Dehydration, n'ibimenyetso by'akaga *.
• Ishuri Rikuru ryubuvuzi bwonsa (ABM Clinical Protocol # 3 & # 22): * Ibyokurya byinyongera mugihe cyiza cyonsa Neonate yonsa, ibiro bitakaza ibiro, hamwe nubuyobozi bwa Neonatal Hyperbilirubinemia *.
• Umuryango w’abana muri Kanada (CPS): * Amabwiriza yo Kumenya, Gucunga, no Kurinda Hyperbilirubinemia mu gihe na nyuma y’impinja zitaravuka *.

Kuyobora¶

• Ibihe byihutirwa byubuvuzi nibimenyetso byibyago byavutse
• Indwara ya psychose na nyuma yo kwiheba: ibihe byihutirwa byo mu mutwe
• Umwana ufite umuriro mwinshi hamwe no gufatwa na febrile
• Guhumeka neza (ubururu na pale syncope) na apnea triage
• Kubura amata, kubura amashanyarazi, konsa, no kugaburira neza
• Imibare yihutirwa ukurikije igihugu