复旦大学：《儿科学》课程教学资源（PPT课件讲稿，英文版）第七讲 新生儿黄疸和感染

Neonatal Jaundice and Hemolysis bazhou@shmu.edu.cn

Neonatal Jaundice and Hemolysis bhzhou@shmu.edu.cn

Jaundice黄疸 Bilirubin胆红素 Hyperbilirubinemia高胆红素血症

Jaundice 黄疸 Bilirubin 胆红素 Hyperbilirubinemia 高胆红素血症

Jaundice is a common neonatal problem. sixty-five percent of newborns develop clinical jaundice with a bilirubin level above 5 mg/d during the first week of life

Jaundice is a common 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↑: breakdown 1 g hemoglobin 34 mg bilirubin Adult 3.8 mg /kg.d Neonatal 8.5mg /kg.d cleaning v: Protein Y and Z l(in liver cell UDPGⅣ↓( glucuronyl transferase-葡萄糖醛酸转移酶) the enterohepatic circulation of bilirubin

Metabolism of bilirubin production ： 1 g hemoglobin 34 mg bilirubin Adult 3.8 mg / kg.d， Neonatal 8.5mg / kg.d， 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 >12.9mg /dl (term baby)or >15 mg /dl premature baby Conjugated bilirubin level >1.5--2.0 mg/dl a Clincial jaundice is not resolved by 1 week in term infant or 2 week in preterm infant

Maisels in 1981 ◼ Clincial jaundice appears in 24 hour after born ◼ Total bilirubin level rises >5 mg / dl per day ◼ Peak bilirubin level > 12.9mg / dl (term baby) or >15 mg / dl ( premature baby) ◼ Conjugated bilirubin level >1.5--2.0 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 a Increased rate of hemolysis Patient with a positive Coombs test ◆ Rh incompatibility ABO blood group incompatibility Patient with negative Coombs test Abnormal red cell shapes Red cell enzyme abnormalities G-6-PD Patient with bacterial or viral sepsis a Nonhemolytic causes of increased biliurbin load e 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 Overproduction of bilirubin ◼ Increased rate of hemolysis ◆ Patient with a positive Coombs test ⧫ Rh incompatibility ⧫ ABO blood group incompatibility ◆ 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 secondar to unconjugated hyperbilirubemia Decreased rate of conjugation Physiologic jaundice(生理性黄疸) Crigler-Najjar syndrome Gillbert syndrome

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 60th1%~2% 80th 20%( De Angelis, 1982 82%( Lascair 1986) Maisels in 1986 1250 baby 97%12.5mg/d breast feeding 157mg/dl

breast jaundice ◼ Reported by Arias in 1960 ◼ 60th 1％～2％ 80th 20％（De Angelis,1982） 82％（Lascair, 1986） ◼ Maisels in1986 1250 baby 97％ 12.5mg/dl breast feeding 15.7mg/dl

Breast jaundice ■ Manifestation: jaundice, general condition is good a 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

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

Hemolytic disease