黄疸

1,新生儿疾病（二）,湘雅医院儿科王庆红,2,新生儿疾病（二）,新生儿黄疸新生儿溶血病新生儿肺透明膜病,新生儿败血症新生儿寒冷损伤综合征新生儿肺炎,3,新生儿黄疸,新生儿黄疸NEONATAL JAUNDICE,Hyperbilirubinemia or Jaundice of Newborn,4,新生儿黄疸NEONATAL JAUNDICE,5,Adult,jaundice,pathological,Newborn,？,新生儿黄疸NEONATAL JAUNDICE,新生儿黄疸NEONATAL JAUNDICE,60% fullterm baby80% preterm baby,6,新生儿为什么易发生黄疸？ special metabolism of bilirubin,新生儿黄疸NEONATAL JAUNDICE,新生儿黄疸NEONATAL JAUNDICE,问题1,7,Where does bilirubin come from?,8,Overproduction,每日生成胆红素 8.8 mg/kg ( 成人 3.8 mg/ kg ),THE FEATURES OF NEONATAL BILIRUBIN METABOLISM,Acidosis, low concentration of serum protein.,Lower conveying capability,新生儿黄疸NEONATAL JAUNDICE,9,Defection of liver function,THE FEATURES OF NEONATAL BILIRUBIN METABOLISM,新生儿黄疸NEONATAL JAUNDICE,肝细胞内 Y，Z 蛋白含量低,尿苷二磷酸葡萄糖醛酸基转移酶（UDPGT）活性不足，为正常 30 % 以下,排泄结合胆红素的功能差,10,Increased enterohepatic circulation(肠肝循环增加 ),THE FEATURES OF NEONATAL BILIRUBIN METABOLISM,新生儿黄疸NEONATAL JAUNDICE,11,Jaundice may be normal !,Jaundice of newborn,physiological,pathological,新生儿黄疸NEONATAL JAUNDICE,新生儿黄疸NEONATAL JAUNDICE,问题2,怎样区分病理性和生理性黄疸？,12,新生儿生理黄疸与病理性黄疸鉴别,新生儿黄疸NEONATAL JAUNDICE,13,Causes of pathological jaundice,overproduction,Lower liver function,新生儿黄疸NEONATAL JAUNDICE,新生儿黄疸NEONATAL JAUNDICE,问题3,Obstructive disease,1,2,3,14,overproduction,hemolytic diseasepolycythemiaextravascular hemolysisinfection,15,increased enterohepatic circulationhemoglobin diseaseabnormal membrane of RBC,overproduction,16,Lower liver function,缺氧(hypoxia):窒息(asphyxia)；心力衰竭(heart failure)Crigler-Najjar综合征Gilbert综合征 Lucey-Driscoll综合征药物：磺胺；消炎痛其他：甲状腺功能低下(hypothyroidism)；21-三体综合征( Dawns syndrome),17,胆道闭锁(biliary atresia)新生儿肝炎(hepatitis of newborn)先天性代谢缺陷病（IEM）Dubin-Johnson综合征,Obstructive disease