新生儿黄疸-05级八年一贯制.pptVIP

NeonatologyNeonatal Jaundice Contents Billirubin metabolism in normal neonates Special problems in neonates The diseases in relation with Neonatal Jaundice Dangerous of the Hyperbillirubinemia Specificity of Billirubin Metabolism in newborns Increased bilirubin formation Excesive RBCs after birth Shorter half life of fetal hemoglobin Heme oxygenase? Increased bilirubin originated from bypass Specificity of Billirubin Metabolism in newborns Insufficient in transiting bilirubin albumin linking/transporting bilirubin ? Specificity of Billirubin Metabolism in newborns Insufficient in treating bilirubin by liver Y. Z protein ? Hepatic Enzyme under developed Activity of hepatic enzyme easily being undermined Serums glucose rapidly ? Specificity of Billirubin Metabolism in newborns Load of hepatoenteral circulation ? Intestine flora ? Activity ofβ-Glucuronidase within mesocaval ? High quantity of bilirubin in meconium Physiological Jaundice Pathological Jaundice Presenting earlier, 24-48 h after birth Higher Serum Billirubin level TBI 12mg/dl increasing rapidly, 5mg/dl/d Longer duration: Term:2 w preterm:4 w Persistently progressing, or re-presence after disappearing Etiology of Pathological Jaundice Unconjugated Hemolytic Disease of the Newborn alloimmune hemolytic (ABO and Rh types) deformity of RBC RBC Enzyme deficiency Extravascular Hemolysis Breastfeeding Jaundice Erythrocytosis Etiology of Pathological Jaundice Conjugated Neonatal Hepatic diseases Congenital bile duct disorders Congenital metabolic disorders Etiology of Pathological Jaundice Mixed by Unconjugated with Conjugated Infectious Hemolytic disease of newborn ABO type incompatability alloimmune hemolytic disease 50% happened in first pregnancy 20％ ABO type incompatability，incidence 10％ majority maternal type O and infant type A or B RH type incompatability alloimmune hemolytic disease No Occurrence in first pregnancy, except the one had history of abortion and transfusion Antigenic: D