文档介绍：Neonatal Hyperbilirubinemia 新生儿高胆红素血症 Neonatal Jaundice 新生儿黄疸 RBC Hb Bilirubin ( 胆红素) Free bilirubin (游离胆红素) bilirubin metabolism Unconjugated bilirubin (未结合胆红素) Transport, Uptake Conjugate Conjugated bilirubin (结合胆红素) Excretion Neonatal bilirubin metabolism 1. Increased bilirubin load on liver cell a. Increased RBC volume b. Decreased RBC survival c. Increased early-labeled bilirubin d. Increa sed enterohepatic circulation of bilirubin Neonatal bilirubin metabolism (Contd.) 2. Defective hepatic uptake of bilirubin from plasma a. Decreased ligandin (Y and Z protein) b. Binding of ligandin by other anions Neonatal bilirubin metabolism (Contd.) 3. Defective bilirubin conjugation a. Decreased uridine diphosphate glucuronyl transferase (UDPG-T) activity 葡萄糖醛酸转移酶 b. Increased uridine diphosphoglucose dehydrogenenase (-glucuronidase) activity Neonatal bilirubin metabolism (Contd.) 4. Decreased excretion of bilirubin Summary: Increased bilirubin production Decreased clearance of bilirubin Physiologic Jaundice Onset of jaundice: 2-3 days of age The time of peak level: 4-6 days of age The resolving time: Full term: 2 weeks of age Preterm: 3-4 weeks of age Level of total serum bilirubin: <12mg/dL Level of conjugated bilirubin: < Physical Jaundice in Full Term Infant Nonphysiologic Jaundice Onset of jaundice: before 24 hours of age Any elevation of serum bilirubin that requires phototherapy A rise of serum bilirubin levels of over 5mg/dL/day Signs of underlying illness Persist jaundice