新生儿黄疸（英文） .ppt

Neonatal Jaundice(Hyperbilirubinemia)IntroductionIntroductionBilirubin MetabolismBilirubin Metabolism“enterohepatic circulation”:b b-glucuronidase in the gut hydrolysis the conjugated bilirubin into unconjugated bilirubin,and reabsorbed into liverCharacteristics of Neonatal Bilirubin Metabolism“enterohepatic circulation”lower in gut bacteria;higher b b-glucuronidase activity“Physiological”Jaundice Up limit for abnormal?Undefined(Term 12mg/dl,or term13,preterm250Cephalocaudal Progression of JaundiceClinical Investigation 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 galactosaemiaRhesus isoimmunisation 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 birth 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 Rarely requires exchange transfusion1/5 for ABO,1/20 for Rh incompatibility will becoming hemolyticClinical Manifestation Jaundice:within 24h in 77%of Rh,28%in ABO Anemia Hepatosplenomegaly Bilirubin encephalopathy(Kernicterus)Early(27d):more in preterm,includes hypertonia,lethargy,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 hypoplasiaDiagnosis Family history:still birth,abortion,jaundice Parents ABO/Rh typing,antibody Ultrasound for hydrops fetalis Postnatal:jaundice,anemia,neurological symptom Blood type and antibodyDirect Coombs,Antibody release,&Free antibody TestManagement Prenatal:Rh(-),monitoring antibody,bilirubin,etcTerminate pregnancy when lungs are maturedPlasma transfusion to remove antibodyIntrauterine blood transfusionMaternal use of phenobarbitone to induce enzymePhototherapy Isomerisation of unconjugated bilirubin Wave length:427475nm(blue),510530nm(green)Blue light,green light/day light Protection of eyes/gonad Invisible water loss Side effects:skin rash,fever,diarrhea Beware of conjugated hyperbilirubinemia(bronze baby)PhototherapyExchange 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 Other Intervention Albumin(1g/kg),plasma(25ml)Correct acidosis Phenobarbitone(5mg/kg)to induce enzymes Intravenous immunoglubulin(1g/kg)Prevent hypoxia/hypothermia/hypoglycemia Anti RhD IgG(300m mg,im)for Rh(-)mother after delivered a Rh(+)baby(within 72h)Good perinatal care