Preventive nursing of neonatal adrenal hyperplasia

When caring for newborns, parents must do so comprehensively. At this time, newborns are prone to some diseases, which are very harmful to the bodies of newborns. Therefore, these diseases must be prevented. So what are the preventive care for neonatal adrenal cortical hyperplasia? There are also many good ways to prevent neonatal adrenal cortical hyperplasia. The following is a detailed introduction.

Preventive care for neonatal adrenal hyperplasia:

1. Neonatal CAH screening mainly refers to the screening and diagnosis of neonatal 21-OHD. The purpose is to prevent life-threatening adrenal crisis and the resulting brain damage or death, prevent female children from having their gender judged incorrectly due to masculinization of their external genitalia, prevent future short stature, psychological and physical developmental disorders caused by excessive androgens, and enable children to receive early diagnosis and treatment before clinical symptoms appear.

The neonatal CAH screening method is to draw blood from the heel of each infant 3 to 5 days after birth, and drop the blood on a special filter paper. Early diagnosis is performed by measuring the 17-OHP concentration in the filter paper blood smear using various detection methods, such as enzyme-linked immunosorbent assay (ELISA) and fluorescent immunoassay. Normal infants have 17-OHP levels >90nmol/L after birth and return to normal after 12 to 24 hours. There is a certain relationship between 17-OHP level and birth weight. The normal 17-OHP level in full-term infants is below 30nmol/L, that in low birth weight (1500-2700g) is -40nmol/L, and that in extremely low birth weight (<1500g) is 50nmol/L. If the newborn has certain cardiopulmonary diseases after birth, 17-OHT will also increase. The above reasons may lead to increased false positive rate and recall rate. During general screening, 17-OHP>500nmol/L is typical CAH, and 150-200nmol/L can be seen in various types of CAH or false positives. The positive cut-off point for 17-OHP screening should still be established according to each laboratory's method and adjusted through long-term observation and summary of experience. Positive cases require close follow-up and confirmation by measuring plasma cortisol, testosterone, DHEA, DHA and 17-OHP levels.

2. Prenatal diagnosis and treatment: 21-hydroxylase gene analysis should be performed on CAH patients and their parents. When the mother becomes pregnant again, she should take dexamethasone 20 μg/(m2·d) orally (usually 1-1.5 mg/d) at 4-5 weeks of pregnancy. At 9-11 weeks of pregnancy, chorionic villus sac (CVS) biopsy should be performed for chromosome testing and DNA should be analyzed for CYP21B gene. If the above results indicate that the fetus is male, heterozygous or normal, dexamethasone treatment can be discontinued. When the amniotic fluid test indicates that the fetus is likely to be a female homozygous patient, dexamethasone treatment is continued until the fetus is born.

After understanding the prevention and care of adrenal hyperplasia in newborns, parents can follow the above methods. However, it should be noted that when abnormalities occur in the newborn's body, parents cannot choose drug treatment at will, otherwise it will have an impact on the newborn's body. Parents should also pay attention to this.