临床医学新生儿黄疸课件

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1、NeonatalHyperbilirubinemia新生儿高胆红素血症NeonatalJaundice新生儿黄疸RBCHbBilirubin(胆红素)Freebilirubin(游离胆红素)bilirubinmetabolismUnconjugatedbilirubin(未结合胆红素)Transport,UptakeConjugateConjugatedbilirubin(结合胆红素)ExcretionNeonatalbilirubinmetabolism1.Increasedbilirubinloadonlivercella.IncreasedRBCvolumeb.DecreasedR

2、BCsurvivalc.Increasedearly-labeledbilirubind.IncreasedenterohepaticcirculationofbilirubinNeonatalbilirubinmetabolism(Contd.)2.Defectivehepaticuptakeofbilirubinfromplasmaa.Decreasedligandin(YandZprotein)b.BindingofligandinbyotheranionsNeonatalbilirubinmetabolism(Contd.)3.Defectivebilirubinconjugat

3、iona.Decreaseduridinediphosphateglucuronyltransferase(UDPG-T)activity葡萄糖醛酸转移酶b.Increaseduridinediphosphoglucosedehydrogenenase(-glucuronidase)activityNeonatalbilirubinmetabolism(Contd.)4.DecreasedexcretionofbilirubinSummary:IncreasedbilirubinproductionDecreasedclearanceofbilirubinPhysiologicJaun

4、diceOnsetofjaundice:2-3daysofageThetimeofpeaklevel:4-6daysofageTheresolvingtime:Fullterm:2weeksofagePreterm:3-4weeksofageLeveloftotalserumbilirubin:<12mg/dLLevelofconjugatedbilirubin:<1.5mg/dLPhysicalJaundiceinFullTermInfantNonphysiologicJaundiceOnsetofjaundice:before24hoursofageAnyelevationofser

5、umbilirubinthatrequiresphototherapyAriseofserumbilirubinlevelsofover5mg/dL/daySignsofunderlyingillnessPersistjaundiceCausesandClinicalFeaturesUnconjugatedhyperbilirubinemiaFetomaternalbloodgroupincompatibilityInfectionBreastjaundice(母乳性黄疸)DelayedmeconiumpassageOthers:asphyxia,hemorrhage,polycythe

6、mia(红细胞增多症)CausesandClinicalFeaturesConjugatedHyperbilirubinemiaHepatitisObstructivedisordersMetabolicandendocrineconditionCholestasis(胆汁淤积)BreastfeedingandJaundice母乳性黄疸Breast-milkjaundice1.Lateonsetbyday5-7oflife2.Risetopeaklevelby2weeksofage3.Bilirubinfallrapidlyifstopbreastfeeding4.Ruleoutpath

7、ologicalcondition5.MechanismisunknownBreastfeedingandJaundiceBreastfeedingjaundiceEarlyonsetHighbilirubinlevelsafter3daysoflifeRelatedtoadecreasedintakeofmilkBilirubinEncephalopathy胆红素脑病Kernicterus(核黄疸)Cellulartoxicity