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男婴,20日龄,发现腹胀、皮肤黄染5天入院。患儿G_1P_1足月顺产,Apgar评分10分。入院前5天发现腹胀、皮肤黄染,呼吸用力、烦躁不安。体检:T38.7℃,R58次/分,P164次/分。皮肤、巩膜黄染+,前囟平坦,心肺听诊正常。腰部膨隆、肝肋下5cm,剑突下6cm,脾肋下7Cm,移动性浊音+。实验室检查:血Hb78g/L,WBC17.8×10~9/L,N0.74,E0.02,M0.01,L0.23。血小板数98×10~9/L,网织红细胞0.013。大小便常规正常。肝功能:GPT120u,HBsAg(-),总胆红素119.7mmol/L,一分种胆红素34.2mmol/L。IgG60mg/L,IgA6900mg/L,IgM530mg/L。腹水:红细胞+++,利凡他反应+++,无细菌生长,未找到肿瘤细胞。骨髓穿刺:增生性骨髓象。B超示肝脾肿大,肝门淋巴结肿大。入院诊断:新生儿肝脾肿大待查:(1)新生儿肝炎.
Baby boy, 20 days old, found bloating, skin yellow dye 5 days admission. Children with full-term G_1P_1 birth, Apgar score of 10 points. Found abdominal distension 5 days before admission, yellow skin, breathing force, irritability. Physical examination: T38.7 ℃, R58 times / min, P164 times / min. Skin, yellow sclera +, anterior bland flat, auscultation cardiopulmonary normal. Lumbar bulge, hepatic ribs 5cm, xiphoid 6cm, spleen ribs 7Cm, mobility dullness +. Laboratory tests: blood Hb78g / L, WBC17.8 × 10 ~ 9 / L, N0.74, E0.02, M0.01, L0.23. Platelet count 98 × 10 ~ 9 / L, reticulocyte 0.013. Normal urine normal. Liver function: GPT120u, HBsAg (-), total bilirubin 119.7mmol / L, a sub-bilirubin 34.2mmol / L. IgG 60 mg / L, IgA 6900 mg / L, IgM 530 mg / L. Ascites: erythrocyte +++, ribavirin +++, no bacterial growth, no tumor cells found. Bone marrow puncture: hyperplastic bone marrow. B ultrasound shows hepatosplenomegaly, hilar lymph nodes. Admission diagnosis: neonatal hepatosplenomegaly to be checked: (1) neonatal hepatitis.