In the end, Sun Lien still failed to enter the nicu and see his little cousin. Qian Hongjun and another pediatrician who Sun Lien had met before received Sun Lien and Yuan Pingan.
"Sit down." The person who came to participate in the exchange was also a doctor, which made Qian Hongjun feel a lot more relaxed. Many of the troubles that are often encountered when communicating with ordinary family members are basically impossible to happen when the other party is also a doctor.
"This child is in very bad condition."
Sun Lien nodded heavily. From his preliminary understanding, he roughly guessed this. But he was still not sure how serious his cousin's condition was.
"The inspection report just now shows that the total bilirubin is almost 400." Qian Hongjun sighed, "Such a high bilirubin is likely to be accompanied by nerve damage. And the most troublesome thing is that we are not sure yet what causes it.
What is the cause of such severe jaundice?"
"It shouldn't be simple neonatal hemolytic jaundice. We will conduct another anti-globulin test and serum antibody test to confirm the diagnosis." Another doctor spoke, and only then did Sun Lien recognize this person. This was his first time.
When I went to the pediatric duty room, the person who made tea with a quarter cup of tea. "I read the treatment records of Changning Maternal and Child Health Hospital. If it is just hemolytic jaundice, after combining phototherapy and intravenous albumin, it should be
Things will get better."
From this point of view, probably all diagnoses are similar. Use all available information to eliminate as many possibilities as possible, so that the scope of suspects can be narrowed down as much as possible, so that the cause of the disease can be determined as soon as possible.
"And the B-ultrasound has also ruled out congenital bile duct malformations and hepatitis." Sun Lien guessed along this line of thought. Anyway, he doesn't have to decide what treatment plan to use for his cousin, so it doesn't hurt to put forward some of his own ideas. "Well,
Is it supposed to be hemolysis caused by infection?”
"You are too young and have not been exposed to the outside world. Where did the source of infection come from? Mother-to-child transmission?" Yuan Pingan disagreed with Sun Lien's suggestion. "Even if it is mother-to-child transmission, the antibodies in breast milk can also
Protect the baby from infection, right? It’s not even six months yet.”
The antibodies that breast milk can provide to babies can last for about six months. During these six months, the baby's immunity is actually not weak. The same is true for infants and young children who grow up on milk powder and are more likely to suffer from acute gastroenteritis.
The risk is about six times greater than breastfeeding.
"Currently, infection is the most likely suspect." Qian Hongjun thought for a while and supported Sun Lien's view. "There are only a few causes of pathological jaundice, not hemolysis, not biliary malformation, not neonatal hepatitis, and since
According to the current monitoring and electrocardiogram, the child does not have congenital heart disease. It can only be infection."
"To determine the type of infection as soon as possible, first check for bacteria and viruses that can cross the placental barrier and be transmitted from mother to child." Another pediatrician nodded at the table, "But I think it is more important now.
, it is necessary to perform plasma exchange on the child as soon as possible. His bilirubin level is too high, and if this continues, it is only a matter of time before kernicterus develops."
"It is relatively risky to perform plasma exchange directly." It was obvious that the pediatrician had not communicated with Qian Hongjun about this before. Qian Hongjun suppressed his suggestion first, "Let's do a simultaneous blood transfusion first to see the situation.
"
Synchronous exchange transfusion, the full name is "peripheral arterial and venous synchronized blood therapy". It is an effective treatment method that uses normal blood or blood products to replace blood containing certain harmful factors in children. This method is relatively milder than plasma exchange.
Some of them have also been used in the field of neonates for a longer time. Doctors have a deeper understanding of the side effects of this therapy, which makes it easier to deal with it.
Qian Hongjun continued, "The part about pathological jaundice is here first. Regarding the issue of neonatal atelectasis..." He looked at Sun Lien, "I think the diagnosis of Changning Maternal and Child Health Hospital is OK. Pulmonary hypoplasia combined with inhalation."
Sexual pneumonia is most likely."
"Then continue to use mechanical ventilation and bovine lung surfactant treatment?" Sun Lien asked, "Will there be no changes to the treatment plan at Changning Maternal and Child Health Hospital?"
"There are still changes, but only after the source of infection is determined and eliminated." Qian Hongjun sighed, "We will use budesonide for inhalation of the child, but this glucocorticoid will also suppress the immune response after all. If
If jaundice is caused by infection, then it must not be used."
In short, the most critical goal now is to determine the source of jaundice. Whether it is infection or not, it must be determined first.
"Then I'll ask the nurse to get blood first." The four doctors discussed with each other and agreed that postponing budesonide inhalation treatment is the most appropriate and safest method at present for advanced synchronized blood circulation. So Qian Hongjun stood up
, he took out a consent form for blood transfusion treatment from the file bag on the side. At the same time, he took out a critical illness notice.
"The child's situation is indeed very troublesome and difficult. You still need to communicate this with your relatives." Qian Hongjun sighed, "I originally thought it might be an ordinary child with the disease."
"I'm causing trouble for you this time." Sun Lien took the two documents and bowed to Qian Hongjun, "My uncle left early, and my cousin has suffered a lot over the years. Now he finally has a child.
The result is like this..." He sighed, "Anyway, I'm sorry to bother you."
"It should be." Qian Hongjun nodded, "Hurry up and get the signature. Once the signature is received, we will perform blood transfusion treatment immediately."
"Critical illness..." Wang Tian looked at the critical illness notice brought by Sun Lien, and tears began to flow on his face again.
"There's nothing we can do about it. After all, we're already living in nicu, so we must issue a critical illness notice." Sun Lien sighed. He sighed a lot more than usual today. "Look at the consent form for blood transfusion treatment. What's there?
Let me answer your question. We will try to complete these written documents as soon as possible. The sooner we complete them, the sooner we can start treatment."
Wang Tian nodded, wiped the tears on his face carelessly, raised his head and asked Sun Lien, "Lien... please tell me, he... can he be saved?"
"We will do our best and use all methods for treatment without reservation." In front of his relatives, Sun Lien has nothing to hide. Looking at the current situation, in addition to explaining the risks of treatment to Wang Tian
, Sun Lien had to encourage him, "Pathological jaundice in newborns is not uncommon. As long as we find the cause of jaundice, we still have a way."
Not only must you be encouraging, but you must also pay attention to the propriety of your encouragement, and be careful not to mislead. The sense of propriety here is indeed difficult to grasp. Sun Lien pondered this passage several times along the way, and only dared to say it out after he was sure that there was no problem.
"Your sister-in-law is still lying in the hospital..." Wang Tian said desperately, signing with trembling hands, "She had a child like this after a narrow escape. If he has some shortcomings, how should I explain...
…”
If you were just worried about not being able to explain, it would be easy. Sun Lien encouraged his cousin again, and then returned to the nurse station at the entrance of NICU with the permission letter.
"Just leave it here with your permission." The little nurse said to Sun Li'en very considerately, "I will notify Director Qian."
"Please hurry up." Sun Lien nodded towards the little nurse, then turned and left the door. As he walked towards the door, he happened to meet Qian Hongjun holding two bags of liquid in his hands.
"Have the things been delivered?" Qian Hongjun asked as soon as he saw Sun Lien, "Does the family agree?"
Sun Lien nodded, looked at a bag of light yellow liquid and a bag of dark red liquid in Qian Hongjun's hand and asked, "Is this... the blood used for simultaneous replacement?"
"Yes." Qian Hongjun nodded and raised the object in his hand towards Sun Lien, "The red blood cells of type O blood and the plasma of type AB blood are both rh-negative."
This is the most "ideal" mixed blood ratio from an immunological point of view. Type O red blood cells do not have two antigens, a and b, and type ab plasma does not have any coagulation antibodies. Therefore, theoretically, such a mixed blood type will not cause
Any ABO blood type is not compatible, thus avoiding transfusion hemolysis. And rh negative is even more valuable. This rare panda blood is suitable for both rh negative and positive blood type patients. If it were not for the two bags of rh negative red blood cells and plasma in the blood bank
There is still stock, and it is to be used for neonatal rescue treatment, so the staff of the blood bank may not be willing to take it out.
"It's not easy to get such things from the people in the blood bank." Qian Hongjun smiled, "Let's not talk about it now. I'm going to arrange treatment."