Ätiologie, Pathogenese und Therapie des Ikterus bei Neugeborenen

Leitthema
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Zusammenfassung

Der Icterus neonatorum ist ein häufiges Problem. Ein vermehrter Anfall von Bilirubin (Hämatome, Hämolyse), eine physiologisch oder genetisch determinierte verzögerte Glukuronidierung, aber auch der hohe Anteil an enterohepatischer Reabsorption spielen bei seiner Entstehung eine Rolle. Sehr hohe Gesamtserumbilirubinwerte im Blut können zur Hirnschädigung, dem Kernikterus, führen. Zu seiner Vermeidung dient 1. die Evaluation der Risikofaktoren, 2. ein Screening aller Neugeborenen durch transkutane und/oder blutige Bilirubinbestimmung, 3. Bewertung der Werte bezogen auf das Lebensalter in Stunden, 4. Festlegung von Nachkontrollen insbesondere bei früher Entlassung und v. a. 5. prompte Therapieeinleitung bei Übersteigen der Grenzwerte durch intensive Phototherapie und selten Austauschtransfusion.

Schlüsselwörter

Hyperbilirubinämie Kernikterus Transkutanes Bilirubinscreening Enterohepatischer Kreislauf Phototherapiegrenzen 

Etiology, pathogenesis and therapy of icterus in neonates

Abstract

Neonatal jaundice is a frequent problem. Increased bilirubin levels (hematoma, hemolysis), physiological or genetically determined impaired glucuronidation, as well as a high amount of enterohepatic reabsorption play a roll in its development. Elevated total serum bilirubin levels can result in brain damage known as kernicterus. As prevention serves 1. evaluation of risk factors, 2. screening of all newborns by transcutaneous and/or serum bilirubin measurement, 3. interpretation of all levels according to the age in hours, 4. provision of follow-up especially in infants discharged early, and 5. treatment with phototherapy or rarely exchange transfusion.

Keywords

Hyperbilirubinemia Kernicterus Transcutaneous bilirubin Enterohepatic circulation Phototherapy guidelines 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Klinik für NeonatologieCharité-Universitätsmedizin Berlin, Campus Virchow-KlinikumBerlinDeutschland

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