Syndrome crigler-Najjar: description, causes, symptoms and treatment

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2018-03-23 06:11:12

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Pretty rare to hear about this disease as a syndrome crigler-Najjar. But, unfortunately, this diagnosis can put one child in a million. It may seem that this is an extremely rare disease, but today, in the age of genetics, mutations are detected very frequently. Let's look at what this disease is and what treatment in this case.

History

I must say that discovered this syndrome fairly recently, in 1952, of the last century. Two pediatricians, kriegler and Nayyar, watching the newborn first described the unusual symptoms of jaundice. Further studies led to the identification of pathology in the liver. Children were greatly elevated indirect bilirubin, which subsequently exerted a toxic effect on the organism as a whole. According to laboratory tests, bilirubin was raised to 765 µmol/l, while he remained in this range throughout the life of a child.

syndrome crigler-Najjar symptoms and treatmentsAfter some time, colleagues have identified similar symptoms in children of more advanced age, but with one peculiarity. Bilirubin was elevated only in 15 times from the norm and for the life decreased to normal. Toxic effects on the body was not. As a result of these observations the disease got its current name: the syndrome of crigler-Najjar, whose description is first made two pediatricians.

Description of the disease

The Syndrome of crigler-Najjar is a genetic disease. Clinic of the disease is reflected in the bright jaundice and severe neurological disorders. Jaundice is detected in the first hours after birth and persists throughout life. Lesions occur equally boys and girls alike. Because yellowness is a manifestation of liver failure, in some patients, the organ increased in size.

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syndrome crigler-Najjar 1 and type 2Signs of CNS occur in infancy, sometimes in the first days of life. They are expressed in muscle tension, involuntary eye twitching, arching my back and spasms. Sick children usually lag behind in mental and physical development. Identifies two types of this disorder. Syndrome crigler-Najjar 1 and type 2 can have different symptoms.

The Symptoms 1 type

Unfortunately, the syndrome, crigler-Najjar type 1 is characterized by a progressive course. The first symptoms appear in the first hours of life. The baby becomes more pronounced yellowness of the whites of the eyes and skin than and different from the usual post-Natal jaundice. He's had it for a few days, and the symptoms are added spasms, involuntary movements of the body and eyes. After a time you may notice a slowing of mental development associated with bilirubinemia encephalopathy.

syndrome crigler-Najjar treatmentThe Indicators of free bilirubin in the analysis are increased to 324—528 µmol/l, in fact, it is 15-50 times. Intoxication of the brain in this case, leads to death within a short time. In exceptional cases, such children survive to school age.

Symptoms of type 2

The First symptoms appear much later than in type 1. The disease can manifest itself in the first years of life. Some children have jaundice is not evident until adolescence, and neurological abnormalities are rare. Symptoms are similar to type 1, but not so heavy. Bilirubin encephalopathy can occur after an infection or severe stress.

syndrome crigler-Najjar descriptionBlood Biochemical parameters in type 2 much lower level of bilirubin of about 200 µmol/l. This figure suggests that the activity of the enzyme glucuronyltransferase less than 20% of normal. Bile has bilirubin-glucuronide. Diagnosis of "Phenobarbital" are positive.

Bilirubin encephalopathy

What a terrible syndrome crigler-Najjar? The symptoms of the disease are manifested in the poisoning of the brain in four phases. In the first phase of toddler behaves apathetically and very sluggish. This is manifested in poor sucking, a relaxed state, a harsh reaction by extraneous sounds. The cry of a baby at the same monotonous, he often spits up and can even open vomiting, his eyes wandering as if he lost something. The breath may be delayed.

The Second phase can last from several days to several months. The child becomes tense, the muscles of the body take an unnatural position, the knob is constantly compressed in a fist, the back is curved arc. A cry from the monotonous turns into a very sharp, lose the sucking reflex and reaction to sounds. Appear cramps, snoring, loss of consciousness.

The Third phase is manifested by a period about improvement. All the previous symptoms will disappear.

The Fourth phase, you may receive 5 months of life and to show clear symptoms of physical and mental retardation. Baby holds her head, does not follow moving objects, does not respond to the voice of the loved ones. He developed seizures, paresis, paralysis. Unfortunately, the poisoning of the brain in type 1 is rapid and the child dies in infancy.

Causes

The Main cause of the disease lies in the genes. They disrupted the process of formation of a specific enzyme,who is responsible for the production of bilirubin. Mostly this disease affects the Asian population. Mutating a gene transmitted in an autosomal recessive manner. In this case both parents of the baby can be carriers of the mutation, but to be healthy. Also can be a carrier of one of the parents, then the probability of disease is 50 to 50%.

syndrome crigler-Najjar disease symptomsHereditary gene mutation leads to the fact that the body is not able to bind free bilirubin with glucuronic acid. And this, in turn, leads to the fact that the free bilirubin poisons the body, penetrating through the blood-brain barrier in infants is not functioning. Poisoning is exposed to the baby's brain, where it accumulates toxic bilirubin.

Treatment

For children diagnosed with the syndrome crigler-Najjar, the treatment is directed on removal from an organism of free bilirubin. It is also important to prevent the development of toxic brain damage.

The treatment uses drugs that increase the activity of uridinediphosphate-glucuronidase, an enzyme, leading to irreversible processes in the liver. This applies to a "Phenobarbital" in dosage to 5 mg per kilogram of body weight per day. It should be noted that it has a positive effect exclusively on the syndrome of crigler-Najjar type 2. In type 1 the body at the "Phenobarbital" practically does not react.

syndrome crigler-Najjar for both types of disease are phototherapy, administered plasma, performed exchange transfusion. All procedures to prepare to perform the liver transplantation for children with type 1 this is the only chance to survive.

Diagnostics

Today, medicine is able to establish the causes of diseases such as the syndrome of crigler-Najjar. The symptoms and methods of treatment described quite a long time, and now using DNA tests to determine genetic predisposition to diseases in utero. After the baby is born DNA diagnostics gives an accurate answer about whether there is mutation in certain genes.

syndrome crigler-Najjar treating the cause of symptomsAlso, when developing jaundice is done to test with "Phenobarbital". The result of the analysis shows the type of the disease.

If you suspect a syndrome crigler-Najjar parents are going medical history and conducted DNA tests to confirm the diagnosis.

Prevention

Preventive measures in the syndrome of crigler-Najjar consist in preventing the appearance of complications.

The syndrome type I is very important to prevent the development bilirubinemia encephalopathy, because it leads to premature death of the patient.

The syndrome of type II prevention is to inform the patient about the circumstances that can provoke exacerbation of the disease. This is a complicating infection, stress, pregnancy, adoption, alcohol and drugs without control of the attending physician. All of this can cause an increase of bilirubin in the blood and cause severe intoxication. In this article it is impossible to describe all the cases because the syndrome crigler-Najjar (treatment, causes, symptoms of which we considered) may occur in children individually.


Article in other languages:

AR: https://tostpost.com/ar/health/11983-syndrome-crigler-najjar-description-causes-symptoms-and-treatment.html

BE: https://tostpost.com/be/zdaro-e/21437-s-ndrom-kriglera-nayyara-ap-sanne-prychyny-s-mptomy-lyachenne.html

DE: https://tostpost.com/de/gesundheit/21445-syndrom-kriglera-najjar-beschreibung-ursachen-symptome-und-behandlung.html

ES: https://tostpost.com/es/la-salud/21464-el-s-ndrome-de-kriglera-nayyara-descripci-n-causas-s-ntomas-y-tratamie.html

HI: https://tostpost.com/hi/health/11993-crigler-najjar.html

JA: https://tostpost.com/ja/health/11994-crigler.html

KK: https://tostpost.com/kk/densauly/21428-sindromy-kriglera-nayyara-sipaty-sebepter-belg-ler-zh-ne-emdeu.html

PL: https://tostpost.com/pl/zdrowie/21392-zesp-kriglera-nayyara-opis-przyczyny-objawy-i-leczenie.html

PT: https://tostpost.com/pt/sa-de/21395-a-s-ndrome-de-kriglera-nayyara-descri-o-causas-sintomas-e-tratamento.html

TR: https://tostpost.com/tr/sa-l-k/21436-sendromu-kriglera-nayyara-tan-m-nedenleri-belirtileri-ve-tedavisi.html

UK: https://tostpost.com/uk/zdorov-ya/21417-sindrom-kriglera-nayyara-opis-prichini-simptomi-l-kuvannya.html

ZH: https://tostpost.com/zh/health/12739-crigler.html






Alin Trodden - author of the article, editor
"Hi, I'm Alin Trodden. I write texts, read books, and look for impressions. And I'm not bad at telling you about it. I am always happy to participate in interesting projects."

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