1, Rh blood group incompatibility
The incidence of neonatal hemolysis caused by Rh blood group incompatibility is low in China. Usually, the mother is Rh negative and the fetus is Rh positive, which leads to blood group incompatibility and hemolysis. Generally, the first child is not sick, and the second child is sick. However, if the Rh-negative mother has received Rh-positive blood transfusion before the first child, then the first child may also get sick.
2.ABO blood group incompatibility
ABO blood group incompatibility is the most common disease, the mother is O type, and the fetus (or baby) is A type or B type. The first child can get sick, and the more times of delivery, the higher the incidence rate, and it is more serious every time. It can still be seen that the mother is type A, the fetus (or baby) is type B or AB, the mother is type B, and the fetus (or baby) >; Type b or AB, but rarely. If the fetus (or baby) is type O, the disease can be ruled out.
Symptoms of neonatal hemolysis
1. Bilirubin decomposed by jaundice red blood cells is yellow, which can be distributed all over the human body, making the color of body tissues yellow. Because the skin and sclera (commonly known as white eyes) are located on the body surface, yellowing is the most obvious, which is jaundice.
2. Mild hepatosplenomegaly has no obvious increase. In severe hemolysis, fetal edema may occur, and obvious hepatosplenomegaly may occur. This symptom is more common in Rh hemolytic disease.
Children with anemia have different degrees of anemia, which can cause heart failure and edema in severe cases.
4, bilirubin encephalopathy When the bilirubin level in the blood is too high, it will damage brain cells and cause bilirubin encephalopathy, which is the most serious complication of hemolytic diseases.
5. Nervous symptoms, such as drowsiness, refusal to milk, weakness of limbs, and then convulsions, are manifested as staring eyes, blinking, stiff limbs, or the whole body's angular arch is reversed, sometimes screaming, which is called nuclear jaundice or bilirubin encephalopathy. It often occurs when serum bilirubin reaches more than 20mg/dl, which is caused by indirect bilirubin entering brain tissue and damaging brain cells.
6, children with fever and hemolysis are often accompanied by fever. Fever may be the physical reaction of the child after hemolysis, or it may be a serious bilirubin encephalopathy. The fever may not be very high, but if it happens because of the latter, it means that the condition is more serious.
Can neonatal hemolysis be cured?
Generally, ABO hemolysis can be cured by blue light therapy, and there will be no sequelae, but some will develop into brain diseases such as nuclear jaundice and ataxia.
1, phototherapy
It is the simplest and most effective method to reduce serum bilirubin. When serum bilirubin reaches the standard of phototherapy, phototherapy should be carried out in time. The standard of phototherapy is to formulate different phototherapy standards according to whether there are complications in different gestational weeks and different days. Active phototherapy measures should be taken to reduce serum bilirubin to avoid bilirubin encephalopathy. Serum bilirubin should be continuously monitored, and those who fail to respond to phototherapy should be treated with exchange transfusion.
2. Drug therapy
Early application of (1) intravenous gamma globulin has a good clinical effect.
(2) Albumin increases the binding of free bilirubin and reduces the occurrence of bilirubin encephalopathy.
3, change blood
When the serum bilirubin level reaches the exchange standard according to different gestational age and different day age, exchange transfusion treatment is needed. ABO hemolysis only needs exchange transfusion in a few serious cases.
Step 4 correct anemia
People with severe anemia in the early stage often have high serum bilirubin and need to change blood. Late mild anemia can be supplemented with iron and vitamin C to promote bone marrow hematopoiesis. However, when anemia is serious and accompanied by increased heart rate, shortness of breath or weight loss, blood transfusion should be appropriate. Blood transfusion should not have blood group antigens and antibodies that can cause disease.
5. Others
Prevent hypoglycemia, hypocalcemia, hypothermia and electrolyte disorder.
Nursing care of neonatal hemolysis
1, implement routine nursing for newborns and strictly implement disinfection and isolation system.
2, aiming at the cause of nursing, prevent the occurrence of nuclear jaundice.
(1) When conservative treatment is taken, liquids and drugs should be given in strict accordance with the doctor's advice, and any adverse reactions should be observed and reported to the doctor in time.
(2) Be ready for exchange transfusion treatment at any time and give assistance.
(3) Strictly observe temperature, pulse, respiration, jaundice, edema, lethargy, breast rejection, etc. When heart failure, respiratory failure or convulsion occur, they should be carried out according to the relevant nursing routine respectively.
3, reasonable feeding: during jaundice, it is often manifested as sucking weakness and poor appetite. Feeding should be patient, and the feeding methods should be adjusted according to the needs, such as small amount and multiple times, and intermittent feeding to ensure the milk quantity.
4. Observation of illness: Pay attention to the color of skin mucosa and sclera, and monitor bilirubin; Pay attention to the manifestations of nervous system, such as refusing to eat, lethargy, hypotonia and other early manifestations of bilirubin encephalopathy, and immediately notify the doctor to prepare for rescue; Observe the frequency, quantity and nature of defecation. If meconium is delayed, enema should be performed to promote the excretion of feces and bilirubin.
5. Health education: let parents know the condition and get the cooperation of parents; Patients with bilirubin encephalopathy should pay attention to the occurrence of sequelae and give rehabilitation treatment and nursing.