儿科学新生儿黄疸(英文)
32页1、Neonatology: Neonatal Jaundice,Contents,Billirubin metabolism in normal neonates Special problems in neonates The diseases in relation with Neonatal Jaundice Dangerous of the Hyperbillirubinemia,Billirubin +plasm albumin-in blood,Capillary bile duct,breakdown of hemoglobin 80%,ineffective erythropoiesis,Reticulo- endothelial system,liver,Bilirubin+Protein Y、Z,conjugative,conjugated Bi,conjugated Bi,Reabsoption:90%,Hepatic cells,Glucuronic acid 90% Glucose conjugates Xylose conjugates,intestine l
2、umen,Bacteria,urobilinogen 80% excrete,Kidney 10%,Portal vein,Urine :urobilinogen (0-4mg/d),Fecal:urobilinogen(40-280mg/d),breakdown of hemoproteins,Normal Billirubin Metabolism in neonates,Intrahepatic hemachrome Tissue hemachrome,Smooth endoplasmic reticulum,Hepato- enteral circulation,Specificity of Billirubin Metabolism in newborns,Increased bilirubin formation Excesive RBCs after birth Shorter half life of fetal hemoglobin Heme oxygenase Increased bilirubin originated from bypass,Specificit
3、y of Billirubin Metabolism in newborns,Insufficient in transiting bilirubin albumin linking/transporting bilirubin ,Specificity of Billirubin Metabolism in newborns,Insufficient in treating bilirubin by liver Y. Z protein Under developed of hepatic enzyme Activity of hepatic enzyme easily being undermined Serums glucose rapidly ,Specificity of Billirubin Metabolism in newborns,Load of hepatoenteral circulation Intestine flora Activity of-Glucuronidase within mesocaval High quantity of bilirubin
4、in meconium,Physiological Jaundice,Pathological Jaundice,Presenting earlier, 12mg/dl increasing rapidly, 5mg/dl/d Longer duration: Term:2 w preterm:4 w Persistently progressing, or re-presence after disappearing,Etiology of Pathological Jaundice,Unconjugated Hemolytic Disease of the Newborn alloimmune hemolytic (ABO and Rh types) deformity of RBC RBC Enzyme deficiency Extravascular Hemolysis Breastfeeding Jaundice Erythrocytosis,Etiology of Pathological Jaundice,Conjugated Neonatal Hepatic disea
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