重庆医科大学儿科学精品课程《新生儿与新生儿疾病》课件：新生儿黄疸（英文）.pptVIP

Neonatal Jaundice Neonatal Ward Dr. Ziyu Hua * * Classification of neonatal jaundice Physiological jaundice Pathological jaundice Etiology of physiological jaundice In the first few days after birth, haemoglobulin concentration falls rapidly. Red cell life span of newborn infants is 70 days which is much shorter than that of adults(120 days). Hepatic bilirubin metabolism is less efficiency. Jaundice is important as A sign of another disorder, e.g. infection, hemolysis Kernicterus: a severe complication of neonatal jaundice, indirect bilirubin (UB) deposited in the brain (basal ganglia). Warning There are no bilirubin levels which are known to be safe or which will definitely cause kernicterus. Infants who experience severe hypoxia, hypothermia or any serious illness may be susceptible to damage from hyperbilirubinemia. Severity of jaundice The jaundice starts on the head and face, spreads down the trunk and limbs. How to measure: Observation by eye: blanching the skin Transcutaneous jaundice meter Blood sample: minibilirubin meter Gestation Preterm infants may be damaged by a lower bilirubin level than term infants. Age from birth is important, higher tolerance with increasing age. Rate of change Rate of rise tends to be linear until reaching plateau. Rapid rise with increasing harm. Serial measurement of serum bilirubin, suitable intervention when necessary. Etiology of pathological jaundice Age of onset is a useful guide to likely cause of jaundice. Within 24 hrs During 24 hrs to 2 wks After 2 wks Jaundice within 24 hrs of age Hemolytic disorders: UB, rise rapidly, high level Rhesus hemolytic disease: jaundice, anemia, hydrops, hepatosplenomegaly; antenatal identify, fetal therapy. ABO incompatibility: less severe, more common, slight or without anemia, peak in the first 12—72hrs. G6PD deficiency: epidemiology; some drugs, infection, hypoxia. Jaundice within 24 hrs of age Hemolytic disorders Spherocytosis: less common, family history; spherocytes found on