NeonatalJaundiceDezhiMuMD/PhDDepartmentofPediatrics,WestChinaSecondUniversityHospital,SichuanUniversityNeonatalJaundiceDezhiMuMD/PIntroductionJaundiceisquitecommon(5mg/dl).Fullterminfants:atleast50%Preterminfants:over80%Elevatedbloodbilirubinlevels:97%IntroductionJaundiceisquiteIntroductioncontinuedWhen?inthefirstweekoflifeWhere?skin,mucosaandwhiteofeyeHowmany?bloodbilirubinconcentrationsis≥5-7mg/dl.IntroductioncontinuedWhenIntroductioncontinuedIntroductioncontinued

ProducingExcreting

WhyJaundiceoccurred?ProducingWhyJaundiceoccu新生兒黃疸(Neonatal-Jaundice)課件BilirubinMetabolism:1.RBC:Hemebilirubin(UCB)2.Blood:carriedbyboundtoalbumin3.Liver:uptaken:Yprotein,Zproteinconjugated:UDPGTexcreted：tothebiliarysystem4.Intestine:stercobilins

-glucuronidase

enterohepatic

circulationBilirubinMetabolism:1.RBC:HThemetaboliccharacteristicsofbilirubininnewborns:

1.Bilirubinproduction 8.8mg/Kg/dinnewborns 3.8mg/Kg/dinadults2.Bilirubin-albumincomplexformationa.preterminfant;b.acidosis

Themetaboliccharacteristics3.Bilirubinmetabolismofhepatocytea.Hepaticuptakeofbilirubinb.Bilirubinconjugation:UDPGT(uridinediphosphateglucoronyltransferase)c.Defectivebilirubinexcretionabilitytobilesystem4.EnterohepaticcirculationThemetaboliccharacteristicsofbilirubincontinued3.BilirubinmetabolismofhBilirubintoxicity

1.Conjugatedbilirubinwater-soluble2.Unconjugatedbilirubinlipid-solublebilirubin-encephalopathy

（kernicterus）Bilirubintoxicity1.ConjugatClinicalManifestationsJaundiceappearsWhen: atanytimeduringthe neonatalperiodWhere: fromfacechest abdomenfeetClinicalManifestationsJaundiEvaluationofjaundice:1.Byeyes:face,5mg/dl(85μmol/L); abdomen,10-15mg/dl; feet,15-20mg/dl;2.Bytranscutaneousmeasurement: usedforscreening3.Byserumlevels:standardManifestationscontinueEvaluationofjaundice:Manife

Classification:PhysiologicalJaundicePathologicalJaundice

ManifestationscontinueClassification:ManifestatioPhysiologicaljaundice:

1.Generalstateiswell 2.Appears2-3days (>24hofage)peaks<12.9mg/dl (fullterminfants) <15mg/dl (preterminfants) fades<2week (terminfants) <4weeks (preterminfants)3.Accumulates<5mg/dl/d4.Directbilirubin<2mg/dlManifestationscontinuePhysiologicaljaundice:

1.PathologicalJaundice 1.Appearsearlier(first24hoursoflife) 2.Peaks>12.9mg/dl(fullterminfants) >15mg/dl(preterminfants) Fades>2weeks(terminfants) >4weeks(preterminfants) 3.Accumulates>5mg/dl/d 4.Directbilirubin>2mg/dl 5.Jaundicerecurrent

ManifestationscontinuePathologicalJaundiceManifesCommoncausesofpathologicaljaundice1.Unconjugatedbilirubinemia:

a.hemolyticdiseases:ABO,Rhincompatibilityb.G-6-PDdeficiency;c.BreastmilkjaundiceCommoncausesofpathological2.Conjugatedbilirubinemia:

a.Neonatalhepatitis b.Biliaryobstruction(cholestaticjaundice)biliaryatresia,commonbileductstenosis c.Congenitalmetabolicdiseasesα-1antitrypsindeficiencyCausesofpathologicaljaundicecontinue2.Conjugatedbilirubinemia:CHemolyticdiseaseofnewbornHemolyticdisease:

ABO:85.3% Rh:14.6% MN:0.1%

HemolyticdiseaseofnewbornHeHemolyticdiseaseofnewborn

continuedABOincompatibility

themother:typeOtheinfant:typeAorB

Rhincompatibility

themother：Rh（-）

theinfant:Rh（+）D,E,C,d,e,cHemolyticdiseaseofnewborn

PathogenesisPathogenesisPathophysiologyRedbloodcellbreakdownHyperbilirubinemiaJaundiceKernicterusSeizuresetc.AnemiaLiverSpleenHeart,otherorgansHydropsPathophysiologyRedbloodcellClinicalManifestations:

ABO Rh1.Jaundice:mild severe 1-2day 24h2.Anemia:

mildsevere(3-6weeks)heartfailure3.Hepato-rarecommonsplenomegaly

ClinicalManifestations: ABComplicationKernicterus:

Phase1:decreasedalertness Hypotonia PoorfeedingPhase2: Hypertonia, Retrocollis,opisthotonusPhase3: Hypotonia

ComplicationKernicterus:1.Bloodtypeincompatibility2.Hyperbilirubinemia:Unconjugatedbilirubinlevel3.Hemolytictests1).Hemoglobinlevel:low2).Reticulocytes:10–15%3).NucleatedRBCLaboratorytests:1.BloodtypeincompatibilityAntibodytest1).DirectCoombstest(+)confirm2).Antibodyreleasetest(+)confirm3).Freeantibodytest(+)judgeLaboratorytestscontinuedAntibodytestLaboratorytes1).Phototherapy2).Exchangetransfusion3).InternalMedicineTreatments1).PhototherapyTreatmenDuringpregnancy1.Intrauterinebloodtransfusion2.EarlydeliveryTreatmentscontinuedDuringpregnancyTreatmentscAfterbirth1.PhototherapyPrinciple:photonoflightThreephotochemicalreactions:1).Structureisomer2).Geometricisomer3).Photo-oxidationPhotoproductsexcretion:w/oconjugation

TreatmentscontinuedAfterbirthTreatmentscontinuIndicationsofphototherapy: UnconjugatedbilirubinemiaBilirubinlevel>12mg/dl

Lightsource: Spectraloutputs420to500nmTreatmentscontinuedIndicationsofphototherapy:TSideeffectsofphototherapy:a.diarrheab.feverc.skinrashd.bronzebabysyndrome(conjugatedbilirubin>4mg/dl)TreatmentscontinuedSideeffectsofphototherapy:新生兒黃疸(Neonatal-Jaundice)課件新生兒黃疸(Neonatal-Jaundice)課件2.ExchangeTransfusions:a.Severehemolyticdiseaseb.Refractorytophototherapy

Treatmentscontinued2.ExchangeTransfusions:TreatAimsoftransfusions: a.Removeantibodies b.Removebilirubin c.CorrectanemiaTreatmentscontinuedAimsoftransfusions:TreatmentIndicationoftransfusions:oneofthefollows20mg/dl(340μmol/L)>4mg/dl,Hgb<120g/L,edema0.7mg/dl/hKernicterusTreatmentscontinuedIndicationoftransfusions:TrSourceofthebloodmothernewbornsForRh:RhABOincompatibilityForABO:“AB”plasma“O”cellsincompatibilitypackedRBC

TreatmentsexchangetransfusionsSourceofthebloodTreatmentsPotentialcomplications:a.Infectionb.NecrotizingenterocolitisNECc.ThromboemboliccomplicationsTreatmentsexchangetransfusionsPotentialcomplications:Treatm3.Pharmacologicalagents: a.Phenobarbital Effects:Uptake,ConjugationExcretion b.Albumin c.IVIGTreatmentscontinued3.Pharmacologicalagents:TreaPreventionsForABOincompatibility:NoForRhincompatibility300μgofhumananti-Dglobulinwithin72hofdelivery.PreventionsForABOincompatibi1.Unconjugatedbilirubinemia:a.Hemolyticdiseases:ABO,Rhincompatibilityb.G-6-PDdeficiency;

c.Breastmilkjaundice1.Unconjugatedbilirubinemia:1.Unconjugatedbilirubinemia:b.G-6-PDdeficiency;male,jaundice,enzymeactivityc.Breastmilkjaundicecauses:unclear,-glucuronidase

followsphysiologicjaundice:4-7dbreastfeedingpersistforseveralweeks.