Ebook Key topics in neonatology (2/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Key topics in neonatology (2/E): Part 2
Ebook Key topics in neonatology (2/E): Part 2
JaundiceAll neonates have a transient rise in bilirubin, and some 30 50% become visibly jaundiced. Preterm and term infants become jaundiced for simil Ebook Key topics in neonatology (2/E): Part 2lar reasons as follows:•increased bilirubin load on the liver due to a high red cell mass, the shorter survival ofthe neonatal erythrocyte, and the increased intestinal reabsorption of bilirubin (the cnterohcpatic circulation)•decreased hepatic uptake of bilirubin from the circulation•impaired bilir Ebook Key topics in neonatology (2/E): Part 2ubin conjugation.rhe bilirubin excretory pathway is therefore both overloaded and operationally inefficient, leading to a transient unconjugated hyperEbook Key topics in neonatology (2/E): Part 2
bilirubinaemia that peaks around day three, fades rapidly over the next three days, and clears by days 10 14. Hyperbilirubinaemia is more pronounced aJaundiceAll neonates have a transient rise in bilirubin, and some 30 50% become visibly jaundiced. Preterm and term infants become jaundiced for simil Ebook Key topics in neonatology (2/E): Part 2m infants (which further enhances the enterohepatic circulation) and the slower maturation of hepatic bilirubin uptake and conjugation contribute to the greater magnitude and duration of jaundice in these infants.Jaundice in neonates is considered as either physiological or pathological. Physiologic Ebook Key topics in neonatology (2/E): Part 2al jaundice is the consequence of transient immaturity and the inefficiency of the bilirubin conjugation and excretory pathways. Prematurity, bruisingEbook Key topics in neonatology (2/E): Part 2
, polycythaemia, breast-feeding, and other factors can increase physiological jaundice (sometimes to the point of needing treatment). Jaundice is pathJaundiceAll neonates have a transient rise in bilirubin, and some 30 50% become visibly jaundiced. Preterm and term infants become jaundiced for simil Ebook Key topics in neonatology (2/E): Part 2ncentration is above the normal range.•It has become prolonged (>10 days at term: >14 days in preterm infants).Term infantsrhe 97th percentile for bilirubin concentration in the first few days of life in the well, breast-fed lean baby is approximately 250 pmol/1, and it is 210 umoL'l in the fonnulaf Ebook Key topics in neonatology (2/E): Part 2ed baby. These thresholds of concentration and lime may therefore be taken as levels above which jaundice should be investigated for potentially pathoEbook Key topics in neonatology (2/E): Part 2
logical causes. They are not thresholds for initiating treatment, nor are they thresholds below which pathological causes for jaundice arc absent. VigJaundiceAll neonates have a transient rise in bilirubin, and some 30 50% become visibly jaundiced. Preterm and term infants become jaundiced for simil Ebook Key topics in neonatology (2/E): Part 2e following are required:•scrum bilimbin concentration•blood group and Coombs’ test.Further tests are not indicated unless the need for treatment is confirmed by a high bilirubin concentration without evidence of haemolytic disease, rests on treated infants should include:•urine culture•urine reduci Ebook Key topics in neonatology (2/E): Part 2ng sugars (to exclude galactosuria, which tests positive on Clinitest, butnegative on Clinistix)•further estimates of total bilirubin concentration•liEbook Key topics in neonatology (2/E): Part 2
ver-function tests and conjugated/unconjugaled bilirubin assays that may be needed toexclude cholestasis, especially if the jaundice is prolonged.SomeJaundiceAll neonates have a transient rise in bilirubin, and some 30 50% become visibly jaundiced. Preterm and term infants become jaundiced for simil Ebook Key topics in neonatology (2/E): Part 2 important cause of jaundice, especially in Southeast Asian and African countries. In the UK, it is justifiable to screen jaundiced male infants who are of an ethnic origin that has a high prevalence of G6PD deficiency.ManagementThe literature on bilirubin-induced brain injury in both term and prete Ebook Key topics in neonatology (2/E): Part 2rm infants is both complex and voluminous, suggesting that no simple relationship exists between peak serum bilirubin levels and later adverse neurodeEbook Key topics in neonatology (2/E): Part 2
velopmenlal outcome. However, there is unequivocal evidence of the neuropalhological damage (kemiclerus) that severe hyperbilirubinaemia can cause. KeJaundiceAll neonates have a transient rise in bilirubin, and some 30 50% become visibly jaundiced. Preterm and term infants become jaundiced for simil Ebook Key topics in neonatology (2/E): Part 2microscopic evidence of neuronal damage in those nuclei, rhe long-term neurological sequelae of this include deafness and choreoalhetoid CP. The aim of treating hyperbilirubinaemia is therefore to prevent bilirubin-related neurodevelopmenlal handicap while avoiding harm. The cornerstones of hyperbil Ebook Key topics in neonatology (2/E): Part 2irubinaemia management are phototherapy and exchange transfusion. Experts differ on what constitutes ‘appropriate guidelines' for these two interventiEbook Key topics in neonatology (2/E): Part 2
ons, and no ‘evidence-based guidelines’ exist.Generally, if the baby is well and is feeding well, and the concentration of bilirubin is below the treaJaundiceAll neonates have a transient rise in bilirubin, and some 30 50% become visibly jaundiced. Preterm and term infants become jaundiced for simil Ebook Key topics in neonatology (2/E): Part 2 threshold and likely to rise to a point where kernicterus is a risk, phototherapy is needed (see Table I). Untreated severe hyperbilirubinaemia can cause fits, opisthotonos, and, indeed, death inJaundice 253the neonate.There is continuing debate about the threshold above which kemicterus is likely Ebook Key topics in neonatology (2/E): Part 2to occur. Recent work suggests that in well term infants without haemolytic disease (including G6PD deficiency) it is higher than originally thought.Ebook Key topics in neonatology (2/E): Part 2
The term ‘vigintiphobia’ (fear of the figure 20) was coined to reflect paediatricians' fear of the total bilirubin concentration rising above 20 mg/dlJaundiceAll neonates have a transient rise in bilirubin, and some 30 50% become visibly jaundiced. Preterm and term infants become jaundiced for simil Ebook Key topics in neonatology (2/E): Part 2 above a bilirubin concentration of 450 pmol'l in this group ol infants. The selling of this value also seis the level (450 pmol/1) al which exchange transfusion to prevent kcrnicterus is mandatory. In turn, phototherapy is started when the bilirubin concentration is 100 Limol/I below this exchange Ebook Key topics in neonatology (2/E): Part 2line. In well term infants, therefore, phototherapy is started at bilirubin concentrations as low asEbook Key topics in neonatology (2/E): Part 2
day three and later.Neither phototherapy nor exchange transfusion is harmless, and they should be initialed only if necessary. There is, however, a grJaundiceAll neonates have a transient rise in bilirubin, and some 30 50% become visibly jaundiced. Preterm and term infants become jaundiced for simil Ebook Key topics in neonatology (2/E): Part 2idosis, or is receiving any drtigs that may displace bilirubin from the albumin-binding sites. The thresholds for action have therefore to be reduced accordingly.Preterm infantsThere are insufficient coherent data on jaundice in preterm infants below 35 weeks' gestation to develop scientific evidenc Ebook Key topics in neonatology (2/E): Part 2e-based guidelines about phototherapy. Table 1 contains some published recommendations and some extrapolations from them. A few observations should beEbook Key topics in neonatology (2/E): Part 2
noted. Despite the near universal finding of clinical jaundice in VLBW infants, kernicterus has virtually disappeared in this group of infants. It haJaundiceAll neonates have a transient rise in bilirubin, and some 30 50% become visibly jaundiced. Preterm and term infants become jaundiced for simil Ebook Key topics in neonatology (2/E): Part 2rapy. However, a report (published in 2001) of kemicterus in two infants at 31 weeks’ (serum bilirubin 224 pmol/1) and 34 weeks’ gestation (serum bilirubin 251 umol/l), neither of whom was ill. have once more raised concerns about what levels of bilirubin are safe in preterm infants. Ebook Key topics in neonatology (2/E): Part 2JaundiceAll neonates have a transient rise in bilirubin, and some 30 50% become visibly jaundiced. Preterm and term infants become jaundiced for similGọi ngay
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