新生儿黄疸英文课件VIP免费

新生儿黄疸（英文）IntroductionAllbabiesdevelopelevatedserumbilirubin(SBR)Allbabiesdevelopelevatedserumbilirubin(SBR)levels,toagreaterorlesserdegree,inthefirstweeklevels,toagreaterorlesserdegree,inthefirstweekoflife.Thisisdueto:oflife.Thisisdueto:increasedproduction(acceleratedRBCbreakdown);increasedproduction(acceleratedRBCbreakdown);decreasedremoval(liverenzymeinsufficiency)decreasedremoval(liverenzymeinsufficiency)Increasedreabsorption(enterohepaticcirculation).Increasedreabsorption(enterohepaticcirculation).Introduction~60%ofinfantsbecomeclinicallyjaundicedin1~60%ofinfantsbecomeclinicallyjaundicedin1ststwkwkBililevelspeakat3~5daysinfullterminfantsBililevelspeakat3~5daysinfullterminfants~1/6offormulafedinfantshavebililevelsover12~1/6offormulafedinfantshavebililevelsover12~1/3ofbreastfedinfantshavebililevelsover12~1/3ofbreastfedinfantshavebililevelsover12Over80%ofallinfantswithbililevels>12.9mg/dlinOver80%ofallinfantswithbililevels>12.9mg/dlinthefirstfourdaysoflifearebreastfedthefirstfourdaysoflifearebreastfedBilirubinMetabolismderivedfromthecatabolismofproteinsthatcontainhemederivedfromthecatabolismofproteinsthatcontainhemethemostimportantsourceisthebreakdownofHbfromRBCthemostimportantsourceisthebreakdownofHbfromRBCnativebilirubinisrelativelyinsolubleinwateratphysiologicnativebilirubinisrelativelyinsolubleinwateratphysiologicpH,butitisverylipidsolublepH,butitisverylipidsolublebilirubincirculatesboundtoalbumininequilibriumwithitsunboundorbilirubincirculatesboundtoalbumininequilibriumwithitsunboundor"free"fraction"free"fractiontheunboundfractionthatreadilycrossestheblood-brainbarrierandtheunboundfractionthatreadilycrossestheblood-brainbarrierandresultsinneurotoxicityresultsinneurotoxicityBilirubinMetabolismBilirubinismademorewater-solubleintheliverbyconjugationwithBilirubinismademorewater-solubleintheliverbyconjugationwithglucuronicacidtoform"conjugated"or"direct-reacting"bilirubin,glucuronicacidtoform"conjugated"or"direct-reacting"bilirubin,thenclearedthroughthebileintotheintestinesandoutthroughthethenclearedthroughthebileintotheintestinesandoutthroughthefeces.feces.PhototherapyworksbyproducingphotoisomersofbilirubinthatarePhototherapyworksbyproducingphotoisomersofbilirubinthataremorewatersoluble,andthatcanbecleareddirectlyinbileorurinemorewatersoluble,andthatcanbecleareddirectlyinbileorurinewithoutconjugationintheliver.withoutconjugationintheliver.“enterohepaticcirculation”:-glucuronidaseintheguthydrolysistheconjugatedbilirubinintounconjugatedbilirubin,andreabsorbedintoliverCharacteristicsofNeonatalBilirubinMetabolism1.1.IncreasedbilirubinproductionIncreasedbilirubinproduction2.2.8.8mg/kgdailyvs3.8mg/kginadults8.8mg/kgdailyvs3.8mg/kginadults3.3.InsufficiencyofbilirubintransportationInsufficiencyofbilirubintransportation4.4.acidosis,hypoalbuminemiaacidosis,hypoalbuminemia5.5.ImmatureofliverfunctionImmatureofliverfunction6.6.loweringestion(y,zprotein);lowerUDPGTactivityloweringestion(y,zprotein);lowerUDPGTactivity7.7.IncreasedIncreased“enterohepaticcirculation”8.loweringutbacteria;higher-glucuronidaseactivity“Physiological”Jaundice1.1.Seenin60%ofterminfantsandover80%ofpretermSeenin60%ofterminfantsandover80%ofpreterm2.2.Serumvaluesreachesmaximumat6mg/dlon4~5dinSerumvaluesreachesmaximumat6mg/dlon4~5din3.3.t...