Hiperbilirrubinemianeonatal-InTERNA RESIDENTADO ECUADOR
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Madre de 25 años, sana, ORH positivo, VDRL
negativo. Primigesta, embarazo bien
controlado, sin complicaciones. Parto cefalovaginal, recién nacido de seo
femenino, !" semanas de edad gestacional,
vigoroso, peso 25#$gr, per í metro cef álico
!#cm, longit%d #"cm, ORH positivo
&in patolog í a perinatal, alimentado a seno
directo ecl%sivo, alta a las #'(s, peso al alta
2#$$ gr. Reingresa a los 5 d í as de vida por
ictericia generalizada. Peso al ingreso 2)2$gr.
&%cción pobre e ineficaz, escasa di%resis *
deposiciones en las últimas #'(s. +febril
http://espaciociencia.com/wp-content/uploads/2009/05/madre-e-hijo.jpghttp://4.bp.blogspot.com/_yv1e5YUot1E/SMabNlAtvOI/AAAAAAAAKps/lbKZ1_yI1VI/s1600-h/9.jpghttp://2.bp.blogspot.com/_yv1e5YUot1E/SMaa73BmIKI/AAAAAAAAKok/x-ioSgbxI64/s1600-h/1.jpg
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ámenes de laboratorio- bilirr%binas totales
2$,52mgdl, bilirr%bina indirecta )"mgdl.
Hemograma gl ób%los blancos )$.2$$
elementosmm, 5$/ polimorfon%cleares * )/
ca*ados, !!$$$$ pla0%etas, (ematocrito 1!/,(emoglobina 2).) gl. Retic%locitosis $.'/
l ámina perif érica no se observan esferocitos
ni otras anomal í as. licemia 3'mgdl.
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Lista de problemas:
• Alta precoz antes de las 72hs•Bilirrubinas totales 20,52mg/dl,
bilirrubina indirecta 17mg/dl•Succión pobre e ineficaz, escasa diuresis y
deposiciones en las últimas 48s•Perdida de peso (2400 gr; 2120gr )
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GLOBINA
HEMO
Fe libre(Fe2+ a Fe3+)
La bilirrubina es
el producto final
del grupo HEM
biliverdina
hemo-oxigenasa
CO
80% proviene de
destrucción diaria de
eritrocitos
20% de eritropoyesis
inefectiva de la medula
ósea y en el hígado
Extraido de Pediatrics in Review, en español, vol.28 Nº3 Mayo 2007
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1.- FASE DE PRODUCCIÓN
Se origina principalmenteen los glóbulos rojos
2.- FASE DE TRANSPORTEBNC se une a la albúmina y estransportada a sinusoides
hepáticos
3.-FASE DE CONJUGACIÓNBNC en hepatocito BC
4.-FASE DE ELIMINACIÓN
En intestino (Urobilinógeno ,estercobilina)
1.- FASE DE PRODUCCIÓN• Vida media del eritrocito•Hcto aumentado•Más células deformes
2.- FASE DE TRANSPORTE•Disminución de la albúmina(Prematuro , RCI)
3.-FASE DE CONJUGACIÓN•Disminución de acidoglucurónido•Disminución de ligandinas•Disminución de UDP
glucuronil transferasa debilirrubina
4.-FASE DE ELIMINACIÓN•Recirculación enterohepática•Hígado y riñones inmaduros
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hiperbilirrubinemia
Ictericia
Aumento de niveles séricosde bilirrubinas sobre el nivel
normal para edad y peso
No conjugadasConjugadas
Condición clínica en que labilirrubina sérica está lo
sufcientemente aumentadacomo para observar un tinte
amarillo en la escleróticaocular, mucosas y piel del RN
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TORCH
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La velocidad deproducción de Bb excede
la velocidad deeliminación
= fnal es elaumento () de Bb
sérica total
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FISIOL!I"#$urante la primerasemana de vida (%&
' da)emite de manera
espont*nea
#
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90 días
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+O FISIOL!I"#
B+" ,-%./m01dl +#2B+" ,-3m01dl +42 (vara se05n edad
0estacional 6 peso)+ivel de Bb 7ue aumenta ,89%m01dl1hr o
,3m01dl1daIctericia durante las -ras %:h de vidaIctericia clnica 7ue persiste , de -semana +#2 6 , de % semanas en
prematuros
Gomella Neonatology, five, sixth edition
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B#+;
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INCOMPATIBILIDAD RH
Traspaso de
IgG anti RHmaternas alfeto
MADRE
RH -FETORH +
vacuna que elimina los anti-Rh, llamada la
gamma inmunoglobulina RhoGAM
Sensibilización previa
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INCOMPATIBILIDAD GRUPO CLÁSICO
Traspaso de anticuerpos maternos, anti A o anti al fetoTraspaso de anticuerpos maternos, anti A o anti al feto
MADRE
O
FETOA, , A
dos tipos de sangre diferentes e
incompatibles se mezclan
http://www.blog.com.es/srv/media/media_item.php?item_ID=982940
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$ ;?2#@#S#"I+S#+!A>+;#
"ealohematomasemorra0ia intraventricular 6
pulmonarematoma hep*tico subcapsular
emorra0ia 0astrointestinal oculta
(;"+)
" 4OLI"I2;
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F
Nivel séricomáimo -./
0.mg1dl entre los-. y -2 días de
vida
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!#L2;#"IO+;S
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#A
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ISustancias 6 trastornos 7ueaectan la fDación de Bb a
alb5mina
#spirinaSulonamidas4enicilina
!entamicinaEcidos 0rasos presentes en
órmulas nutricionales
#sfxia#cidosisSepsis
ipotermiahipo0lucemia
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+ivel sérico de Bb 3&Gm01dl
Letar0oechaHo delalimento@ómitos
ipotona conpro0resión hacia
el desarrollo deconvulsiones
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9 $; J#
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J;+I"2;AS
por lo 0eneral no aecta la corteHacerebral. se puede revertir si el nivelsérico de Bb desciende antes de 7ue
ten0a lu0ar la saturación de los n5cleosdel S+"9
4i0mentación 6necrosis de las
neuronas
0an0lios
basales
corteHahipocampic
a
n5cleossubtal*mic
os
cerebelo
Se debe a la acción directa de la bilirrubina indirecta libre sobre el sistema nervioso
central, inhibiendo la fosforilación oxidativa de las mitocondrias y los procesos de
síntesis proteica
http://upload.wikimedia.org/wikipedia/commons/5/58/Schmorl_kernicterus.JPGhttp://www.mdconsult.com/das/patient/body/0/0/10041/22694_en.jpghttp://www.google.com.ec/imgres?imgurl=http://blogs.librodearena.com/myfiles/charles/ni%C3%B1o-1.jpg&imgrefurl=http://www.librodearena.com/blog/charles/1647%3F%26total%3D64%26page%3D3&usg=__UIoXVLGkrZY2gzj9n60AwtlZyHk=&h=540&w=510&sz=39&hl=es&start=60&um=1&itbs=1&tbnid=xyCSsUM4jbqaEM:&tbnh=132&tbnw=125&prev=/images%3Fq%3DNI%25C3%2591OS%2BTIERNOS%26start%3D40%26um%3D1%26hl%3Des%26sa%3DN%26ndsp%3D20%26tbs%3Disch:1http://4.bp.blogspot.com/_yv1e5YUot1E/SMaa8e-C5jI/AAAAAAAAKpE/sT0WTarvZ24/s1600-h/5.jpg
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Entre el 0 y el !" de
los ni#os con ictericia
nuclear mueren
preco$mente
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;studios de laboratorio
Bilirrubina total 6directa
emo0rama completo 6recuento deeticulocitos
!rupo san0uneo 6actor h
4rueba de "oombsdirecta en el niMo
+ivel sérico de alb5mina
Bilirrubinometratranscut*nea
http://www.google.com.ec/imgres?imgurl=http://imagenes.mailxmail.com/cursos/imagenes/0/4/examenes-de-laboratorio-hemoglobina-glicosilada_24440_3_1.jpg&imgrefurl=http://www.mailxmail.com/curso-diabetes-mellitus-sintomas-tratamiento-dieta/examenes-laboratorio-hemoglobina-glicosilada&usg=__yPwbmhKXMCwqpozI-vtQ5eND7_I=&h=227&w=310&sz=60&hl=es&start=5&um=1&itbs=1&tbnid=8A4gGfD0L5EOcM:&tbnh=86&tbnw=117&prev=/images%3Fq%3Dexamenes%2Bde%2Blaboratoria%26um%3D1%26hl%3Des%26gbv%3D2%26tbs%3Disch:1http://www.google.com.ec/imgres?imgurl=http://www.perfilesytrazas.com.co/images/fotos/fot14.jpg&imgrefurl=http://www.perfilesytrazas.com.co/temas/index.htm&usg=__DfvTch0w_y4syCFGcSd14Z3BrHo=&h=260&w=213&sz=13&hl=es&start=3&um=1&itbs=1&tbnid=pCtbn4_enQLsaM:&tbnh=112&tbnw=92&prev=/images%3Fq%3Dexamenes%2Bde%2Blaboratoria%26um%3D1%26hl%3Des%26gbv%3D2%26tbs%3Disch:1http://2.bp.blogspot.com/_yv1e5YUot1E/SMaa73BmIKI/AAAAAAAAKok/x-ioSgbxI64/s1600-h/1.jpg
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9 $; J#
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Fototerapia
;xan0uinotransusión
Farmacoterapia
http://images.google.com.ec/imgres?imgurl=http://www.elblogdebebes.com/wp-content/uploads/2009/04/ictericia-1-150x137.jpg&imgrefurl=http://www.elblogdebebes.com/desarrollo/ictericia/&usg=__PXeKTyas-CsQHyAxEi9BYCy9DC8=&h=137&w=150&sz=7&hl=es&start=43&tbnid=DXtMTuqQfc_XaM:&tbnh=88&tbnw=96&prev=/images%3Fq%3Drecien%2Bnacido%2Bict%25C3%25A9rico%26gbv%3D2%26ndsp%3D18%26hl%3Des%26sa%3DN%26start%3D36
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3+4+45RA'6A7 longitudes de onda de 82. nm a 2.. nm
#$creción por la orina
% heces
de un producto
soluble en a&ua no
tó$ico
trans'orm(ndola enisómeros no tó$icos
)lumirrubina* e
hidrosolubles
"otoisomeri9ación
"otooidación
6someri9aciónestructural
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"+-+
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Ó
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EXANGUINEOTRANSFUSIÓN • Remoci!n
mec"nica dela sangre delR# $ su
reempla%opor sangrede un
donadorcompati&le
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si0no de disunciónhepatobiliar se manifesta
después de - semanaIncapacidad para eliminar
Bb conDu0ada
, -93 a %m01dL o , %8R
se Bb2
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;+F;
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;+F;
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;studios de laboratorio
Bilirrubina total 6directa
emo0rama completo 6recuento de
eticulocitos4F+iveles séricos de
colesterol. tri0licéridos.alb5mina
+ivel sérico de urea.
0lucosa
;studios radioló0icosBilirrubinometra
transcut*nea
http://www.google.com.ec/imgres?imgurl=http://cris1818.files.wordpress.com/2008/11/2007112034laboratorio_200711211.jpg&imgrefurl=http://cris1818.wordpress.com/2008/11/26/subiendo-una-imagen/&usg=__gSgYbpyGJYCGyCp63Sp74AbWXnY=&h=300&w=600&sz=59&hl=es&start=1&um=1&itbs=1&tbnid=yc-oWeWSbgHrBM:&tbnh=68&tbnw=135&prev=/images%3Fq%3Dlaboratorio%26um%3D1%26hl%3Des%26tbs%3Disch:1http://www.google.com.ec/imgres?imgurl=http://puntoazul.files.wordpress.com/2008/09/laboratorio1.jpg&imgrefurl=http://puntoazul.wordpress.com/2008/09/15/un-hallazgo-casual-podria-allanar-el-camino-a-una-vacuna-contra-el-vih/&usg=__kNqBRh7dtegRffneX31RYDUwFd0=&h=1131&w=1698&sz=141&hl=es&start=2&um=1&itbs=1&tbnid=GTyMOf9vyuahjM:&tbnh=100&tbnw=150&prev=/images%3Fq%3Dlaboratorio%26um%3D1%26hl%3Des%26tbs%3Disch:1http://3.bp.blogspot.com/_yv1e5YUot1E/SMabNd2VTvI/AAAAAAAAKpk/opK2-muyfac/s1600-h/10.jpghttp://4.bp.blogspot.com/_yv1e5YUot1E/SMaa8e-C5jI/AAAAAAAAKpE/sT0WTarvZ24/s1600-h/5.jpg
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2#2#
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peso al alta en ascenso 2!"$gr, eamenne%rol ó gico normal. 4ilirr%binas al alta totales
)),#2 mgdl.
http://www.google.com.ec/imgres?imgurl=http://blogs.librodearena.com/myfiles/charles/ni%C3%B1o-1.jpg&imgrefurl=http://www.librodearena.com/blog/charles/1647%3F%26total%3D64%26page%3D3&usg=__UIoXVLGkrZY2gzj9n60AwtlZyHk=&h=540&w=510&sz=39&hl=es&start=60&um=1&itbs=1&tbnid=xyCSsUM4jbqaEM:&tbnh=132&tbnw=125&prev=/images%3Fq%3DNI%25C3%2591OS%2BTIERNOS%26start%3D40%26um%3D1%26hl%3Des%26sa%3DN%26ndsp%3D20%26tbs%3Disch:1http://3.bp.blogspot.com/_yv1e5YUot1E/SMabNd2VTvI/AAAAAAAAKpk/opK2-muyfac/s1600-h/10.jpghttp://3.bp.blogspot.com/_yv1e5YUot1E/SMabMz_rT0I/AAAAAAAAKpM/4RDDGucM4mY/s1600-h/6.jpghttp://1.bp.blogspot.com/_yv1e5YUot1E/SMabY8WJMGI/AAAAAAAAKp0/g23dEsdkbBI/s1600-h/11.jpg
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+os veo traa"ar a mi alrededor.
+os oigo !alar de mí. Sé %ue se preocupan.
veces me asusto al verlos, sore tod o cuando vienen !acia mí con agu"as.
Pero tamién me asusto cuando no los v eo. veces paso muc!o tiempo sin ver a
nad ie.#-ué !orrile es no poder llamarlos cuando los nec esito$
N o me de"en. ependo de ustedes. Mis padres y yo confiamos en ustedes.
lgunos sé %ue me %uieren de verdad. No s*lo como prof esionales.
M &s, si creen como yo %ue es posile %uerer m& s.
Me doy cuenta por l a forma en %ue me tocan, a(n cuando lo %ue me !acen es doloroso.
/tros sé %ue no me %uieren, %ui'&s por%ue significo m& s traa"o.
Me tratan con rude'a y sin afecto.
P ero y o les pido... si no me %uieren, por favor no me c uiden.
No se enga0en a sí mismos por%ue a mí no me enga0an.
Sé d iferenciar una caricia y el afecto de una agresi*n y el rec!a'o.
Tamién sé %ue algunos de ustedes son me"ores, m& s capaces.
) o no pretendo %ue s*lo ellos me cuiden.
T( %ue eres nu evo puedes !acerlo pero, por favor... si tienes dudas,
si ves %ue no puedes, llama al m&s capa'.
Re%uiere m&s v alor decir %ue no saes %ue ocultarte protegido por mi silencio.
)o nunca te denunciaría. No puedo. No %uiero... T( te cond enarías solo.
+es pido por favor por%ue yo estoy preparado para decir1 muc!as gracias
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8/18/2019 Hiperbilirrubinemianeonatal-InTERNA RESIDENTADO ECUADOR
55/55
LA PAZ COMIENZA CON UNA SONRISA
2+os pe%ue0os detalles de la vida son
los %ue marcan y !acen las grandes
diferencias2