《儿科学》Neonatal Jaundice.pptVIP

Neonatal Jaundice Li weizhong Introduction Neonatal Jaundice is known as the visible clinical manifestation of dying skin and sclera yellow during the neonatal period, resulting from deposition of bilirubin in the neonatal bodies. Introduction Jaundice is observed during the 1st wk in approximately 60% of term infant and 80% of preterm infant. Hyperbilirubinemia can be toxic, with high levels resulting in an encephalopathy known as kerni-cterus. Metabolism of Bilirubin Increased bilirubin production Less effective binding and transportation Less efficient hepatic conjugation Enhanced absorption of bilirubin via the enterohepatic circulation Clinical Manifestation Jaundice may be present at birth or at any time during the neonatal period. Jaundice usually begins on the face and, as the serum level increases, progresses to the chest and abdomen and then the feet. Jaundice resulting from deposition of indirect bilirubin in the skin tends to appear bright yellow or orange; jaundice of the obstructive type (direct bilibrubin), a greenish or muddy yellow. Methods of Diagnosis A complete diagnostic evaluation Determination of direct and indicrect bilirubin fractions Determination of hemoglobin Reticulocyte count Blood type Coombs’ test Examination of the peripheral blood smear Classifications Direct-reacting hyperbilirubinemia Hepatitis Cholestasis Inborn errors of metabolism Sepsis Classifications Indirect-reacting hyperbilirubinemia Hemolysis Reticulocytosis Evidences of red blood cell destruction A positive Coomb’s test Blood group incompatibility Positive results of specific examination Classifications Direct and indirect- reactin hyperbilirubinemia Hepatitis Sepsis Liver damage complicated by Hemolysis Classifications Physiologic jaundice Clinical jaundice appears at 2-3 days. Total bilirubin rises by less than 5 mg/dl (86 umol/L) per day. Peak bilirubin occurs at 3-5 days of age. Peak bilirubin concentration in Full-