儿科12级-12级儿科课件-06 neonatal jaundice.pptVIP

Neonatal Jaundice Prof. Jialin Yu 余加林 教授 Dept. of Neonatology, Children’s Hospital of Chongqing Medical University, 400014 讲课内容 新生儿黄疸 概 述 胆红素代谢 新生儿胆红素代谢特点 新生儿黄疸分类 病理性黄疸的分类 新生儿肝炎 新生儿溶血症 发病机制 ABO溶血病 Rh溶血病 临床表现 胆红素脑病 实验室检查 先天性胆道闭锁 母乳性黄疸 遗传性疾病 诊断线索与评估 黄疸的治疗 新生儿败血症 临床表现 实验室检查 治疗 诊断 治疗 病原学 Neonatal jaundice also as hyperbilirubinemia, Within 1 week of age，incident of visibly jaundice：60% in full-term infants， 80% in preterm infants. Introduction Physiological phenomenon Pathologic sign Significance of Jaundice in newborn: It may be a sign of another disorder ,e.g. infection Unconjugated bilirubin can be deposited in the brain, particularly in the basal ganglia, causing kernicterus. May develop into liver cirrhosis if biliary atresia not perform hepatoportoenterostomy in time. METABOLIC PATHWAY OF BILIRUBIN 间接胆红素（游离） 大脑 葡萄糖醛酸基转移酶 胆红素代谢 More bilirubin production : (more bilirubin load for liver）：a newborn produces bilirubin of 6-8mg/kg.d，a adult only 3-4mg/kg.d 1．Excessiver hematoclasis 2．Shorter red cell life span 3. more bypass origin of bilirubin ①      heme protein eg. peroxidase, cytochrome P450 ②      bilirubin prosoma ←ineffective hematopoisis 4. bilirubin-produce-enzyme: high content of haem oxygenase(d1-7） Characteristic of neonatal bilirubin metabolism Not enough transportation：plasma-albumin，or poor bounding Immaturity of liver function ： 1. uptake↓：Y . Z protein↓（d5 -15 reach adult level ） 2. process↓：glucuronyl transferase↓（about 1wk↑，reach adult level at 2wk ） 3. excretion↓：easy to cholestasis Unusual enterohepatic circulation： 1．Normal flora↓，bilirubin inside gut --∥→prophobilinogen （urobinogen，stercobilinogen） 2. β-glucuronidase↑：enterohepatic circulation↑ Characteristic of neonatal bilirubin metabolism Summary of neonatal bilirubin metabolism ↑Bilirubin load Albumin not enough: Defective transport Immaturity of liver enzymes ↑reabsorption of bil