期刊
SEMINARS IN FETAL & NEONATAL MEDICINE
卷 20, 期 1, 页码 14-19出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.siny.2014.12.002
关键词
Bilirubin-induced neurological dysfunction; Hypoxia; Kernicterus; White matter damage; Sensitive time-window; Sepsis
类别
资金
- Fundacao para a Ciencia e a Tecnologia (Lisbon, Portugal) [PTDC/SAU-NEU/64385/2006, PEst-OE/SAU/UI4013/2011-2014]
- Fundação para a Ciência e a Tecnologia [PTDC/SAU-NEU/64385/2006] Funding Source: FCT
Bilirubin-induced neurologic dysfunction (BIND) and classical kernicterus are clinical manifestations of moderate to severe hyperbilirubinemia whenever bilirubin levels exceed the capacity of the brain defensive mechanisms in preventing its entrance and cytotoxicity. In such circumstances and depending on the associated co-morbidities, bilirubin accumulation may lead to short- or long-term neuro-developmental disabilities, which may include deficits in auditory, cognitive, and motor processing. Neuronal cell death, astrocytic reactivity, and microglia activation are part of the bilirubin-induced pathogenesis. Less understood is how abnormal growth and maturation of oligodendrocytes may impact on brain development, affecting the formation of myelin tracts. Based on in-vitro and in-vivo models, as well as in clinical cases presented here, we propose the existence of impaired myelination by bilirubin with long-term sequelae, mainly in pre-term infants. Sensitive time-windows are highlighted and centered on the different developmental-dependent impairments determined by bilirubin, and the influence of sepsis and hypoxia is reviewed. (C) 2014 Elsevier Ltd. All rights reserved.
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