新生儿黄疸诊治概要课件.pptVIP

新生儿黄疸诊治 yaoyue28@ 参考文献 Paediatrics Child Health 1999;4(2):161-164Reference No. FN98-02 Revision in progress May 2007 Paediatrics Child Health 2007;12(5): 1B-12BReference No. FN07-02 Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants Hyperbilirubinemia is very common and usually benign in the term newborn infant and the late preterm infant at 35 to 36 completed weeks. Critical hyperbilirubinemia is uncommon but has the potential for causing long-term neurological impairment. Early discharge of the healthy newborn infant, particularly those in whom breastfeeding may not be fully established, may be associated with delayed diagnosis of significant hyperbilirubinemia. 胆红素水平与胆红素脑病发生 It is estimated that 60% of term newborns develop jaundice and 2% reach a TSB concentration greater than 340 μmol/L(19.8mg/dl). Acute encephalopathy does not occur in full-term infants whose peak TSB concentration remains below 340 μmol/L and is very rare unless the peak TSB concentration exceeds 425 μmol/L (24.85mg/dl) . Above this level, the risk for toxicity progressively increases. More than three-quarters of the infants in the United States kernicterus registry (between 1992 and 2002) had a TSB concentration of 515 μmol/L(30.1mg/dl) or greater, and two-thirds had a concentration exceeding 600 μmol/L(35mg/dl). Even with concentrations greater than 500 μmol/L(29.2mg/dl), there are still some infants who will escape encephalopathy. Kernicterus （核黄疸）:the pathological finding of deep-yellow staining of neurons and neuronal necrosis of the basal ganglia（基底节） and brainstem nuclei（脑干神经元）. Acute bilirubin encephalopathy（急性胆红素脑病） :a clinical syndrome, in the presence of severe hyperbilirubinemia, of lethargy （昏睡）, hypotoniaand（肌张力减低） poor suck, which may progress to hypertonia (with opisthotonos（角弓反张） and retrocollis（颈后倾）) with a high-pitched cry and fever, and eventually