新生儿黄疸（英文）课件

1、新生儿黄疸（英文）Neonatal Jaundice(Hyperbilirubinemia)新生儿黄疸（英文）Introduction新生儿黄疸（英文）Introduction新生儿黄疸（英文）Bilirubin Metabolism新生儿黄疸（英文）Bilirubin Metabolism “enterohepatic circulation”: b b-glucuronidase in the gut hydrolysis the conjugated bilirubin into unconjugated bilirubin, and reabsorbed into liver新生儿黄疸

2、（英文）Characteristics of Neonatal Bilirubin Metabolism“enterohepatic circulation” lower in gut bacteria; higher b b-glucuronidase activity新生儿黄疸（英文）“Physiological” Jaundice Up limit for abnormal? Undefined(Term 12mg/dl, or term13, preterm250Cephalocaudal Progression of Jaundice新生儿黄疸（英文）Clinical Investi

3、gation Total SBR conjugated SBR full blood count - may reveal spherocytes or septic Group & Direct Coombs test hemolytic jaundice high TSH & low T4 - suspect thyroid disease G6PD screen - male and appropriate ethnic group sepsis screen if indicated galactosaemia新生儿黄疸（英文）Rhesus isoimmunisatio

4、n Rh antigen: C, D, E, c, d, e most common type is RhD Rh (-) refers to D- Rare in un-transfused 1st pregnancy In severe cases fetal anaemia develops, causing congestive cardiac failure (hydrops fetalis) The fetus is protected with placental removal of bilirubin, following rapidly rising SBR after b

5、irth 新生儿黄疸（英文）ABO Incompatibility Most often seen in the setting of mother being group O and the baby being groups A or B Milder that Rhesus disease, rarely affects the fetus Jaundice that becomes apparent on day 1 or 2 Diagnosis with blood groups and direct Coombs Test Responds well to phototherapy

6、 Rarely requires exchange transfusion1/5 for ABO, 1/20 for Rh incompatibility will becoming hemolytic新生儿黄疸（英文）Clinical Manifestation Jaundice: within 24h in 77% of Rh, 28% in ABO Anemia Hepatosplenomegaly Bilirubin encephalopathy (Kernicterus)Early (27d): more in preterm, includes hypertonia, lethar

7、gy, feeding difficulty, seizures, 1/3 death, bilirubin staining of the basal gangiaLate: Survivors may go on to develop sensorineural hearing loss and cerebral palsy, often with ataxia and choreoathetosis; disorders in eye movement; enamel hypoplasia新生儿黄疸（英文）Diagnosis Family history: still birth, ab

8、ortion, jaundice Parents ABO/Rh typing, antibody Ultrasound for hydrops fetalis Postnatal: jaundice, anemia, neurological symptom Blood type and antibodyDirect Coombs, Antibody release, & Free antibody Test新生儿黄疸（英文）Management Prenatal: Rh (-), monitoring antibody, bilirubin, etcTerminate pregnan

9、cy when lungs are maturedPlasma transfusion to remove antibodyIntrauterine blood transfusionMaternal use of phenobarbitone to induce enzyme新生儿黄疸（英文）Phototherapy Isomerisation of unconjugated bilirubin Wave length: 427475nm (blue), 510530nm (green) Blue light, green light/day light Protection of eyes

10、/gonad Invisible water loss Side effects: skin rash, fever, diarrhea Beware of conjugated hyperbilirubinemia (bronze baby)新生儿黄疸（英文）Phototherapy新生儿黄疸（英文）Exchange Transfusion Prenatal diagnosed, Hb12 m mmol/L/hr (0.75mg/dl) SBR 342 m mmol/L (20mg/dl) Preterm/Rh history/Hypoxia/Acidosis/Sepsis For Rh: Rh same as mother, ABO same as infant For ABO: AB/plasma and O/RBS; or type O Volume: 150180ml/kg via umbilical vein catheter 新生儿黄疸（英文）Other Intervention Albumin (1g/kg), plasma (25ml) Correct acidosis Phenobarbitone (5mg/kg) to induce enzymes Intravenous immunoglubulin (1g/kg) Prevent hypoxia/