In the end, Sun Lien still couldn't enter the NICU and see his little cousin. Qian Hongjun and another pediatrician whom Sun Lien had met before received Sun Lien and Yuan Ping'an.

"Sit. The doctors who came to participate in the exchange also made Qian Hongjun feel a lot more relaxed. There are many troubles that are often encountered when communicating with ordinary family members, but it is basically impossible to happen when the other party is also a doctor. "This kid is in a bad situation. ”

Sun Lien nodded heavily, and from the preliminary understanding, he probably guessed this. But he wasn't sure how serious his cousin's condition really was.

"In the examination report just now, the total bilirubin has almost reached 400. Qian Hongjun sighed, "Such a high level of bilirubin is likely to be accompanied by nerve damage." And the trickiest thing is that we don't know for sure what causes such severe jaundice. ”

"It should not be a simple neonatal hemolytic jaundice, we will add an antiglobulin test and a serum antibody test to confirm the diagnosis. Another doctor spoke, and Sun Lien recognized that this person was the one who made tea with a quarter cup of tea when he first went to the pediatric duty room. "I looked at the treatment records of Changning Maternal and Child Health Hospital, and if it was only hemolytic jaundice, it should get better after combining phototherapy and intravenous albumin. ”

From this point of view, probably all diagnoses are more or less the same. The use of all available information to rule out as many possibilities as possible would make it possible to narrow down the range of suspects so that the cause could be identified as soon as possible.

"And ultrasound also ruled out congenital bile duct malformations and hepatitis. Sun Lien guessed along this line of thought, anyway, he didn't have to decide what treatment plan to use for his cousin, so it was not in the way to put forward some of his own ideas. "So, it's supposed to be hemolysis caused by infection?"

"I'm too young, and I haven't been in contact with the outside world, where does the source of infection come from?" Yuan Ping'an disagreed with Sun Lien's proposal, "Even if it is transmitted from mother to child, the antibodies in breast milk can protect the baby from infection, right?" ”

The antibodies that can be supplied to the baby in breast milk can last for about six months, during which the baby's immunity is not weak. In the same infants and young children, children who grow up on formula are about six times more likely to develop acute gastroenteritis than breastfeeding.

"At present, it is still the most suspected infection. After pondering for a while, Qian Hongjun supported Sun Lien's opinion. "There are only a few causes of pathological jaundice, not hemolysis, not biliary tract malformation, not neonatal hepatitis, and from the current monitoring and electrocardiogram, the child does not have congenital heart disease. It can only be an infection. ”

"To determine the type of infection as soon as possible, first check for bacteria and viruses that can cross the placental barrier and can be transmitted from mother to child. Another pediatrician nodded to the table, "But I think it's more important now to have plasmapheresis as soon as possible." His bilirubin levels were too high, and if it went on like this, it was only a matter of time before kernicterus developed. ”

"Direct plasmapheresis is risky. Obviously, the pediatrician had not communicated with Qian Hongjun about this before. The suggestion he put forward was held down by Qian Hongjun first, "Let's do a synchronous blood exchange first and see the situation." ”

Synchronous exchange transfusion, the full name is "peripheral arteriovenous synchronous blood therapy". It is an effective treatment that uses normal blood or blood products to replace the blood containing a certain harmful factor in the child's body. It is a milder procedure than plasmapheresis, has been used in neonatal space for a longer period of time, and doctors have a better understanding of the side effects of this therapy, which makes it easier to deal with.

Qian Hongjun continued, "The part of pathological jaundice is here first, and the problem of neonatal atelectasis is ......" He looked at Sun Lien, "I think the diagnosis of Changning Maternal and Child Health Hospital is fine, and pulmonary hypoplasia combined with aspiration pneumonia is the most likely." ”

"Then continue to be treated with mechanical ventilation and bovine lung surfactant?" Sun Lien asked, "Won't the treatment plan of Changning Maternal and Child Health Hospital be changed?"

"There will still be changes, but only after the source of infection has been identified and ruled out. Qian Hongjun sighed, "We will use budesonide for inhalation for children, but this glucocorticoid will also suppress the immune response after all, if the jaundice is caused by infection, then it must not be used." ”

In short, the most critical goal now is to identify the source of jaundice. Whether it is infected or not, you have to confirm it first.

"Then I'll ask the nurse to go and get the blood first. The four doctors discussed with each other and agreed that the most appropriate and safest treatment is currently the most appropriate and safest treatment for advanced synchronous ring blood and the suspension of budesonide inhalation therapy. So Qian Hongjun stood up and took out a consent form for blood transfusion treatment from the document bag on the side. At the same time, there was also a critical illness notice.

"The child's situation is really troublesome and tricky. You still have to communicate this with your relatives. Qian Hongjun sighed, "I thought it might be an ordinary child." ”

"I'm sorry for your trouble 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 that I finally have a child, it turns out like this......" he sighed, "Anyway, I'm sorry for you." ”

"It should. Qian Hongjun nodded, "You hurry up and ask for the signature, and when the signature is reached, we will do exchange transfusion treatment immediately." ”

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"Critically ill ......" Wang Tian looked at the critical illness notice that Sun Lien took, and tears began to flow on his face again.

"There is no way to do this, after all, I have been admitted to the NICU, and the critical illness notice must be issued. Sun Lien sighed, he sighed much more often than usual today. "If you look at the consent form for blood transfusion treatment, I'll answer any questions for you - let's try to find these paperwork as soon as possible, and the sooner we can complete it, the sooner we can start treatment. ”

Wang Tian nodded, wiped the tears from his face, raised his head and asked Sun Lien, "Lien...... You give me the answer, he ...... Will he be able to get it back?"

"We will do everything in our power and without reservation to use all methods to treat it. Looking at the current situation, in addition to explaining the risks of treatment to Wang Tian, Sun Lien also had to cheer him up, "Neonatal pathological jaundice is not uncommon, as long as we find the cause of jaundice, we still have a way." ”

Not only should we be motivated, but we should also pay attention to the proportions of our encouragement and be careful not to mislead. It is really difficult to grasp the proportions in this, Sun Lien pondered this passage several times along the way, and only dared to say it after making sure that there was no problem.

"Your sister-in-law is still lying in the hospital...... Wang Tian said desperately, and signed with a trembling hand, "She only had such a child after nine deaths, if he has three long and two short, how should I explain it......"

If you're just worried about it, it's easy to explain. Sun Lien cheered his cousin up again, and then returned to the nurses' station at the entrance of the NICU with the permission letter.

"Just leave it here. The little nurse said to Sun Lien very intimately, "Director Qian, I'll inform you." ”

"Excuse me as soon as possible. Sun Lien nodded to the little nurse, then turned and left the door. When I walked to the door, I happened to meet Qian Hongjun who was holding two bags of liquid in his hand.

"Did you send something?" Qian Hongjun asked as soon as he saw Sun Lien, "The family agreed?"

Sun Lien nodded, looked at the bag of pale yellow liquid and the bag of dark red liquid in Qian Hongjun's hand and asked, "Is this ...... Blood for synchronous replacement?"

"Yes. Qian Hongjun nodded and raised the thing in his hand towards Sun Lien, "The red blood cells of type O blood and the plasma of blood type AB are both RH negative. ”

This is the most "ideal" blood mix from an immunological point of view. There are no A and B antigens on the RBCs in type O, and there are no coagulation antibodies in the plasma of type AB, so theoretically such a mixed blood group will not cause any ABO blood group intolerance, thus avoiding transfusion hemolysis. Rh-negative is even more valuable – this rare panda blood is suitable for both RH-negative and positive blood type patients. If it weren't for the fact that the two bags of RH-negative red blood cells and plasma in the blood bank were still in stock, and they were to be used for neonatal rescue treatment, the staff of the blood bank might not have been willing to take them out.

"It's not easy to get something like that from the blood bank. Qian Hongjun smiled, "Let's not talk about it yet, I'll arrange treatment." ”