新生儿黄疸（英文）.pptVIP

Factors likely to make “physiological jaundice” worse prematurity bruising cephalohematoma polycythaemia delayed passage of meconium breast feeding certain ethnic groups, esp Chinese Characteristics of Pathological Jaundice Jaundice appears within 24 hrs of life Severe jaundice: SBR12~15mg/dl, or 5mg/dl/day Sustained jaundice (term2w, preterm4w ) Recurrence of jaundice Increased serum conjugated bilirubin (1.5~2mg/dl) Pathological Jaundice Infectious diseases Neonatal hepatitis (Torch infection) Neonatal septicemia Non-infectious diseases Hemolytic diseases Biliary atresia Breast milk jaundice Genetic metabolic diseases: G6PD, a1-antitrypsin, CF Drugs induced: Vitamin K3, K4 Breast Milk Jaundice Occurs infrequently (1%), peaks in 2~3wk, may persist at moderately high levels for 3-4 weeks before declining slowly It is a diagnosis of exclusion In an otherwise well infant, it is considered a benign condition. If breast feeding stopped, the serum bilirubin usually falls The potential harms of stopping breast feeding would outweigh any risks of a mild or moderate hyperbilirubinaemia Aetiology is unknown, some hormonal in the milk may acting on the infants hepatic metabolism, or enzyme (lipase) facilitating intestinal absorption of bilirubin. Breast-feeding Jaundice increased bilirubin levels seen during the first week of life in infants who are breast fed due to both caloric deprivation (mostly) and some fluid deprivation (a small part) during the first few days of life The more frequently breast feeding occurs during the first few days, the lower are subsequent bili levels can be prevented by teaching effective breast-feeding practices and support policies Clinical Investigation: Kramers Rule Zone 1 2 3 4 5 SBR (mmol/L) 100 150 200 250 250 Cephalocaudal Progression of Jaundice Clinical Investigation Total SBR conjugated SBR full blood count - may reveal spherocytes or septic Group Direct Coombs test –hemolytic jaundice high TSH low T