Patient's question:
Liver function test for a two-month-old infant: Total bilirubin 152.6, direct bilirubin 114.5, indirect bilirubin 38.1, total bile acid 126.0, alanine aminotransferase 82, aspartate aminotransferase 220, alkaline phosphatase 790, glutamyl transferase 718, gamma-glutamyl transpeptidase 341, the rest are normal, total protein 58.1 is low, albumin 37.3 is low. Is it normal? How should it be treated?Doctor's answer:
Analysis of the Condition: Neonatal jaundice refers to the yellowing of the skin, sclera, and mucous membranes during the neonatal period, also known as neonatal hyperbilirubinemia. Its etiology is specific and complex, and severe cases can lead to bilirubin encephalopathy (kernicterus), often resulting in death and severe sequelae. Neonatal jaundice is generally divided into two major categories: physiological jaundice and pathological jaundice. Physiological jaundice is a normal physiological phenomenon. Due to the metabolic characteristics of bilirubin in newborns, approximately 60% of full-term infants and over 80% of preterm infants may develop jaundice 3-5 days after birth, but they are generally in good condition. In full-term infants, jaundice typically resolves within 14 days, while in preterm infants, it may persist for up to 3-4 weeks. Pathological jaundice, on the other hand, is abnormal and is generally associated with the following factors: ① bacterial infections and neonatal sepsis, as well as viral infections such as hepatitis A virus, hepatitis B virus, and cytomegalovirus; ② neonatal hemolytic disease; ③ congenital biliary atresia and biliary cysts; ④ breast milk jaundice, which typically appears 4-7 days after birth, peaks within 2-3 weeks, and the bilirubin level can decline within 1-3 days after stopping breastfeeding. If there is no significant decline after 3 days, breast milk jaundice can be ruled out; ⑤ other factors such as genetic diseases, drug-induced jaundice, etc. If a newborn exhibits any of the following conditions, it should be considered pathological jaundice: early onset of jaundice (appearing within 24 hours after birth); severe jaundice or rapid progression; prolonged duration of jaundice (more than 2 weeks in full-term infants, more than 4 weeks in preterm infants); reappearance of jaundice after it has subsided. Pathological jaundice caused by any reason should be treated by identifying the underlying cause. This is particularly important for preterm infants within the first week and for those with severe hypoxia, acidosis, intracranial lesions, or severe infections, who must receive prompt and active treatment to avoid adverse outcomes.