新生儿胆红素代谢特点(The Metabolic Characteristics of Bilirubin in Newborns).ppt

* The Metabolic Characteristics of Bilirubin in Newborns Wu jinlin Department of Pediatrics West China Second University Hospital Sichuan University Baby on Phototherapy Introduction of Neonatal Jaundice Jaundice is quite common in neonatal period [1] 60% of term infants and 80% of preterm infants [2] Visible jaundice from sclera, mucosa and skin Introduction of Neonatal Jaundice Can cause serious consequences [1] Actue phase respiratory failure bilirubin encephalopathy neonatal death [2] lifelong neurologic sequelae— kernicterus cerebral palsy epilepsy mental retardation auditory and visual  disfunctions Why jaundice is so prevalent in neonatal period ??? The Metabolic Characteristics of Bilirubin in Newborns Normal Bilirubin Metabolism YZ protein UDPGT β-glucuronidase Albumin shunt  bilirubin Enterohepatic  Circulation What’s the distinct metabolic characteristics of bilirubin in newborns comparing with our adults? 1. Increased bilirubin production in newborns 2. Insufficient binding between bilirubin and albumin 3. Deficient bilirubin conjugation in the hepatocyte 4. Increased enterohepatic circulation of bilirubin Neonatal Bilirubin Metabolism 5. Others (1) Increased oxygen partial pressure 1. Increased bilirubin production PO2 PO2 RBC RBC bilirubin [1] Life span of RBC Preterm: ﹤70 days Term: 80 days Adult: 120 days [2] Turnover rate of neonatal hemoglobin: 2 times faster than that of adults (2) Short survival of neonatal erythrocyte 1. Increased bilirubin production (3) Over production of shunt bilirubin 1. Increased bilirubin production heme bone marrow precusor shunt bilirubin 1. Increased bilirubin production in newborns 2.Insufficient binding between bilirubin and albumin 3. Deficient bilirubin conjugation in the hepatocyte 4. Increased enterohepatic circulation of bilirubin Neonatal Bilirubin Metabolism 5. Others 2. Insufficient Binding between Bilirubin and A