新生儿胆红素代谢特点(2)：口胆红素运输不足：血浆白蛋白量不足，或连接能力差口肝功能不成熟：1.摄取l：Y.Z蛋白1（5-15天达成人水平）2.处理I：葡萄糖醛酸基转移酶I（1周左右始↑，2周达成人水平）3.排泄1：易行成胆汁郁积口肠肝循环特殊：1.正常菌群，肠道内胆红素-一胆素原（尿胆原，粪胆原）2.β-葡萄糖醛酸苷酶个：肠肝循环个
□ 胆红素运输不足：血浆白蛋白量不足，或连接能力差 □ 肝功能不成熟： 1.摄取↓：Y . Z蛋白↓（5 -15天达成人水平） 2. 处理↓：葡萄糖醛酸基转移酶↓（1周左右始↑，2周达 成人水平） 3.排泄↓：易行成胆汁郁积 □ 肠肝循环特殊： 1. 正常菌群↓，肠道内胆红素- →胆素原（尿胆原，粪 胆原） 2. β-葡萄糖醛酸苷酶↑：肠肝循环↑ 新生儿胆红素代谢特点(2) :
Summary of neonatal bilirubinmetabolism Bilirubin loadAlbumin not enough: DefectivetransportImmaturityofliverenzymest reabsorption of bilirubin from gut胆红素白蛋白联肠肝循肝细胞处理结的胆红生成↑环个胆红素1素INeonatal infants are easy to happen jaundiceandbecome pathologic jaundice
S u m m a r y of neonatal bilirubin m e t a b o l i s m • ↑Bilirubin load • A l b u m i n not enough: Defective transport • Immaturity of liver e n z y m e s • ↑reabsorption of bilirubin f r o m gut Neonatal infants are easy to happen jaundice and become pathologic jaundice. 胆红素 生成↑ 白 蛋 白 联 结 的 胆 红 素↓ 肝细胞处理 胆红素↓ 肠肝循 环↑
Diagnostic CriteriaPhysiologic Jaundice:Pathologic Jaundice:(alloffollowsfeature)(anyoffollowsfeature)jaundice appears in 2-3d of lifejaundice appears in<24hof lifeFade<14d (premature<3-4w)Persist for >2w,>4w in prematureTotal serum bilirubin (TB)≤TB >12.9mg/dl (221 μmol/L)12.9mg/dl(221μumol/L)Normal conditionofBBFaded jaundice appears againDirect bilirubin(DB)>2.9mg/dl (50μmol/L)orDB/TB >25%早产儿黄疽问题？
Physiologic Jaundice: (all of follows feature) Pathologic Jaundice： (any of follows feature) jaundice appears in 2-3d of life jaundice appears in < 24h of life Fade ≤14d (premature ≤ 3-4w） Persist for >2w, >4w in premature Total serum bilirubin (TB) ≤ 12.9mg/dl (221 µmol/L) TB >12.9mg/dl (221 µmol/L) Normal condition of BB Faded jaundice appears again Direct bilirubin(DB) >2.9mg/dl (50 µmol/L) or DB/TB >25% Diagnostic Criteria 早产儿黄疸问题？
口病理性黄疽的分类：新生儿肝炎感染性新生儿败血症新生儿溶血症胆道闭锁非感染性母乳性黄遗传性疾病
□ 病理性黄疸的分类： 感染性 非感染性 新生儿肝炎 新生儿败血症 新生儿溶血症 胆道闭锁 母乳性黄疸 遗传性疾病
Clinical Classification of Pathologic Jaundicel. InfectionJaundice:-Neonatal hepatitis :Major pathogenisvirus:CMV, hepatitisB--Neonatal sepsismechanism of jaundice happening:toxic-hepatitis,or/and hemolysis
1. Infection Jaundice： - Neonatal hepatitis ： Major pathogen is virus：CMV, hepatitis B - Neonatal sepsis: mechanism of jaundice happening: toxic-hepatitis， or/and hemolysis Clinical Classification of Pathologic J a u n d i c e