新生儿胆红素代谢特点(The-Metabolic-Characteristics-of-Bilirubin-in-Newborns)课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,The Metabolic Characteristics of Bilirubin in Newborns,Wu jinlin,Department of Pediatrics,West China Second University Hospital,Sichuan University,The Metabolic Characteristics,1,新生儿胆红素代谢特点(The-Metabolic-Characteristics-of-Bilirubin-in-Newborns)课件,2,Baby on Phototherapy,Baby on Phototherapy,3,Introduction of Neonatal Jaundice,Jaundice is quite common in neonatal period,1 60%of term infants and 80%of preterm infants,2 Visible jaundice from sclera,mucosa and skin,Introduction of Neonatal Jaun,4,Introduction of Neonatal Jaundice,Can cause serious,consequences,1 Actue phase,respiratory failure,bilirubin encephalopathy,neonatal death,Introduction of Neonatal Jau,5,2 lifelong neurologic sequelae,kernicterus,cerebral palsy,epilepsy,mental retardation,auditory and visual disfunctions,2 lifelong neurologic sequel,6,新生儿胆红素代谢特点(The-Metabolic-Characteristics-of-Bilirubin-in-Newborns)课件,7,Why jaundice is so prevalent,in neonatal period?,The Metabolic Characteristics of,Bilirubin in Newborns,Why jaundice is so prevalent T,8,Normal Bilirubin Metabolism,Y&Z protein,UDPGT,-glucuronidase,Albumin,shunt bilirubin,Enterohepatic Circulation,Normal Bilirubin,9,Whats the distinct metabolic,characteristics of bilirubin in,newborns comparing,with our adults?,Whats the distinct metabolic,10,1.Increased bilirubin production in newborns,2.I,nsufficient binding between bilirubin and albumin,3.,Deficient bilirubin conjugation in the hepatocyte,4.Increased enterohepatic circulation of bilirubin,Neonatal Bilirubin Metabolism,5.Others,1.Increased bilirubin product,11,(1)Increased o,xygen partial pressure,1.Increased bilirubin production,PO,2,PO,2,RBC,RBC,bilirubin,(1)Increased oxygen partial,12,1,Life span of RBC,Preterm:,70,days,Term:,80,days,Adult:,120,days,2,Turnover rate of neonatal hemoglobin,:,2 times,faster than that of adults,(2),Short survival of neonatal erythrocyte,1.Increased bilirubin production,1 Life span of RBCPreterm:,13,(3),Over production of shunt bilirubin,1.Increased bilirubin production,heme,bone marrow precusor,shunt bilirubin,(3)Over production of shunt b,14,1.Increased bilirubin production in newborns,2.I,nsufficient binding between bilirubin and albumin,3.,Deficient bilirubin conjugation in the hepatocyte,4.Increased enterohepatic circulation of bilirubin,Neonatal Bilirubin Metabolism,5.Others,1.Increased bilirubin product,15,2.I,nsufficient Binding between Bilirubin and Albumin,low content of serum albumin,GA,albumin bilirubin-albumin complex,different degree of acidosis at birth,binding affinity,B,A,A,A,A,B,A,B,B,B,B,B,B,B,B,A,B,B,B,serum,2.Insufficient Binding betwee,16,1.Increased bilirubin production in newborns,2.I,nsufficient binding between bilirubin and albumin,3.,Deficient bilirubin conjugation in the hepatocyte,4.Increased enterohepatic circulation of bilirubin,Neonatal Bilirubin Metabolism,5.Others,1.Increased bilirubin product,17,3.,Deficient Bilirubin Conjugation in the Hepatocyte,UDPGT,reaches the adults values 1 week after birth,Y carrier protein,increases rapidly 510 days later,conjugation of bilirubin with glucuronic acid,3.Deficient Bilirubin Conjuga,18,1.Increased bilirubin production in newborns,2.I,nsufficient binding between bilirubin and albumin,3.,Deficient bilirubin conjugation in the hepatocyte,4.Increased enterohepatic circulation of bilirubin,Neonatal Bilirubin Metabolism,5.Others,1.Increased bilirubin product,19,4.Increased Enterohepatic Circulation of Bilirubin,intestinal flora is not fully developed,abundant,-glucuronidase,delayed excretion of meconium,4.Increased Enterohepatic Cir,20,1.Increased bilirubin production in newborns,2.I,nsufficient binding between bilirubin and albumin,3.,Deficient bilirubin conjugation in the hepatocyte,4.Increased enterohepatic circulation of bilirubin,Neonatal Bilirubin Metabolism,5.Others,1.Increased bilirubin product,21,5.Others,dehydration,acidosis,intracranial hemorrhage,cephalohematoma,hunger,hypoxia,5.Othersdehydrationacidosisin,22,Summary,1 Jaundice is much more frequent in neonates,2 Pathogenesis:over-production of bilirubin,immature liver function,Summary1 Jaundice is much,23,Thank you,Thank you,24,