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新生儿黄疸诊治VIP免费

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1新生儿黄疸诊治yaoyue28@sina.comPaediatrics&ChildHealth1999;4(2):161-164ReferenceNo.FN98-02RevisioninprogressMay2007Paediatrics&ChildHealth2007;12(5):1B-12BReferenceNo.FN07-02Guidelinesfordetection,managementandpreventionofhyperbilirubinemiaintermandlatepretermnewborninfants参考文献•Hyperbilirubinemiaisverycommonandusuallybenigninthetermnewborninfantandthelatepreterminfantat35to36completedweeks.•Criticalhyperbilirubinemiaisuncommonbuthasthepotentialforcausinglong-termneurologicalimpairment.Earlydischargeofthehealthynewborninfant,particularlythoseinwhombreastfeedingmaynotbefullyestablished,maybeassociatedwithdelayeddiagnosisofsignificanthyperbilirubinemia.高胆红素血症很常见,多为良性。危险的高胆红素血症并不常见,但是有潜在的导致长期神经损害的可能。•胆红素水平与胆红素脑病发生•Itisestimatedthat60%oftermnewbornsdevelopjaundiceand2%reachaTSBconcentrationgreaterthan340μmol/L(19.8mg/dl).•Acuteencephalopathydoesnotoccurinfull-terminfantswhosepeakTSBconcentrationremainsbelow340μmol/LandisveryrareunlessthepeakTSBconcentrationexceeds425μmol/L(24.85mg/dl).Abovethislevel,theriskfortoxicityprogressivelyincreases.Morethanthree-quartersoftheinfantsintheUnitedStateskernicterusregistry(between1992and2002)hadaTSBconcentrationof515μmol/L(30.1mg/dl)orgreater,andtwo-thirdshadaconcentrationexceeding600μmol/L(35mg/dl).•Evenwithconcentrationsgreaterthan500μmol/L(29.2mg/dl),therearestillsomeinfantswhowillescapeencephalopathy.•Kernicterus(核黄疸):thepathologicalfindingofdeep-yellowstainingofneuronsandneuronalnecrosisofthebasalganglia(基底节)andbrainstemnuclei(脑干神经元).•Acutebilirubinencephalopathy(急性胆红素脑病):aclinicalsyndrome,inthepresenceofseverehyperbilirubinemia,oflethargy(昏睡),hypotoniaand(肌张力减低)poorsuck,whichmayprogresstohypertonia(withopisthotonos(角弓反张)andretrocollis(颈后倾))withahigh-pitchedcryandfever,andeventuallytoseizures(发作)andcoma.•Chronicbilirubinencephalopathy(慢性胆红素脑病):theclinicalsequelaeofacuteencephalopathywithathetoidcerebralpalsy(手足徐动症样大脑麻痹)withorwithoutseizures,developmentaldelay,hearingdeficit,oculomotor(眼球运动异常)disturbances,dentaldysplasia(牙发育异常)andmentaldeficiency.•Severehyperbilirubinemia(严重的高胆红素血症):atotalserumbilirubin(TSB)concentrationgreaterthan340μmol/Latanytimeduringthefirst28daysoflife.•Criticalhyperbilirubinemia(危险的高胆红素血症):aTSBconcentrationgreaterthan425μmol/Lduringthefirst28daysoflife.具有危险因素人群中患者与非患者之比相当于不具有危险因素人群中患者与非患者之比的倍数•脱水,高渗,呼吸窘迫,水肿,早产,酸中毒,低白蛋白血症,缺氧,抽搐可增加急性脑病的发生率•与败血症的关系?•Allofthereasonsforthevariablesusceptibilityofinfantsarenotknown;however,dehydration,hyperosmolarity,respiratorydistress,hydrops,prematurity,acidosis,hypoalbuminemia,hypoxiaandseizuresaresaidtoincreasetheriskofacuteencephalopathyinthepresenceofseverehyperbilirubinemia,althoughreliableevidencetoconfirmtheseassociationsislacking.•Inaddition,someinfantswithseverehyperbilirubinemiaarefoundtohavesepsis,butbothsepsisandhyperbilirubinemiaarecommonintheneonatalperiod,andsepsisappearstobeuncommoninthewell-appearinginfantwithseverehyperbilirubinemia.黄疸的发生(总体发生情况)•Early(days1-2)-uncommon–Haemolyticjaundice(ABO,others)•Normal(days3-10)-verycommon–Uncomplicated–Complicated-seebelo...

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新生儿黄疸诊治

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