Neonatal
Hyperbilirubinemia
新生儿高胆红素血症
Neonatal Jaundice
新生儿黄疸
RBC Hb Bilirubin ( 胆红素 )
Free bilirubin (游离胆红素 )
bilirubin metabolism
Unconjugated bilirubin
(未结合胆红素 )
Transport,Uptake
Conjugate
Conjugated bilirubin
(结合胆红素 )
Excretion
Neonatal bilirubin metabolism
1,Increased bilirubin load on liver cell
a,Increased RBC volume
b,Decreased RBC survival
c,Increased early-labeled bilirubin
d,Increa sed enterohepatic circulation
of bilirubin
Neonatal bilirubin metabolism
(Contd.)
2,Defective hepatic uptake of bilirubin
from plasma
a,Decreased ligandin (Y and Z protein)
b,Binding of ligandin by other anions
Neonatal bilirubin metabolism
(Contd.)
3,Defective bilirubin conjugation
a,Decreased uridine diphosphate
glucuronyl transferase (UDPG-T) activity
葡萄糖醛酸转移酶
b,Increased uridine diphosphoglucose
dehydrogenenase (?-glucuronidase) activity
Neonatal bilirubin metabolism
(Contd.)
4,Decreased excretion of bilirubin
Summary,
Increased bilirubin production
Decreased clearance of bilirubin
Physiologic Jaundice
Onset of jaundice,2-3 days of age
The time of peak level,4-6 days of age
The resolving time:
Full term,2 weeks of age
Preterm,3-4 weeks of age
Level of total serum bilirubin,<12mg/dL
Level of conjugated bilirubin,<1.5mg/dL
Physical Jaundice in Full Term Infant
Nonphysiologic Jaundice
Onset of jaundice,before 24 hours of age
Any elevation of serum bilirubin that requires
phototherapy
A rise of serum bilirubin levels of over
5mg/dL/day
Signs of underlying illness
Persist jaundice
Causes and Clinical Features
Unconjugated hyperbilirubinemia
1,Fetomaternal blood group incompatibility
2,Infection
3,Breast jaundice(母乳性黄疸 )
4,Delayed meconium passage
5,Others,asphyxia,hemorrhage,
polycythemia (红细胞增多症 )
Causes and Clinical Features
Conjugated Hyperbilirubinemia
1,Hepatitis
2,Obstructive disorders
3,Metabolic and endocrine condition
4,Cholestasis (胆汁淤积 )
Breastfeeding and Jaundice
母乳性黄疸
Breast-milk jaundice
1,Late onset by day 5-7 of life
2,Rise to peak level by 2 weeks of age
3,Bilirubin fall rapidly if stop breastfeeding
4,Rule out pathological condition
5,Mechanism is unknown
Breastfeeding and Jaundice
Breastfeeding jaundice
1,Early onset
2,High bilirubin levels after 3 days of life
3,Related to a decreased intake of milk
Bilirubin Encephalopathy
胆红素脑病
Kernicterus (核黄疸 )
Cellular toxicity of bilirubin
Blood-Brain Barrier permeability
Bilirubin Encephalopathy
Hemolytic disease of the
newborn
新生儿溶血病
Rh incompatibility
ABO incompatibility
Onset in fetal and neonatal period
Rhesus Hemolytic Disease
Rh 溶血病
Rh blood group
Rh-positive,D antigen,DD or Dd
Rh negative,dd
1,Pathogenesis
Mother RhD (－ ),Fetus RhD(＋ )
fetal RBC maternal
circulation
IgM
Second pregnancy placenta IgG
Primary
Sensitized fetal RBC Sensitized RBC bind to the Fc receptor
Hemolysis
First pregnancy
1,Pathogenesis
Mother,Rh D (－ ) neonate,Rh D (＋ )
Rh E (－ ) Rh E (＋ )
Rh C (－ ) Rh C (＋ )
May occur in neonate whose
mother is Rh-positive
2,Clinical Manifestations
a,Fetal hydrops (胎儿水肿 )
b,Jaundice,early onset,rise rapidly
and severe
c,Anemia
d,Hepatosplenomegaly (肝脾肿大 )
e,Bilirubin encephalopathy
3,Diagnosis
a,Clinical features
b,Laboratory findings
(1) Blood group of mother and infant
(2) Coombs’ test (抗人球蛋白试验 )
Direct Coombs’ test,identify sensitized RBC
ABO Hemolytic Disease
Mother,type O
Fetus,type A or B,
最多见的新生儿溶血病
1,Pathogenesis
A,B
substances
Enter
maternal
circulation
AntiA,AntiB
antibody IgG
Pregancy
placentafetausSensitize red
blood cells
Hemolysis
2,Clinical feature
Jaundice,anemia and Hepatosplenomegaly
3,Diagnosis
a,Blood group
b,Coombs’ Test
Direct Coombs’ test
Elution test
Management
1,Phototherapy (光疗 )
(1) Indication,full-term> 15 mg /dl
(2) Light,blue lamps,wavelength 450～ 460nm
(3) Mechanism,photochemical reaction
Structural isomerization
(4) Technique,single or double phototherapy
Phototherapy
2,Decreasing free bilirubin
Albumin,plasma
3,Inhibiting bilirubin production
competitive inhibitors of heme oxygenase
(血红素加氧酶 )
4.Increasing bilirubin conjugation
Phenobarbital
5.Inhibiting hemolysis
High-dose intravenous immune globulin
(IVIG) 静脉丙种球蛋白
6.Exchange transfusion (交换输血 )
(1) Indication
In Rh hemolytic disease,total
bilirubin>20mg/dl
(2) Mechanisms
Remove antibodies,antibody-coated RBCs
(sensitized red blood cells) and bilirubin，
correct anemia
(3) Blood
Rh hemolytic disease:Rh cross-matched against
the mother,ABO cross-matched against the infant
ABO hemolytic disease,type O cells with AB
plasma
4,Volume,double the volume of the infant’s blood
(two-volume exchange),160ml/kg
5,Complications
Hypocalcemia,hypoglycemia,Acid-base balance,
hyperkalemia,embolization,bleeding,infections
新生儿感染
新生儿感染特点
宫内感染
1,TORCH 综合征
T,弓形虫； O,其它； R,风疹 V
C,巨细胞 V； H,庖疹 V
2,梅毒
3,AIDS
4,病毒性肝炎
新生儿败血症
一、病因
1,免疫功能不完善
2,环境因素
感染源：器械、操作
途 径：皮肤、脐部、呼吸道、消化道、
泌尿道
3,病原菌
杆菌：大肠杆菌、克雷白杆菌、绿脓杆菌
球菌：金葡菌、表皮葡萄球菌
二、临床表现
1,不典型、非特异性
2,不哭、不吃、体温不升
3,黄疸、呕吐、腹胀、呼吸困难、
呼吸暂停、酸中毒
4,易并发 化脓性脑膜炎
三、诊断
1,临床表现：仔细观察才能发现
2,病原检查：细菌培养、涂片
3,其他检查：白细胞、血小板、
血气分析
四、治疗
1,抗菌治疗：合理治疗
2,免疫治疗：免疫球蛋白、粒细胞、
细胞因子
3,支持疗法：保证营养供给
Hyperbilirubinemia
新生儿高胆红素血症
Neonatal Jaundice
新生儿黄疸
RBC Hb Bilirubin ( 胆红素 )
Free bilirubin (游离胆红素 )
bilirubin metabolism
Unconjugated bilirubin
(未结合胆红素 )
Transport,Uptake
Conjugate
Conjugated bilirubin
(结合胆红素 )
Excretion
Neonatal bilirubin metabolism
1,Increased bilirubin load on liver cell
a,Increased RBC volume
b,Decreased RBC survival
c,Increased early-labeled bilirubin
d,Increa sed enterohepatic circulation
of bilirubin
Neonatal bilirubin metabolism
(Contd.)
2,Defective hepatic uptake of bilirubin
from plasma
a,Decreased ligandin (Y and Z protein)
b,Binding of ligandin by other anions
Neonatal bilirubin metabolism
(Contd.)
3,Defective bilirubin conjugation
a,Decreased uridine diphosphate
glucuronyl transferase (UDPG-T) activity
葡萄糖醛酸转移酶
b,Increased uridine diphosphoglucose
dehydrogenenase (?-glucuronidase) activity
Neonatal bilirubin metabolism
(Contd.)
4,Decreased excretion of bilirubin
Summary,
Increased bilirubin production
Decreased clearance of bilirubin
Physiologic Jaundice
Onset of jaundice,2-3 days of age
The time of peak level,4-6 days of age
The resolving time:
Full term,2 weeks of age
Preterm,3-4 weeks of age
Level of total serum bilirubin,<12mg/dL
Level of conjugated bilirubin,<1.5mg/dL
Physical Jaundice in Full Term Infant
Nonphysiologic Jaundice
Onset of jaundice,before 24 hours of age
Any elevation of serum bilirubin that requires
phototherapy
A rise of serum bilirubin levels of over
5mg/dL/day
Signs of underlying illness
Persist jaundice
Causes and Clinical Features
Unconjugated hyperbilirubinemia
1,Fetomaternal blood group incompatibility
2,Infection
3,Breast jaundice(母乳性黄疸 )
4,Delayed meconium passage
5,Others,asphyxia,hemorrhage,
polycythemia (红细胞增多症 )
Causes and Clinical Features
Conjugated Hyperbilirubinemia
1,Hepatitis
2,Obstructive disorders
3,Metabolic and endocrine condition
4,Cholestasis (胆汁淤积 )
Breastfeeding and Jaundice
母乳性黄疸
Breast-milk jaundice
1,Late onset by day 5-7 of life
2,Rise to peak level by 2 weeks of age
3,Bilirubin fall rapidly if stop breastfeeding
4,Rule out pathological condition
5,Mechanism is unknown
Breastfeeding and Jaundice
Breastfeeding jaundice
1,Early onset
2,High bilirubin levels after 3 days of life
3,Related to a decreased intake of milk
Bilirubin Encephalopathy
胆红素脑病
Kernicterus (核黄疸 )
Cellular toxicity of bilirubin
Blood-Brain Barrier permeability
Bilirubin Encephalopathy
Hemolytic disease of the
newborn
新生儿溶血病
Rh incompatibility
ABO incompatibility
Onset in fetal and neonatal period
Rhesus Hemolytic Disease
Rh 溶血病
Rh blood group
Rh-positive,D antigen,DD or Dd
Rh negative,dd
1,Pathogenesis
Mother RhD (－ ),Fetus RhD(＋ )
fetal RBC maternal
circulation
IgM
Second pregnancy placenta IgG
Primary
Sensitized fetal RBC Sensitized RBC bind to the Fc receptor
Hemolysis
First pregnancy
1,Pathogenesis
Mother,Rh D (－ ) neonate,Rh D (＋ )
Rh E (－ ) Rh E (＋ )
Rh C (－ ) Rh C (＋ )
May occur in neonate whose
mother is Rh-positive
2,Clinical Manifestations
a,Fetal hydrops (胎儿水肿 )
b,Jaundice,early onset,rise rapidly
and severe
c,Anemia
d,Hepatosplenomegaly (肝脾肿大 )
e,Bilirubin encephalopathy
3,Diagnosis
a,Clinical features
b,Laboratory findings
(1) Blood group of mother and infant
(2) Coombs’ test (抗人球蛋白试验 )
Direct Coombs’ test,identify sensitized RBC
ABO Hemolytic Disease
Mother,type O
Fetus,type A or B,
最多见的新生儿溶血病
1,Pathogenesis
A,B
substances
Enter
maternal
circulation
AntiA,AntiB
antibody IgG
Pregancy
placentafetausSensitize red
blood cells
Hemolysis
2,Clinical feature
Jaundice,anemia and Hepatosplenomegaly
3,Diagnosis
a,Blood group
b,Coombs’ Test
Direct Coombs’ test
Elution test
Management
1,Phototherapy (光疗 )
(1) Indication,full-term> 15 mg /dl
(2) Light,blue lamps,wavelength 450～ 460nm
(3) Mechanism,photochemical reaction
Structural isomerization
(4) Technique,single or double phototherapy
Phototherapy
2,Decreasing free bilirubin
Albumin,plasma
3,Inhibiting bilirubin production
competitive inhibitors of heme oxygenase
(血红素加氧酶 )
4.Increasing bilirubin conjugation
Phenobarbital
5.Inhibiting hemolysis
High-dose intravenous immune globulin
(IVIG) 静脉丙种球蛋白
6.Exchange transfusion (交换输血 )
(1) Indication
In Rh hemolytic disease,total
bilirubin>20mg/dl
(2) Mechanisms
Remove antibodies,antibody-coated RBCs
(sensitized red blood cells) and bilirubin，
correct anemia
(3) Blood
Rh hemolytic disease:Rh cross-matched against
the mother,ABO cross-matched against the infant
ABO hemolytic disease,type O cells with AB
plasma
4,Volume,double the volume of the infant’s blood
(two-volume exchange),160ml/kg
5,Complications
Hypocalcemia,hypoglycemia,Acid-base balance,
hyperkalemia,embolization,bleeding,infections
新生儿感染
新生儿感染特点
宫内感染
1,TORCH 综合征
T,弓形虫； O,其它； R,风疹 V
C,巨细胞 V； H,庖疹 V
2,梅毒
3,AIDS
4,病毒性肝炎
新生儿败血症
一、病因
1,免疫功能不完善
2,环境因素
感染源：器械、操作
途 径：皮肤、脐部、呼吸道、消化道、
泌尿道
3,病原菌
杆菌：大肠杆菌、克雷白杆菌、绿脓杆菌
球菌：金葡菌、表皮葡萄球菌
二、临床表现
1,不典型、非特异性
2,不哭、不吃、体温不升
3,黄疸、呕吐、腹胀、呼吸困难、
呼吸暂停、酸中毒
4,易并发 化脓性脑膜炎
三、诊断
1,临床表现：仔细观察才能发现
2,病原检查：细菌培养、涂片
3,其他检查：白细胞、血小板、
血气分析
四、治疗
1,抗菌治疗：合理治疗
2,免疫治疗：免疫球蛋白、粒细胞、
细胞因子
3,支持疗法：保证营养供给
