Neonatal Jaundice
Neonatal Jaundice
INTRODUCTION:.Neonatal jaundicealso ashyperbilirubinemia,withinlweekofage,incident of visiblyjaundice: 60% in full-term infants, 80% inpreterm infants
• Neonatal jaundice also a s hyperbilirubinemia, • Within 1 w e e k of a g e， incident of visibly j a u n d i c e：6 0 % in fullt e r m infants，80% in preterm infants. INTRODUCTION：
Significance of Jaundice in newborn·Physiological phenomenon Pathologic signIt may be a sign of another disorder ,e.g. infectionUnconjugated bilirubin can be deposited in the brainparticularly in the basal ganglia, causing kernicterus.May develop into liver cirrhosis if biliary atresia notperform hepatoportoenterostomy in time
Significance of Jaundice in newborn: • Physiological phenomenon • Pathologic sign □ It may be a sign of another disorder ,e.g. infection □Unconjugated bilirubin can be deposited in the brain, particularly in the basal ganglia, causing kernicterus. □May develop into liver cirrhosis if biliary atresia not perform hepatoportoenterostomy in time
BreakdownofUnconjugated bilirubinhaemoglobinboundtoalbuminUnconjugatedandotherhaem proteinsGindirecubilirubialbuminConjugadionUnconjugated(gltuicurony)SHOPtransferasebilirubinLiverMETABOLICConjugatedcellsbilirubinPATHWAY OFBILIRUBINproteinZproteinSoluble in lipidsSoluble in waterExcretion聘inbileconjugatedUnconjugatedbilirubinbilirubin葡羞GlucuronyltransferaseurobilinogenEnterohepaticStercobilinogencirculationGlucuronic acid residues
ur obilinogen albumin Unconjugated (indirect) bilirubin Y protein Z protein Liver cells Unconjugated bilirubin Glucuronyl transferase Glucuronic acid residues Unconjugated bilirubin conjugated bilirubin Soluble in lipids Soluble in water METABOLIC PATHWAY OF BILIRUBIN
新生儿胆红素代谢特点(1)胆红素生成较多：（肝细胞胆红素负荷增加）：新生儿胆红素产生6-8mg/kg.d，而成人只3-4mg/kg.d1．红细胞破坏过多2.红细胞寿命短3.胆红素旁路来源较多血红素蛋白（过氧化氢酶、细胞色素P45o等）胆红素前体一无效造血4.产生胆红素的酶一血红素加氧酶含量高（1-7天）
□ 胆红素生成较多：（肝细胞胆红素负荷增加）：新生儿胆 红素产生6-8mg/kg.d，而成人只3-4mg/kg.d 1. 红细胞破坏过多 2. 红细胞寿命短 3. 胆红素旁路来源较多 ① 血红素蛋白（过氧化氢酶、细胞色素P450等） ② 胆红素前体←无效造血 4. 产生胆红素的酶—血红素加氧酶含量高（1-7天） 新生儿胆红素代谢特点(1) :