The Metabolic Characteristics of Bilirubin in Newborns Wu jinlin Department of Pediatrics West China Second University Hospital Sichuan University Baby on Phototherapy Introduction of Neonatal Jaundice Jaundice.
Download ReportTranscript The Metabolic Characteristics of Bilirubin in Newborns Wu jinlin Department of Pediatrics West China Second University Hospital Sichuan University Baby on Phototherapy Introduction of Neonatal Jaundice Jaundice.
Slide 1
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 2
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 3
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 4
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 5
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 6
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 7
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 8
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 9
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 10
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 11
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 12
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 13
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 14
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 15
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 16
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 17
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 18
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 19
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 20
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 21
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 22
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 23
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 24
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 2
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 3
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 4
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 5
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 6
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 7
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 8
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 9
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 10
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 11
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 12
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 13
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 14
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 15
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 16
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 17
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 18
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 19
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 20
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 21
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 22
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 23
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function
Slide 24
The Metabolic Characteristics of
Bilirubin in Newborns
Wu jinlin
Department of Pediatrics
West China Second University Hospital
Sichuan University
Baby on Phototherapy
Introduction of Neonatal Jaundice
Jaundice is quite common in neonatal period
[1] 60% of term infants and 80% of preterm infants
[2] Visible jaundice from sclera, mucosa and skin
Introduction of Neonatal Jaundice
Can cause serious consequences
respiratory failure
[1] Actue phase
bilirubin encephalopathy
neonatal death
[2] lifelong neurologic sequelae— kernicterus
cerebral palsy
epilepsy
mental retardation
auditory and visual
disfunctions
Why jaundice is so prevalent
in neonatal period ???
The Metabolic Characteristics of
Bilirubin in Newborns
Albumin
shunt
bilirubin
Y&Z protein
UDPGT
β-glucuronidase
Enterohepatic
Circulation
Normal Bilirubin Metabolism
What’s the distinct metabolic
characteristics of bilirubin in
newborns comparing
with our adults?
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
1. Increased bilirubin production
(1) Increased oxygen partial pressure
PO2
PO2
RBC
bilirubin
RBC
1. Increased bilirubin production
(2) Short survival of neonatal erythrocyte
Preterm: ﹤70 days
[1] Life span of RBC
Term: 80 days
Adult: 120 days
[2] Turnover rate of neonatal hemoglobin:
2 times faster than that of adults
1. Increased bilirubin production
(3) Over production of shunt bilirubin
heme
shunt bilirubin
bone marrow precusor
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2.Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
2. Insufficient Binding between Bilirubin and Albumin
low content of serum albumin
GA
albumin
bilirubin-albumin complex
different degree of
acidosis at birth
binding affinity
A
A
serum
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3.Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5. Others
3. Deficient Bilirubin Conjugation in the Hepatocyte
Y carrier protein
increases rapidly
5~10 days later
UDPGT
reaches the adult’s
values 1 week
after birth
conjugation of
bilirubin with
glucuronic acid
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4.Increased enterohepatic circulation of bilirubin
5. Others
4. Increased Enterohepatic Circulation of Bilirubin
intestinal flora is not fully
developed
abundant β-glucuronidase
delayed excretion of meconium
Neonatal Bilirubin Metabolism
1. Increased bilirubin production in newborns
2. Insufficient binding between bilirubin and albumin
3. Deficient bilirubin conjugation in the hepatocyte
4. Increased enterohepatic circulation of bilirubin
5.Others
5. Others
cephalohematoma
dehydration
hunger
……
intracranial
hemorrhage
acidosis
hypoxia
Summary
[1] Jaundice is much more frequent in neonates
[2] Pathogenesis : over-production of bilirubin
immature liver function