文档介绍：Neonatal Jaundice and Hemolysis ******@shmu.
Jaundice 黄疸
Bilirubin 胆红素
Hyperbilirubinemia 高胆红素血症
Jaundice is mon neonatal problem. Sixty-five percent of newborns develop clinical jaundice with a bilirubin level
above 5 mg/dl during the first week of life.
Metabolism of bilirubin
production :
1 g hemoglobin 34 mg bilirubin
Adult mg / ,
Neonatal / ,
cleaning :
Protein Y and Z (in liver cell )
UDPGT(glucuronyl transferase - 葡萄糖醛酸转移酶)
the enterohepatic circulation of bilirubin
breakdown
Maisels in 1981
Clincial jaundice appears in 24 hour after born
Total bilirubin level rises >5 mg / dl per day
Peak bilirubin level > / dl (term baby) or >15 mg / dl ( premature baby)
Conjugated bilirubin level >-- mg / dl
Clincial jaundice is not resolved by 1 week in term infant or 2 week in preterm infant
Etiology of jaundice secondary
to unconjugated hyperbilirubemia
Overproduction of bilirubin
Increased rate of hemolysis
Patient with a positive Coombs test
Rh patibility
ABO blood group patibility
Patient with negative Coombs test
Abnormal red cell shapes
Red cell enzyme abnormalities G-6-PD
Patient with bacterial or viral sepsis
Nonhemolytic causes of increased biliurbin load
Extravascular hemorrhage
Polycythemia (红细胞增多症)
Exaggerated enterohepatic circulation(肠肝循环)of biliurbin
Etiology of jaundice secondary
to unconjugated hyperbilirubemia
Decreased rate of conjugation
Physiologic jaundice (生理性黄疸)
Crigler-Najjar syndrome
Gillbert syndrome
breast jaundice
Reported by Arias in 1960
60th 1%~2%
80th 20%(De Angelis,1982)
82%(Lascair, 1986)
Maisels in1986 1250 baby 97%
breast feeding
Breast jaundice
Manifestation:
jaundice,general condition is good
diagnosis:
the presence of moderate unconjugated hyperbilirubinemia for 6 ~ 8 weeks in a thriving infant without evidence for hemolysis, hypothyroidism, or other disease strongly suggests this breast jaundice.
Hemolytic disease