新生儿黄疸（Neonatal Jaundice）课件.pptVIP

2. Exchange Transfusions: a. Severe hemolytic disease b. Refractory to phototherapy Treatments continued Aims of transfusions: a. Remove antibodies b. Remove bilirubin c. Correct anemia Treatments continued Indication of transfusions: one of the follows 20mg/dl (340 μmol/L) 4mg/dl,Hgb120g/L, edema 0.7mg/dl/h Kernicterus Treatments continued Source of the blood mother newborns For Rh: Rh ABO incompatibility For ABO: “AB” plasma “O” cells incompatibility packed RBC Treatments exchange transfusions Potential complications: a. Infection b. Necrotizing enterocolitis NEC c. Thromboembolic complications Treatments exchange transfusions 3. Pharmacological agents: a. Phenobarbital Effects: Uptake, Conjugation Excretion b. Albumin c. IVIG Treatments continued Preventions For ABO incompatibility: No For Rh incompatibility 300 μg of human anti-D globulin within 72 h of delivery. 1.Unconjugated bilirubinemia: a. Hemolytic diseases: ABO, Rh incompatibility b. G-6-PD deficiency; c. Breast milk jaundice 1.Unconjugated bilirubinemia: b. G-6-PD deficiency; male, jaundice, enzyme activity c. Breast milk jaundice causes: unclear, ?-glucuronidase follows physiologic jaundice: 4-7 d breast feeding persist for several weeks. Conjugated bilirubinemia: 2.Conjugated bilirubinemia: a. neonatal hepatitis b. biliary obstruction (cholestatic jaundice) biliary atresia, common bile duct stenosis c. congenital metabolic diseases α-1 antitrypsin deficiency Case analysis : 24 old male infant, gravida1,para 1. Apgar scores: 8 at 1 min Mother: blood type “O” PE: icterus appeared on face and trunk skin liver edge 1cm palpable spleen tip Case analysis continued Lab tests: Hgb:13g/dl, reticulocyte