NEONATAL JAUNDICE，新生儿黄疸.pptVIP

NEONATAL JAUNDICE General Consideration Jaundice is a common neonatal problem. About 65 percent of newborns develop clinical jaundice with a bilirubin level above 5 mg/dl during the first week of life. Bilirubin Unconjugated bilirubin connects with albumin (reversiby bound)---”indirect” conjugated bilirubin ---”direct” Unconjugated bilirubin (free) Delta bilirubin Metabolism of Bilirubin Characteristics of Neonatal Bilirubin Metabolism Characteristics of Neonatal Bilirubin Metabolism 1.Increased bilirubin production. The level of RBC count is very high in fetus. The destruction of erythrocytes increase in newborn. lifetime of RBC is short. Characteristics of Neonatal Bilirubin Metabolism 2.The ability that albumin connects with bilirubin is deficiency Bilirubin is carried bound to albumin to the liver. The amount of serum albumin is low in premature. Acidosis interfere with the connection. Characteristics of Neonatal Bilirubin Metabolism 3.Defect of the metabolism of bilirubin in liver. The activity of enzyme uridyldiphosphoglucuronyl (UDPGT) is deficiency. The amount of protein Y、 Z is not enough. The ability of hepatocyte excretion is deficiency. Characteristics of Neonatal Bilirubin Metabolism . 4.The characteristics of enterohepatic circulation of bilirubin . In the absence of gut flora and with slow intestinal motility, the conjugated bilirubin remains in the intestinal lumen. Characteristics of Neonatal Bilirubin Metabolism 4.The characteristics of enterohepatic circulation of bilirubin . β-glucuronidase (mucosal enzyme) can cleave off the glucuronide molecules, leaving unconjugated bilirubin to be reabsorbed. Neonatal jaundice Neonatal jaundice may be divided into two groups: Physiologic jaundice; pathologic jaudice. Physiologic Jaundice Physiologic Jaundice 2. The serum bilirubin level: 12mg/dl (205μmol/L)in full- term infants . 15 mg/dl (256.5μmol/L) in preterm infants.