新生儿黄疸,可能是大部分新手爸妈遭遇的第一个难题.大部分宝宝出生后，都会经历变成小黄人的阶段。
Neonatal jaundice may be the first problem encountered by most novice parents. Most babies will experience the stage of turning into little yellow people after birth.
什么是黄疸？What is jaundice?

首先，黄疸是一个症状，其本质是血液中胆红素的升高，由于胆红素是橙黄色，所以在皮肤和粘膜上呈现出黄色，我们就叫黄疸，而血液中的胆红素升高，在医学上被称为“高胆红素血症”。
First of all, jaundice is a symptom, and its essence is an increase in bilirubin in the blood. Because bilirubin is orange-yellow, it appears yellow on the skin and mucous membranes. We call it jaundice, and bilirubin in the blood rises High, medically known as "hyperbilirubinemia."
如何区分生理性黄疸和病理性黄疸？
 How to distinguish between physiological jaundice and pathological jaundice?

生理性黄疸是指，单纯的因胆红素代谢特点引起的暂时性的黄疸，一般是出生在2到3天出现，4到6天达到高峰，然后逐渐消退，14天左右退完。早产儿持续时间较长，除有轻微的食欲不振外，没有其他的临床表现。
Physiological jaundice refers to temporary jaundice caused by bilirubin metabolism. It usually occurs at 2 to 3 days after birth, reaches a peak at 4 to 6 days, and then subsides. Preterm infants last longer and have no clinical manifestations except for a slight loss of appetite.
什么是病理性黄疸？What is pathological jaundice?

简单来说，就是黄疸数值超过正常标准。如果已经超出了安全范围，那么肯定是需要治疗的。
In simple terms, the value of jaundice exceeds normal standards. If it is out of safety, then treatment is definitely needed.
下图截取自中华医学会2014年10月发布的《新生儿高胆红素血症诊断和治疗专家共识》，这也是2004年美国儿科学会推荐的光疗参考标准。
The following figure is taken from the "Consensus of Diagnosis and Treatment of Neonatal Hyperbilirubinemia" released by the Chinese Medical Association in October 2014, which is also the phototherapy reference standard recommended by the American Academy of Pediatrics in 2004.

Note: High-risk factors include: Fetomaternal blood group incompatibility (e.g., Rh, ABO)、G6PD deficiency，asphyxia, significant lethargy, unstable body temperature, sepsis, metabolic acidosis, and hypoalbuminemia
病理性黄疸可能不容易与生理性黄疸区分开。以下情况提示病理性高胆红素血症，需要进行检查：
A.一般条件
1.出生 24小时内出现黄疸。
2.血清胆红素升高达到需要光疗的水平。
3.血清胆红素水平快速升高超过> 0.5 mg / dL /小时。
4.任何婴儿的潜在疾病迹象（呕吐，嗜睡，喂养不良，体重减轻过多，呼吸暂停，呼吸急促或温度不稳定）。
5.足月婴儿8天后或早产婴儿14天后黄疸持续存在。
NONPHYSIOLOGIC HYPERBILIRUBINEMIA.
Nonphysiologic jaundice may not be easy to distinguish from physiologic jaundice. The following situations suggest nonphysiologic hyperbilirubinemia and require investigation :
A. General conditions
1. Onset of jaundice before 24 hours of age.
2. Any elevation of serum bilirubin that requires phototherapy.
3. A rise in serum bilirubin levels of >0.5 mg/dL/hour.
4. Signs of underlying illness in any infant (vomiting, lethargy, poor feeding, excessive weight loss, apnea, tachypnea, or temperature instability).
5. Jaundice persisting after 8 days in a term infant or after 14 days in a premature infant.

黄疸的随访时间
宝宝出院时间 出院后随访时间
＜1天 生后3天
1-2天 生后4天
2-3天 生后5天

对于某些在48小时之前出院的新生儿，可能需要进行两次随访，第一次随访在24至72小时之间，第二次随访在72至120小时之间。在确定随访结果时应采用临床判断。对于那些具有高胆红素血症危险因素的人，应该提供更早或更频繁的随访，而在间隔较长的时间后，可以发现那些很少或没有危险因素的人。
 

Timing of Follow-up
Infant discharged Should be seen by age
Before age 24 h 72 
Between 24 and 47.9 h 96 h
Between 48 and 72 h 120 h
For some newborns discharged before 48 h, two follow-up visits may be required, the first visit between 24 and 72 h and the second between 72 and 120 h. Clinical judgment should be used in determining follow-up. Earlier or more frequent follow-up should be provided for those who have risk factors for hyperbilirubinemia, whereas those discharged with few or no risk factors can be seen after longer intervals. 
关于黄疸的治疗
1）观察——多吃多拉便便，晒太阳
2）益生菌——调理胃肠功能，促进排便，有利于退黄疸
3）中药熏洗——促进黄疸消退的中药进行泡浴
4）日间光疗——8小时新生儿光疗，适合轻度黄疸
5）住院治疗——适合黄疸明显升高，需住院检查及治疗

MANAGEMENT OF UNCONJUGATED  HYPERBILIRUBINEMIA.
1）Observed——Eat more, increase daily bowel movements and bask in the sun
2）Probiotics——Regulate gastrointestinal function, promote bowel movements
3）Chinese medicine fumigation——Traditional Chinese medicine for jaundice resolution
4）Daylight phototherapy——8 hours phototherapy for newborns, suitable for mild jaundice
5）Inpatient treatment——suitable for marked increase in jaundice, need inpatient examination and treatment

晒太阳的注意事项
1）选择早晨7点左右、傍晚5点左右阳光不太猛烈时
2）需要到户外进行，不能隔着玻璃
3）6个月内阳光不要直接晒到宝宝皮肤上
4）拉开宝宝衣服及包被，多露出胳膊、腿及背部皮肤
5）每次晒20-30分钟，每天1-2次

Sun precautions
1) Choose when the sun is not too intense around 7am and 5pm
2) Need to go outdoors, not through glass
3) Don't directly touch the baby's skin within 6 months when basking in the sun
4) Pull off the baby's clothes and cover, exposing the skin of the arms, legs and back
5) 20-30 minutes each time, 1-2 times a day