新生儿胆红素代谢特点(The-Metabolic-Characteristics-of-Bilirubin-in-Newborns)课件

TheMetabolicCharacteristicsofBilirubininNewbornsWujinlinDepartmentofPediatricsWestChinaSecondUniversityHospitalSichuanUniversityTheMetabolicCharacteristics1新生儿胆红素代谢特点(The-Metabolic-Characteristics-of-Bilirubin-in-Newborns)课件2

BabyonPhototherapyBabyonPhototherapy3

IntroductionofNeonatalJaundiceJaundiceisquitecommoninneonatalperiod[1]60%ofterminfantsand80%ofpreterminfants[2]Visiblejaundicefromsclera,mucosaandskinIntroductionofNeonatalJaun4

IntroductionofNeonatalJaundiceCancauseseriousconsequences[1]Actuephaserespiratoryfailurebilirubinencephalopathy

neonataldeathIntroductionofNeonatalJau5[2]lifelongneurologicsequelae—kernicterus

cerebralpalsyepilepsy

mentalretardationauditoryandvisual

disfunctions

[2]lifelongneurologicsequel6新生儿胆红素代谢特点(The-Metabolic-Characteristics-of-Bilirubin-in-Newborns)课件7Whyjaundiceissoprevalentinneonatalperiod???TheMetabolicCharacteristicsofBilirubininNewborns

WhyjaundiceissoprevalentT8

NormalBilirubinMetabolism

Y&ZproteinUDPGTβ-glucuronidase

Albumin

shunt

bilirubinEnterohepatic

Circulation

NormalBilirubin9

What’sthedistinctmetaboliccharacteristicsofbilirubininnewbornscomparingwithouradults?

What’sthedistinctmetabolic101.Increasedbilirubinproductioninnewborns2.Insufficientbindingbetweenbilirubinandalbumin

3.Deficientbilirubinconjugationinthehepatocyte

4.IncreasedenterohepaticcirculationofbilirubinNeonatalBilirubinMetabolism5.Others1.Increasedbilirubinproduct11

(1)Increasedoxygenpartialpressure1.Increasedbilirubinproduction

PO2PO2RBCRBCbilirubin(1)Increasedoxygenpartial12[1]LifespanofRBCPreterm:﹤70daysTerm:80daysAdult:120days[2]Turnoverrateofneonatalhemoglobin:

2timesfasterthanthatofadults

(2)Shortsurvivalofneonatalerythrocyte1.Increasedbilirubinproduction[1]LifespanofRBCPreterm:﹤13(3)Overproductionofshuntbilirubin1.Increasedbilirubinproduction

hemebonemarrowprecusorshuntbilirubin(3)Overproductionofshuntb141.Increasedbilirubinproductioninnewborns

2.Insufficientbindingbetweenbilirubinandalbumin

3.Deficientbilirubinconjugationinthehepatocyte

4.IncreasedenterohepaticcirculationofbilirubinNeonatalBilirubinMetabolism5.Others1.Increasedbilirubinproduct152.InsufficientBindingbetweenBilirubinandAlbumin

lowcontentofserumalbumin

GA

albumin

bilirubin-albumincomplex

differentdegreeof

acidosisatbirth

bindingaffinity

BAAAABABBBBBBBBABBBserum2.InsufficientBindingbetwee161.Increasedbilirubinproductioninnewborns

2.Insufficientbindingbetweenbilirubinandalbumin

3.Deficientbilirubinconjugationinthehepatocyte

4.IncreasedenterohepaticcirculationofbilirubinNeonatalBilirubinMetabolism5.Others1.Increasedbilirubinproduct173.DeficientBilirubinConjugationintheHepatocyte

UDPGTreachestheadult’svalues1weekafterbirth

Ycarrierproteinincreasesrapidly5~10dayslaterconjugationofbilirubinwithglucuronicacid

3.DeficientBilirubinConjuga181.Increasedbilirubinproductioninnewborns

2.Insufficientbindingbetweenbilirubinandalbumin

3.Deficientbilirubinconjugationinthehepatocyte

4.IncreasedenterohepaticcirculationofbilirubinNeonatalBilirubinMetabolism5.Others1.Increasedbilirubinproduct194.IncreasedEnterohepaticCirculationofBilirubinintestinalfloraisnotfully

developed

abundantβ-glucuronidasedelayedexcretionofmeconium

4.IncreasedEnterohepaticCir201.Increasedbilirubinproductioninnewborns

2.Insufficientbindingbetweenbilirubinandalbumin

3.Deficientbilirubinconjugationinthehepatocyte

4.IncreasedenterohepaticcirculationofbilirubinNeonatalBilirubinMetabolism5.Others1.Increasedbilirubinproduct215.Othersdehydrationacidosisintracranialhemorrhage……cephalohematomahunger

hypoxia