新生儿黄疸(英文).ppt
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1、Neonatal Jaundice,(Hyperbilirubinemia),Introduction,All babies develop elevated serum bilirubin (SBR) levels, to a greater or lesser degree, in the first week of life. This is due to: increased production (accelerated RBC breakdown); decreased removal (liver enzyme insufficiency) Increased reabsorpt
2、ion (enterohepatic circulation).,Introduction,60% of infants become clinically jaundiced in 1st wk Bili levels peak at 35 days in full term infants 1/6 of formula fed infants have bili levels over 12 1/3 of breast fed infants have bili levels over 12 Over 80% of all infants with bili levels12.9 mg/d
3、l in the first four days of life are breast fed,Bilirubin Metabolism,derived from the catabolism of proteins that contain heme the most important source is the breakdown of Hb from RBC native bilirubin is relatively insoluble in water at physiologic pH, but it is very lipid soluble bilirubin circula
4、tes bound to albumin in equilibrium with its unbound or “free“ fraction the unbound fraction that readily crosses the blood-brain barrier and results in neurotoxicity,Bilirubin Metabolism,Bilirubin is made more water-soluble in the liver by conjugation with glucuronic acid to form “conjugated“ or “d
5、irect-reacting“ bilirubin, then cleared through the bile into the intestines and out through the feces. Phototherapy works by producing photoisomers of bilirubin that are more water soluble, and that can be cleared directly in bile or urine without conjugation in the liver. “enterohepatic circulatio
6、n”: b-glucuronidase in the gut hydrolysis the conjugated bilirubin into unconjugated bilirubin, and reabsorbed into liver,Characteristics of Neonatal Bilirubin Metabolism,Increased bilirubin production 8.8mg/kg daily vs 3.8mg/kg in adults Insufficiency of bilirubin transportation acidosis, hypoalbum
7、inemia Immature of liver function lower ingestion (y, z protein); lower UDPGT activity Increased “enterohepatic circulation” lower in gut bacteria; higher b-glucuronidase activity,“Physiological” Jaundice,Seen in 60% of term infants and over 80% of preterm Serum values reaches maximum at 6mg/dl on 4
8、5d in term and 1012mg/dl on 57d in premature infants Jaundice declines gradually, reaching normal values within 2 wks in term, and 34w (12m) in preterm Causes no damage in term infants Up limit for abnormal? Undefined (Term 12mg/dl, or term13, preterm15mg/dl),Factors likely to make “physiological ja
9、undice” 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: SBR1215mg/dl, or 5mg/dl/day Sustained jaundice (term2w, pret
10、erm4w ) Recurrence of jaundice Increased serum conjugated bilirubin (1.52mg/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-anti
11、trypsin, CF Drugs induced: Vitamin K3, K4,Breast Milk Jaundice,Occurs infrequently (1%), peaks in 23wk, 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 stopp
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