儿科教学课件：NEONATAL JAUNDICE.ppt

* * * * * * * * * * * * * * * * * * * * * * NEONATAL JAUNDICE ZHENLANG LIN YUYING CHILDREN’S HOSPITAL WENZHOU MEDICAL COLLEGE is a common finding in the majority of newborn infants. An elevation of serum bilirubin concentration >2mg/dl is found in most newborns. Sixty-five percent of newborns are clinically jaundiced. Neonatal Jaundice 胆红素代谢特点 肝脾网状 内皮C 血红素铁和 珠蛋白 胆绿素 胆红素 肝C 结合胆红素 肠道 大量排出 少量肠肝循环 衰老红C 血红素 加氧酶 Y、Z 蛋白 G醛酸转移酶 4 尿胆原 粪胆原 G醛酸甘酶 Mechanisms Increased bilirubin load 8.8mg/kg (3.8) Defective uptake of bilirubin by the liver 5-10d Defective conjugation 1 week Impared excretion into bile Increased enterohepatic circulation Physiologic Jaundice Full-term infant. Serum bilirubin progressively rise to a mean peak of 5mg/ dl by the third day of life and a peak of 12.9mg /dl at 4-5 days, and resolves spontaneously during the second week of life. Preterm neonates. 15mg/dl ,3-4 week. Pathologic jaundice Bilirubin level >12.9mg/dl in the term infant or > 15mg/dl in the preterm infant Bilirubin level increasing at a rate >5mg/dl/d Jaundice in the first 24h of life Conjugated bilirubin level >1.5- 2mg/dl Clinical jaundice persisting > 2 week in full-term infants or >4 week in preterm infants Jaundice appears again after it has resolved Causes of hyperbilirubin Hapatitis HBsAg, TORCH(toxoplsmosis, other, rubella, cytomegelovirus,herpes simplex virus Sepsis Hemolytic disease of the newborn Billary atresia Breast milk jaundice Increased enterohepatic circulation Cause of hyperbilirubin Red blood cell defects G6PD Metabolic disorders Galactosemia,hypothyroidism Substances and disorders affecting binding of bilirubin to albumin aspirin, sulfonamides,fatty acids, asphxia, acidosis, hypothermia, hyperosmolality and hypoglycemia Encephalopathy Transient Early bilirubin-induced neurologic dysfunction is transient and