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1、NEONATALJAUNDICEZHENLANGLINYUYINGCHILDREN’SHOSPITALWENZHOUMEDICALCOLLEGEisacommonfindinginthemajorityofnewborninfants.Anelevationofserumbilirubinconcentration>2mg/dlisfoundinmostnewborns.Sixty-fivepercentofnewbornsareclinicallyjaundiced.NeonatalJaundice胆红素代谢特点肝脾网状内皮C血红素铁和珠蛋白胆绿素胆红素肝C结合胆红素肠道大量排出少量肠肝循环
2、衰老红C血红素加氧酶Y、Z蛋白G醛酸转移酶4尿胆原粪胆原G醛酸甘酶MechanismsIncreasedbilirubinload8.8mg/kg(3.8)Defectiveuptakeofbilirubinbytheliver5-10dDefectiveconjugation1weekImparedexcretionintobileIncreasedenterohepaticcirculationPhysiologicJaundiceFull-terminfant.Serumbilirubinprogressivelyrisetoameanpeakof5mg/dlbythethirddayo
3、flifeandapeakof12.9mg/dlat4-5days,andresolvesspontaneouslyduringthesecondweekoflife.Pretermneonates.15mg/dl,3-4week.PathologicjaundiceBilirubinlevel>12.9mg/dlintheterminfantor>15mg/dlinthepreterminfantBilirubinlevelincreasingatarate>5mg/dl/dJaundiceinthefirst24hoflifeConjugatedbilirubinlevel>1.5-2mg
4、/dlClinicaljaundicepersisting>2weekinfull-terminfantsor>4weekinpreterminfantsJaundiceappearsagainafterithasresolvedCausesofhyperbilirubinHapatitisHBsAg,TORCH(toxoplsmosis,other,rubella,cytomegelovirus,herpessimplexvirusSepsisHemolyticdiseaseofthenewbornBillaryatresiaBreastmilkjaundiceIncreasedentero
5、hepaticcirculationCauseofhyperbilirubinRedbloodcelldefectsG6PDMetabolicdisordersGalactosemia,hypothyroidismSubstancesanddisordersaffectingbindingofbilirubintoalbuminaspirin,sulfonamides,fattyacids,asphxia,acidosis,hypothermia,hyperosmolalityandhypoglycemiaEncephalopathyTransientEarlybilirubin-induce
6、dneurologicdysfunctionistransientandreversibleAuditorybrainstemevokedresponses(ABRs)AnearlypredictorBilirubinencephalopathyBilirubinencephalopathyPhaseⅠPoorsuck,hypotonia,depressedsensoriumPhaseⅡFeverandhypertoniaPhaseⅢHigh-pitchedcry,poorfeeding,andathetosisLong-termsurvivorsChoreoathetoidcerebralp
7、alsy,upwardgazepalsy,sensorineuralhearingloss,mentalretardationImmediatequestionsHowoldistheinfant?Istheinfantbeingbreast-fed?Whatisthefamilyethnicity?ClinicalPresentationHistoryFamilyhistorypreviouss