新生儿黄疸(Neonatal-Jaundice)课件.ppt
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- 新生儿 黄疸 Neonatal Jaundice 课件
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1、Neonatal JaundiceDezhi Mu MD/PhDDepartment of Pediatrics, West China Second University Hospital, Sichuan UniversityIntroduction Jaundice is quite common (5mg/dl). Full term infants: at least 50% Preterm infants: over 80% Elevated blood bilirubin levels: 97%Introduction continued When? in the first w
2、eek of life Where? skin , mucosa and white of eye How many? blood bilirubin concentrations is 5-7mg/dl. Introduction continued Producing Excreting Why Jaundice occurred?Bilirubin Metabolism:1. RBC: Heme bilirubin (UCB) 2. Blood: carried by bound to albumin3. Liver: uptaken : Y protein, Z protein con
3、jugated: UDPGT excreted: to the biliary system 4. Intestine: stercobilins -glucuronidase enterohepatic circulationThe metabolic characteristics of bilirubin in newborns: 1. Bilirubin production 8.8mg/Kg/d in newborns3.8mg/Kg/d in adults 2. Bilirubin-albumin complex formation a. preterm infant; b. ac
4、idosis 3. Bilirubin metabolism of hepatocyte a. Hepatic uptake of bilirubin b. Bilirubin conjugation: UDPGT (uridine diphosphate glucoronyl transferase) c. Defective bilirubin excretion ability to bile system 4. Enterohepatic circulation The metabolic characteristics of bilirubin continuedBilirubin
5、toxicity 1. Conjugated bilirubin water-soluble 2. Unconjugated bilirubin lipid-soluble bilirubin-encephalopathy (kernicterus)Clinical Manifestations Jaundice appears When: at any time during the neonatal period Where: from face chest abdomen feetEvaluation of jaundice :1. By eyes: face, 5mg/dl ( 85m
6、ol/L ); abdomen, 10-15mg/dl; feet, 15-20mg/dl ;2. By transcutaneous measurement : used for screening3. By serum levels : standardManifestations continue Classification: Physiological Jaundice Pathological Jaundice Manifestations continue Physiological jaundice : 1. General state is well 2. Appears 2
7、-3days (24h of age) peaks 12.9mg/dl (full term infants) 15mg/dl (preterm infants) fades 2 week (term infants) 4 weeks (preterm infants) 3. Accumulates 5mg/dl/d 4. Direct bilirubin 12.9mg/dl (full term infants) 15mg/dl (preterm infants) Fades 2 weeks (term infants) 4 weeks (preterm infants)3. Accumul
8、ates 5mg/dl/d4. Direct bilirubin 2mg/dl5.Jaundice recurrent Manifestations continueCommon causes of pathological jaundice1. Unconjugated bilirubinemia: a. hemolytic diseases: ABO, Rh incompatibility b. G-6-PD deficiency; c. Breast milk jaundice 2. Conjugated bilirubinemia: a. Neonatal hepatitisb. Bi
9、liary obstruction (cholestatic jaundice) biliary atresia, common bile duct stenosis c. Congenital metabolic diseases -1 antitrypsin deficiencyCauses of pathological jaundice continueHemolytic disease of newbornHemolytic disease: ABO: 85.3%Rh : 14.6%MN : 0.1% Hemolytic disease of newborn continuedABO
10、 incompatibility the mother: type O the infant: type A or B Rh incompatibility the mother: Rh(-) the infant: Rh(+)D,E,C,d,e,cPathogenesisPathophysiologyRed blood cell breakdownHyperbilirubinemiaJaundiceKernicterus Seizures etc.Anemia1. Liver 2. Spleen3. Heart, other organs4. Hydrops Clinical Manifes
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