新生儿黄疸.pptVIP

Case study You are in your first week of a 2-week NICU rotation（轮转） as an intern（实习生） You are called by a nurse from the department of obstetrics（产科）. she ask you come by to see a 3-day-old baby with jaundice（黄疸），whose transcutaneous bilirubin(经 皮测胆红素) is 17mg/dl(290μmol/L) Case study What is wrong with the baby? How does it happen? What will you do next? History? Physical assessment? Transfer to NICU? Differential diagnosis? Laboratory tests? Management plan? Case study What is wrong with the baby? How does it happen? What will you do next? History? Physical assessment? Transfer to NICU? Differential diagnosis? Laboratory tests? Management plan? Neonatal Jaundice A yellowish pigmentation（色素沉着） of the skin and mucous membranes, including the conjunctival membranes over the sclera（巩膜） About 60% of term babies（足月儿） and more than 80% of premature babies （早产儿）have jaundice during the first few days or weeks of life Neonatal Jaundice Neonatal Jaundice Case study What is wrong with the baby? How does it happen? What will you do next? History? Physical assessment? Transfer to NICU? Differential diagnosis? Laboratory tests? Management plan? How does it happen? It is caused by too much of bilirubin（胆红素）builds up in the body. Bilirubin is a yellow-coloured bile salts which can deposit in tissues Jaundice is visible if serum bilirubin levels≥2mg/dl in adults, but ≥5-7mg/dl in neonates It is also called hyperbilirubinemia（高胆红素血症） Hyper bilirubin emia 高 胆红素 血症 Neonatal Jaundice Why occurs in neonates? Bilirubin Production Metabolism Clinical Manifestations Area of body Bilirubin levels mg/dl (*17.1=umol/L) Face 5 Upper trunk 10 Lower trunk thighs 12 Arms and lower legs 15 Palms soles 15 出现时间　　生后第2-3天　　　 生后24小时内 消退时间　　成熟儿10-14天 足月