新生儿黄疸ppt课件

1、Neonatal Jaundice(Hyperbilirubinemia)IntroductionIntroductionBilirubin Metabolism bilirubin circulates bound to albumin in equilibrium with its unbound or free fractionthe unbound fraction that readily crosses the blood-brain barrier and results in neurotoxicityBilirubin Metabolism“enterohepatic cir

2、culation: b-glucuronidase in the gut hydrolysis the conjugated bilirubin into unconjugated bilirubin, and reabsorbed into liverCharacteristics of Neonatal Bilirubin Metabolism lower in gut bacteria; higher b-glucuronidase activity“Physiological Jaundice(Term 12mg/dl, or term13, preterm250Cephalocaud

3、al Progression of JaundiceClinical Investigation Total SBR conjugated SBR full blood count - may reveal spherocytes or septic Group & Direct Coombs test hemolytic jaundice high TSH & low T4 - suspect thyroid disease G6PD screen - male and appropriate ethnic group sepsis screen if indicated g

4、alactosaemiaRhesus isoimmunisation Rh antigen: C, D, E, c, d, e most common type is RhD Rh (-) refers to D- Rare in un-transfused 1st pregnancy In severe cases fetal anaemia develops, causing congestive cardiac failure (hydrops fetalis) The fetus is protected with placental removal of bilirubin, fol

5、lowing rapidly rising SBR after birth ABO Incompatibility Most often seen in the setting of mother being group O and the baby being groups A or B Milder that Rhesus disease, rarely affects the fetus Jaundice that becomes apparent on day 1 or 2 Diagnosis with blood groups and direct Coombs Test Respo

6、nds well to phototherapy Rarely requires exchange transfusion1/5 for ABO, 1/20 for Rh incompatibility will becoming hemolyticClinical Manifestation Jaundice: within 24h in 77% of Rh, 28% in ABO Anemia Hepatosplenomegaly Bilirubin encephalopathy (Kernicterus) Early (27d): more in preterm, includes hy

7、pertonia, lethargy, feeding difficulty, seizures, 1/3 death, bilirubin staining of the basal gangia Late: Survivors may go on to develop sensorineural hearing loss and cerebral palsy, often with ataxia and choreoathetosis; disorders in eye movement; enamel hypoplasiaDiagnosis Family history: still b

8、irth, abortion, jaundice Parents ABO/Rh typing, antibody Ultrasound for hydrops fetalis Postnatal: jaundice, anemia, neurological symptom Blood type and antibodyDirect Coombs, Antibody release, & Free antibody TestManagement Prenatal: Rh (-), monitoring antibody, bilirubin, etc Terminate pregnan

9、cy when lungs are matured Plasma transfusion to remove antibody Intrauterine blood transfusion Maternal use of phenobarbitone to induce enzymePhototherapy Isomerisation of unconjugated bilirubin Wave length: 427475nm (blue), 510530nm (green) Blue light, green light/day light Protection of eyes/gonad

10、 Invisible water loss Side effects: skin rash, fever, diarrhea Beware of conjugated hyperbilirubinemia (bronze baby)PhototherapyExchange Transfusion Prenatal diagnosed, Hb12 mmol/L/hr (0.75mg/dl) SBR 342 mmol/L (20mg/dl) Preterm/Rh history/Hypoxia/Acidosis/Sepsis For Rh: Rh same as mother, ABO same as infant For ABO: AB/plasma and O/RBS; or type O Volume: 150180ml/kg via umbilical vein catheter Other Intervention Albumin (1g/kg), plasma (25ml) Correct acidosis Phenobarbitone (5mg/kg) to induce enzymes Intravenous immunoglubulin (1g/kg) Prevent