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ID:19457721
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时间:2018-10-02
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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,managementandpreventionofhyperbilirubinemiaintermandlatepreter
2、mnewborninfants参考文献Hyperbilirubinemiaisverycommonandusuallybenigninthetermnewborninfantandthelatepreterminfantat35to36completedweeks.Criticalhyperbilirubinemiaisuncommonbuthasthepotentialforcausinglong-termneurologicalimpairment.Earlydischargeofthehealth
3、ynewborninfant,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%oftermnewbornsdevelopjaundicean
4、d2%reachaTSBconcentrationgreaterthan340μmol/L(19.8mg/dl).Acuteencephalopathydoesnotoccurinfull-terminfantswhosepeakTSBconcentrationremainsbelow340μmol/LandisveryrareunlessthepeakTSBconcentrationexceeds425μmol/L(24.85mg/dl).Abovethislevel,theriskfortoxici
5、typrogressivelyincreases.Morethanthree-quartersoftheinfantsintheUnitedStateskernicterusregistry(between1992and2002)hadaTSBconcentrationof515μmol/L(30.1mg/dl)orgreater,andtwo-thirdshadaconcentrationexceeding600μmol/L(35mg/dl).Evenwithconcentrationsgreater
6、than500μmol/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):acl
7、inicalsyndrome,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.Chronicbilirubinencep
8、halopathy(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)andmentaldeficien
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