NEONATAL JAUNDICE新生儿黄疸.ppt

1、NEONATAL JAUNDICE,General Consideration,Jaundice is a common neonatal problem. About 65 percent of newborns develop clinical jaundice with a bilirubin level above 5 mg/dl during the first week of life.,Bilirubin,Unconjugated bilirubin connects with albumin (reversiby bound)-”indirect” conjugated bil

2、irubin -”direct” Unconjugated bilirubin (free) Delta bilirubin,Metabolism of Bilirubin,Characteristics of Neonatal Bilirubin Metabolism,Characteristics of Neonatal Bilirubin Metabolism,1.Increased bilirubin production. The level of RBC count is very high in fetus. The destruction of erythrocytes inc

3、rease in newborn. lifetime of RBC is short.,Characteristics of Neonatal Bilirubin Metabolism,2.The ability that albumin connects with bilirubin is deficiency Bilirubin is carried bound to albumin to the liver. The amount of serum albumin is low in premature. Acidosis interfere with the connection.,C

4、haracteristics of Neonatal Bilirubin Metabolism,3.Defect of the metabolism of bilirubin in liver. The activity of enzyme uridyldiphosphoglucuronyl (UDPGT) is deficiency. The amount of protein Y、 Z is not enough. The ability of hepatocyte excretion is deficiency.,Characteristics of Neonatal Bilirubin

5、 Metabolism,. 4.The characteristics of enterohepatic circulation of bilirubin . In the absence of gut flora and with slow intestinal motility, the conjugated bilirubin remains in the intestinal lumen.,Characteristics of Neonatal Bilirubin Metabolism,4.The characteristics of enterohepatic circulation

6、 of bilirubin . -glucuronidase (mucosal enzyme) can cleave off the glucuronide molecules, leaving unconjugated bilirubin to be reabsorbed.,Neonatal jaundice,Neonatal jaundice may be divided into two groups: Physiologic jaundice; pathologic jaudice.,Physiologic Jaundice,1.Progress,Physiologic Jaundic

7、e,2. The serum bilirubin level: 12mg/dl (205mol/L)in full- term infants . 15 mg/dl (256.5mol/L) in preterm infants. 3. rises at a rate of less than 5 mg/dl/24 hr.(85mol/L/24 hr).,Physiologic Jaundice,4. The conjugated bilirubin level: 2 mg/dl ( 34mol/L). 5. General conditions are well.,Pathologic Ja

8、undice,1.appears in the first 24 hr of life. 2.persists 2 weeks of life in full-term; 4 weeks of life in preterm infants. 3. Serum bilirubin is rising at a rate greater than 5 mg/dl/24 hr (85 mol/L/24hr). 4.Serum bilirubin 12.9mg/dl(221 mol/L )in the full-term or 15 mg/dl (257 mol/L) in preterm infa

9、nts.,Pathologic Jaundice,5. Conjugate bilirubin (direct reacting) is greater than 2 mg/dl ( 34 mol/L). 6. Jaundice occur after it has disappeared.,Hyperbilirubinemia in the Newborn,When serum bilirubin is greater than 5 mg/dl the jaundice may be observed in the newborn. Hyperbilirubinemia may be dis

10、tinguished into two sorts: Unconjugated (indirect) hyperbilirubinemia ;conjugated (direct) hyperbilirubinemia.,Diseases Result In Pathologic Jaundice,Three class: 1.Increased bilirubin production. 2.Metabolism of bilirubin disorder in liver. 3.Icterus acathecticus.,Diseases Result In Pathologic Jaun

11、dice,1.Increased bilirubin production: . Erythrocytosis: RBC61012/L,HGB220g/L,HCT65%. Extra vascular hemolysis. intracranial hemorrhage; cephalic hematoma; pneumorragia ,Diseases Result In Pathologic Jaundice,1.Increased bilirubin production: .Hemolytic disease of newborn（HDN） Isoimmunization hemoly

12、sis: Rh . ABO. Others G-6-PD deficiency.,Diseases Result In Pathologic Jaundice,1.Increased bilirubin production: .infection: bacterial or viral sepsis. Spirochete. Staphylococcus aureus. Bacillus coli .Increased enterohepatic circulation: hunger. Congenital megacolon. .RBC enzyme abnormalities. .Ab

13、normal RBC shapes.,Diseases Result In Pathologic Jaundice,1.Increased bilirubin production: .Hemoglobin disease. .Others: VitE deficiency, hypozincmia.,Diseases Result In Pathologic Jaundice,2.Metabolism of bilirubin disorder in liver. .Hypoxia .Infection. .Crigler-Najjar syndrome. .Gibert syndrome.

14、 .Lucey Driscoll syndrome. .Drugs. .Others:Down syndrome,Diseases Result In Pathologic Jaundice,3.Icterus acathecticus .Neonatal hepatitis. .Congenital metabolic defect. .Dubin-Johnson syndrome. .Obstruction of bile duct.,Hemolytic disease of newborn（HDN）,1.ABO hemolysis: mother “O” infant “A”/ “B”.

15、 occur in the first baby(about40%50%). attack :about 20%,Hemolytic disease of newborn（HDN）,2.Rh hemolysis: Ag: D、 E 、C、 c、 d、 e . DECce mother Rh negative; baby Rh positive. occur in the baby to be not the first baby (about 100%). attack : about 5%.,Hemolytic disease of newborn（HDN）,3.Pathophysiolog

16、y and clinical manifestation : (1)Jaudice 24h (Rh) 23d (ABO) (2) Anemia 06w (3) Hepatosplenomegaly,Hemolytic disease of newborn（HDN）,4.Complication: Bilirubin encephalopathy (Kernicterus),Bilirubin Encephalopathy (Kernicterus),It is a neurologic syndrome resulting from the deposition of unconjugated

17、 bilirubin in brain cells.,Bilirubin Encephalopathy (Kernicterus),Warning period.1224h. Spasm period.1248h. Recovery period.2w. Sequel period.,Hemolytic disease of newborn（HDN）,5.Laboratory examination: Blood group (type) ：ABO and Rh hemolytic reaction: HB6%; total bilirubin; unconjugated bilirubin.

18、 nucleated RBC ,Hemolytic disease of newborn（HDN）,5.Laboratory examination: Antibody of blood group : modified Coombs test Antibody release test free antibody test,Hemolytic disease of newborn（HDN）,6. Diagnosis Prenatal partum: Antibody of the pregnant woman IgG Ab Postnatal partum: Pathologic Jaund

19、ice 24h Blood group Serum bilirubin. Coombs test or antibody release test.,Hemolytic disease of newborn（HDN）,7.Treatment (to neonatal) (1) Phototherapy A to reduce uncojugated bilirubin. B wavelength 450460 nm, Z- E. C side effect: fever, diarrhea, anemia, rash, defect of V it B2 “bronze illness” ,H

20、emolytic disease of newborn,7.Treatment (to neonatal) （2） Medicine treatment: Albumin To treat metabolic acidosis Liver enzyme Immunoglobulin,Hemolytic disease of newborn（HDN）,7.Treatment (to neonatal) （3）Exchange transfusion. A to treat hyperbilirubinemia B in operation room C through umbilicus vessel,Diagnosis Procedure,Jaundice: total bilirubin; conjugated bilirubin.,Diagnosis Procedure,Conjugated bilirubin : septicemia intrauterine infection biliary atresia neonatal hepatitis ,Diagnosis Procedure,Unconjugated bilirubin blood type, Coomb, s test, RBC morphology, reticulocyte.,Diagn