Phenobarbital用于小儿黄胆的讨论.ppt

Phenobarbital用於小兒黃膽的討論 報告者: 康碧芬 報告日期:94年7月21日 處方: Phenobarbital 在藥理分類上屬於:long-acting barbiturate FDA labeled indications Anticonvulsant, generalized and partial seizures Hypnotic Sedative Seizures Non-FDA labeled indications Antihyperbilirubinemic Jaundice is visible when a baby has a serum bilirubin level that exceeds 5 mg/dl. Generally jaundice is visible first on the head and progresses to the feet. Physiologic Hyperbilirubinemia. -Usually not present in first 24 hours. -Rarely increases by more than 5 mg/dl in 1 day. -Peaks at 48 to 72 hours in full-term infants and 4 to 5 days in the premature ones. Serum bilirubin does not exceed 13 mg/dl in the full-term infant and 15 mg/dl in the preterm infant. Nonphysiologic Hyperbilirubinemia -Infections -From increased production of bilirubin (ex, hemolysis) -delayed excretion of bilirubin (ex, inherited disorders) or prematurity Breast Milk Jaundice. General One in every 200 infants has prolonged unconjugated hyperbilirubinemia. Serum bilirubin may reach maximum concentration (15 to 25 mg/dl) during the second to third week. Etiology is unknown. About half of all newborn infants born at term develop jaundice during their first days of life Newborns develop hyperbilirubinemia because of a large bilirubin production, low hepatic excretion In newborns almost all bilirubin in plasma is unconjugated. Only unconjugated bilirubin is toxic. When plasma bilirubin concentration is very high, the infants can have signs and symptoms of central nervous system In term newborns the hyperbilirubinemia most often culminates on day 3-5 of life, in preterm newborns most often on day 5-7 of life. The reason for this is that the liver function matures and the enterohepatic recirculation decreases. The severity of the jaundice depends on: (I) 1.Gestational age. The lower the gestational age, the more immature the liver and thus the higher the plasma biliru