Presentation on theme: "Neonatal Jaundice Dezhi Mu MD/PhD Department of Pediatrics, West China Second University Hospital, Sichuan University."— Presentation transcript:
Neonatal Jaundice Dezhi Mu MD/PhD Department of Pediatrics, West China Second University Hospital, Sichuan University
Introduction Jaundice is quite common (5mg/dl). Full term infants: at least 50% Preterm infants: over 80% Elevated blood bilirubin levels: 97%
Introduction continued When? in the first week of life Where? skin, mucosa and white of eye How many? blood bilirubin concentrations is ≥5-7mg/dl.
Producing Excreting Why Jaundice occurred?
Bilirubin Metabolism: 1. RBC: Heme bilirubin (UCB) 2. Blood: carried by bound to albumin 3. Liver: uptaken : Y protein, Z protein conjugated: UDPGT excreted ： to the biliary system 4. Intestine: stercobilins -glucuronidase enterohepatic circulation
The metabolic characteristics of bilirubin in newborns: 1. Bilirubin production 8.8mg/Kg/d in newborns 3.8mg/Kg/d in adults 2. Bilirubin-albumin complex formation a. preterm infant; b. acidosis
3. Bilirubin metabolism of hepatocyte a. Hepatic uptake of bilirubin b. Bilirubin conjugation: UDPGT (uridine diphosphate glucoronyl transferase) c. Defective bilirubin excretion ability to bile system 4. Enterohepatic circulation The metabolic characteristics of bilirubin continued
Clinical Manifestations Jaundice appears When: at any time during the neonatal period Where: from face chest abdomen feet
Evaluation of jaundice : 1. By eyes: face, 5mg/dl ( 85μmol/L ); abdomen, 10-15mg/dl; feet, 15-20mg/dl ; 2. By transcutaneous measurement : used for screening 3. By serum levels : standard Manifestations continue
Physiological jaundice : 1. General state is well 2. Appears 2-3days (>24h of age) peaks < 12.9mg/dl (full term infants) <15mg/dl (preterm infants) fades <2 week (term infants) <4 weeks (preterm infants) 3. Accumulates <5mg/dl/d 4. Direct bilirubin <2mg/dl Manifestations continue
Pathological Jaundice 1. Appears earlier (first 24 hours of life) 2. Peaks >12.9mg/dl (full term infants) >15mg/dl (preterm infants) Fades >2 weeks (term infants) >4 weeks (preterm infants) 3. Accumulates >5mg/dl/d 4. Direct bilirubin >2mg/dl 5.Jaundice recurrent Manifestations continue
Common causes of pathological jaundice 1. Unconjugated bilirubinemia: a. hemolytic diseases: ABO, Rh incompatibility b. G-6-PD deficiency; c. Breast milk jaundice
2. Conjugated bilirubinemia: a. Neonatal hepatitis b. Biliary obstruction (cholestatic jaundice) biliary atresia, common bile duct stenosis c. Congenital metabolic diseases α-1 antitrypsin deficiency Causes of pathological jaundice continue
Antibody test 1). Direct Coombs test (+) confirm 2). Antibody release test (+) confirm 3). Free antibody test (+) judge Laboratory tests continued
1). Phototherapy 2). Exchange transfusion 3). Internal Medicine Treatments
During pregnancy 1. Intrauterine blood transfusion 2. Early delivery Treatments continued
After birth 1. Phototherapy Principle : photon of light Three photochemical reactions: 1). Structure isomer 2). Geometric isomer 3). Photo-oxidation Photoproducts excretion: w/o conjugation Treatments continued
Indications of phototherapy : Unconjugated bilirubinemia Bilirubin level >12mg/dl Light source: Spectral outputs 420 to 500nm Treatments continued
Side effects of phototherapy : a. diarrhea b. fever c. skin rash d. bronze baby syndrome (conjugated bilirubin>4mg/dl) Treatments continued
2. Exchange Transfusions: a. Severe hemolytic disease b. Refractory to phototherapy Treatments continued
Aims of transfusions: a. Remove antibodies b. Remove bilirubin c. Correct anemia Treatments continued
Indication of transfusions: one of the follows a. 20mg/dl (340 μmol/L) b. >4mg/dl,Hgb<120g/L, edema c. 0.7mg/dl/h d. Kernicterus Treatments continued
Source of the blood mother newborns For Rh: Rh ABO incompatibility For ABO: “AB” plasma “O” cells incompatibility packed RBC Treatments exchange transfusions
Potential complications: a. Infection b. Necrotizing enterocolitis NEC c. Thromboembolic complications Treatments exchange transfusions
3. Pharmacological agents: a. Phenobarbital Effects: Uptake, Conjugation Excretion b. Albumin c. IVIG Treatments continued
Preventions For ABO incompatibility: No For Rh incompatibility 300 μg of human anti-D globulin within 72 h of delivery.
1.Unconjugated bilirubinemia: a. Hemolytic diseases: ABO, Rh incompatibility b. G-6-PD deficiency; c. Breast milk jaundice
1.Unconjugated bilirubinemia: b. G-6-PD deficiency; male, jaundice, enzyme activity c. Breast milk jaundice causes: unclear, -glucuronidase follows physiologic jaundice: 4-7 d breast feeding persist for several weeks.
Conjugated bilirubinemia: 2.Conjugated bilirubinemia: a. neonatal hepatitis b. biliary obstruction (cholestatic jaundice) biliary atresia, common bile duct stenosis c. congenital metabolic diseases α-1 antitrypsin deficiency
Case analysis : 24 old male infant, gravida1,para 1. Apgar scores: 8 at 1 min Mother: blood type “O” PE: icterus appeared on face and trunk skin liver edge 1cm palpable spleen tip
Case analysis continued Lab tests: Hgb:13g/dl, reticulocyte count : 7% Blood smear: nucleated RBC Blood type: A, Rh-positive Serum bilirubin: 12.9mg/ml Direct Coomb’s test: weakly positive Question: what’s the risk factor ?
Thank you! Questions ？ Department of Pediatrics