复旦大学：《儿科学》课程教学资源（PPT课件讲稿，英文版）第六讲 新生儿黄疸

Neonatal Jaundice 新生儿黄疸 Neonatal Hyperbilirubinemia 新生儿高胆红素血症

Neonatal Hyperbilirubinemia 新生儿高胆红素血症 Neonatal Jaundice 新生儿黄疸

bilirubin metabolism RBC Hb Bilirubin(胆红素) Free bilirubin(游离胆红素)

RBC Hb Bilirubin ( 胆红素) Free bilirubin (游离胆红素) bilirubin metabolism

Breakdown of Unconjugated bilirubin haemoglobin bound to albumin and other haem proteins Unconjugated bilirubin (未结合胆红素) Transport, Uptake Conjugation (glucuronyl transferase) Conjugate Conjugated bilirubin Conjugated bilirubin (结合胆红素) Excretion in bile Excretion Enterohepatic Stercobilinogen circulati

Unconjugated bilirubin (未结合胆红素) Transport, Uptake Conjugate Conjugated bilirubin (结合胆红素) Excretion

Neonatal bilirubin metabolism 1. ncreased 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 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.) 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(B-glucuronidase)activity

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 a Increased bilirubin production Decreased clearance of bilirubin

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 I The time of peak level: 4-6 days of age I The resolving time Full term: 2 weeks of age Preterm:3-4 weeks of age 1 Level of total serum bilirubin: <12mg/dL 1 Level of conjugated bilirubin: <1.5mg/dL

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: <1.5mg/dL

Physical jaundice in full Term Infant

Physical Jaundice in Full Term Infant

Nonphysiologic Jaundice 1 Onset of jaundice: before 24 hours of age 1 Any elevation of serum bilirubin that requires phototherapy A rise of serum biliru bin levels of over 5mg/dL/day I Signs of underlying illness ■ Persist jaundice

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