Avtor/Urednik		Bratanič, Borut
Naslov		Novosti in klinična obravnava neonatalne nekonjugirane hiperbilirubinemije
Prevedeni naslov		Update on and clinical management of neonatal unconjugated hyperbilirubinemia
Tip		članek
Vir		Med Razgl
Vol. in št.		Letnik 43, št. 4
Leto izdaje		2004
Obseg		str. 373-84
Jezik		slo
Abstrakt		Neonatal unconjugated hyperbilirubinemia continues to be one of the most frequent and puzzling problems in neonatology. Ten years ago, the guidelines for management of neonatal unconjugated hyperbilirubinemia were changed when the decision levels for therapeutic interventions were elevated. This year, the American Academy of Pediatrics reviewed and updated its guidelines for management of neonatal unconjugated hyperbilrubinemia. This review article describes advances in the field of neonatal unconjugated hyperbilirubinemia. Among diagnostic procedures, measurements of exhaled CO, "free" bilirubin, transcutaneous bilirubin, screening test for evoked auditory brainstem potentials and brain imaging are highlighted. Investigation of bilirubin's neurotoxicity goes on with research on inhibition of protein/peptide phosphorylation, impaired homeostasis of intracellular calcium, effects of bifirubin on cell membranes and apoptosis, and on the role of P-glycoprotein in protection of the brain against bilirubin. Recent advances in therapy are described, including improvement of light sources for phototherapy using light emitting diodes, and the use of inhibitors of hem oxygenase, bilirubin reductase, photonic analogues, miniature reactors of glucuronosyl transpherase, as well as gene therapy for the Cligler Najjar type 1 genetic syndrome. In the last part of the article, new guidelines for clinical management of jaundiced new-borns are summarised, with special emphasis on new-borns in whom serum bilirubin reaches level of 427 micromol/1. The appendix contains a new decision tree for clinical management of jaundiced new-borns.
Izvleček		Nekonjugirana hiperbilirubinemija je eden najpogostejših in še vedno ne docela pojasnjenih problemov v neonatologiji. Pred desetimi leti je prišlo do spreminjanja navodil za obravnavo zlateničnih novorojenčkov, ko so se meje za indikacije terapevtskih posegov pomaknile navzgor, letos pa so v Ameriškem pediatričnem združenju navodila za obravnavo zlatenice novorojenčka dopolnili. V preglednem prispevku so opisana novejša dognanja na področju nekonjugirane hiperbilirubinemije novorojenčka. Pri diagnostiki opisujemo merjenje izdihanega ogljikovega monoksida, "prostega" bilirubina v serumu, presejalno merjenje vzbujenih slušnih potencialov možganskega debla, merjenje kožnega bilirubina in slikovno diagnostiko možganov. Pri razumevanju nevrotoksičnega delovanja bilirubina v zadnjem času raziskujejo inhibicijo fosforilacije beljakovin/peptidov, moteno homeostazo kalcija v celicah, vpliv bilirubina na celične membrane s posledično apoptozo in vlogo P-glikoproteina pri zaščiti možganov pred bilirubinom. Novosti pri zdravljenju zajemajo izboljšave svetlobnih virov pri fototerapiji z uporabo svetlobnih diod in inhibitorje hem oksigenaze, biliverdinske reduktaze, fotonske analoge ter miniaturne reaktorje z glukuronosil transferazo. Na koncu prispevka so v skladu z novejšimi izsledki povzeti osnovni principi klinične obravnave zlateničnih novorojenčkov s posebnim opozorilom na tiste novorojence, kjer bilirubin v serumu presega koncentracijo 427 mikromol/l. V prilogi prispevka je sodoben algoritem klinične obravnave novorojenčkov z zlatenico.
Deskriptorji		JAUNDICE, NEONATAL HYPERBILIRUBINEMIA KERNICTERUS INFANT, NEWBORN