My baby is 22 days old and his jaundice has not subsided. What should I do?

If your baby's jaundice has not completely subsided after 22 days of treatment, parents will become very anxious, fearing that their baby's jaundice cannot subside due to other special reasons. In fact, the most important thing at this time is to find the reason why the jaundice does not subside. At present, the best treatment method is blood exchange therapy, which is mainly used after phototherapy fails.

2. Exchange blood therapy

Exchange transfusion can effectively reduce bilirubin, replace sensitized red blood cells and alleviate anemia. However, blood transfusion requires certain conditions and may also produce some adverse reactions, so the indications should be strictly followed and it is generally used when phototherapy fails.

3. Medication

Use drugs to reduce bilirubin production, accelerate bilirubin clearance or inhibit bilirubin enterohepatic circulation, including supplying albumin, correcting metabolic acidosis, liver enzyme inducers (such as phenobarbital), and intravenous immunoglobulin.

4. Supportive treatment

The main thing is to actively prevent and treat hypoxia, hypercapnia, cold injury, hunger, infection, and hyperosmotic drug infusion, prevent temporary opening of the blood-brain barrier, and prevent the occurrence of bilirubin encephalopathy.

(1) Red blood cells, hemoglobin, reticulocytes, and nucleated red blood cells must be routinely checked in neonatal jaundice to help screen for hemolytic disease of the newborn. In the presence of hemolytic disease, the red blood cell count and hemoglobin decrease, and the reticulocytes increase.

(2) Blood type includes the blood types of the father, mother and newborn (ABO and Rh systems), which is very important, especially when neonatal hemolytic disease is suspected. If necessary, further serum specific antibody testing can be performed to assist in diagnosis.

(3) Red blood cell fragility test: This test can be performed if jaundice is suspected to be caused by hemolysis but hemolytic disease due to blood type incompatibility has been ruled out. If fragility increases, consider hereditary spherocytosis, autoimmune hemolytic disease, etc. If fragility is reduced, it can be seen in hemoglobin disorders such as thalassemia.

(4) The normal methemoglobin reduction rate is >75%. This value is lower in patients with G-6PD (6-phosphate glucose dehydrogenase) deficiency, and further G-6PD activity measurement is required to confirm the diagnosis.