新生儿黄疸诊治课件

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1、新生儿黄疸诊治yaoyue28@sina.comPaediatrics&ChildHealth1999;4(2):161-164ReferenceNo.FN98-02RevisioninprogressMay2007Paediatrics&ChildHealth2007;12(5):1B-12BReferenceNo.FN07-02Guidelinesfordetection,managementandpreventionofhyperbilirubinemiaintermandlatepretermne

2、wborninfants参考文献Hyperbilirubinemiaisverycommonandusuallybenigninthetermnewborninfantandthelatepreterminfantat35to36completedweeks.Criticalhyperbilirubinemiaisuncommonbuthasthepotentialforcausinglong-termneurologicalimpairment.Earlydischargeofthehealthynewbo

3、rninfant,particularlythoseinwhombreastfeedingmaynotbefullyestablished,maybeassociatedwithdelayeddiagnosisofsignificanthyperbilirubinemia.高胆红素血症很常见，多为良性。危险的高胆红素血症并不常见，但是有潜在的导致长期神经损害的可能。胆红素水平与胆红素脑病发生Itisestimatedthat60%oftermnewbornsdevelopjaundiceand2%reacha

4、TSBconcentrationgreaterthan340μmol/L(19.8mg/dl).Acuteencephalopathydoesnotoccurinfull-terminfantswhosepeakTSBconcentrationremainsbelow340μmol/LandisveryrareunlessthepeakTSBconcentrationexceeds425μmol/L(24.85mg/dl).Abovethislevel,theriskfortoxicityprogressiv

5、elyincreases.Morethanthree-quartersoftheinfantsintheUnitedStateskernicterusregistry(between1992and2002)hadaTSBconcentrationof515μmol/L(30.1mg/dl)orgreater,andtwo-thirdshadaconcentrationexceeding600μmol/L(35mg/dl).Evenwithconcentrationsgreaterthan500μmol/L(2

6、9.2mg/dl),therearestillsomeinfantswhowillescapeencephalopathy.Kernicterus（核黄疸）:thepathologicalfindingofdeep-yellowstainingofneuronsandneuronalnecrosisofthebasalganglia（基底节）andbrainstemnuclei（脑干神经元）.Acutebilirubinencephalopathy（急性胆红素脑病）:aclinicalsyndrome,int

7、hepresenceofseverehyperbilirubinemia,oflethargy（昏睡）,hypotoniaand（肌张力减低）poorsuck,whichmayprogresstohypertonia(withopisthotonos（角弓反张）andretrocollis（颈后倾）)withahigh-pitchedcryandfever,andeventuallytoseizures（发作）andcoma.Chronicbilirubinencephalopathy（慢性胆红素脑病）:th

8、eclinicalsequelaeofacuteencephalopathywithathetoidcerebralpalsy（手足徐动症样大脑麻痹）withorwithoutseizures,developmentaldelay,hearingdeficit,oculomotor（眼球运动异常）disturbances,dentaldysplasia（牙发育异常）andmentaldeficien