新生儿医学-简介英文ppt课件.ppt

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1、新生儿医学,-,简介（英文）,Historical Perspectives,?,Early,History,of,Care,of,Infants,(1900,-,small,infants,were,not,expected,to,live,-,temperature:,hot-water,bottles,heated,cribs,-,feeding:,tube,feeding,diluted,cow,milk,-,separated,facilities,isolation,washing,hands,-,hyaline,membrane,diseases-respiratory,dist

2、ress,syndrome,-,1940s,modernized,incubator,more,oxygen,-,1940s,retrolental,fibroplasia,-,1945,The,Physiology,of,the,Newborn,Infant,-,C.,Smith,Historical Perspectives,?,Rapid,Advances,in,Neonatal,Care,(19551970),-,1959,surfactant,deficiency,Avery,ME,Mead,J.,Am,J,Dis,Child,-,1960,Disease,of,the,Newbor

3、n,-,Neonatology,-,A.,Schaffer,-,culture,blood,counts,urinalyses,radiographs,biopsies,-,milk,formulas,breast,milk,bank,-,iv,glucose,&,bicarbonate,-,blood,gas,analysis,-,improved,incubators,-,early,attempts,of,mechanical,ventilation,Historical Perspectives,?,Emergence,of,neonatal,Intensive,Care,(19711

4、989),-,1971,continuous,positive,airway,pressure,(CPAP),-,Gregory,-,neonatal,intensive,care,unit,(NICU),-,designated,by,level,according,to,the,intensity,of,service,I:,normal,birthing,and,NB,care,II:,common,obstetric,complications,&,intermediate,NB,care,III:,high,risk,maternal,care,and,NICU,-,transfer

5、ring,of,high,risk,infants,or,mothers,-,high,risk,and,long,term,outcome,-,1980s,extracorporeal,membrane,oxygenation,(ECMO),Historical Perspectives,?,Expansion,of,Clinical,Trials,to,Assess,Therapy:,the,Surfactant,Era,(19801996),-,1970s1990s,glucocorticoids,to,accelerate,lung,maturation,-,1980,first,su

6、rfactant,replacement,therapy,in,humans,-,total,parenteral,nutrition,(TPN),-,high,frequency,oscillators,-,inhaled,nitric,oxide,-,prenatal,diagnosis,and,genetic,counseling,-,prospective,controlled,clinical,trials,for,intervention,-,“quiet,premature,nursery”,to,“a,bustling,space,station”,Le Tour daband

7、on,(Decertion Tower),Century of Progress International Exposition,Chicago Worlds Fair,Chicago,Illinois,The Dionne quintuplets,May 28,1934,13 pounds 6 ounces,All together!,Emelie,Cecile,Marie,Annette,Yvonne,Julius Hess,“quiet premature nursery”,How small is too small?,How much is too much?,Life suppo

8、rt:,To continue or discontinue?,Definitions of Terms,?,Newborn or neonate,refers to a infant period from birth to 28,days.,Neonatology,health care,pathophysiology and management,?,Early Neonate,refers to the first 7 completed days of life.,?,Late Neonate,refers to a period between 8 to 28 days of li

9、fe.,?,Perinatal period,extends from the 28,th,completed week of,pregnancy to the 7,th,day of life.,Perinatology or Perinatal Medicine,Definitions of Terms,?,Term,defines births that occur from 37,th,to less than 42 completed,weeks,measured from the day of onset of the last normal menstrual,period(25

10、9293 days,with an average of 280 days).,?,Preterm,is defined as less than 37 completed weeks,or 259 days,gestation.(37weeks of gestation birth weight of 3000g),?,Post-term,refers to births that occurs at 42 or more completed,weeks(294 days).,?,Stillbirth and Fetal Death.,Early fetal death,occurs at

11、20 completed weeks of gestation,intermediate fetal death,occurs 20 and 28 completed weeks,late fetal death,occurs after 28weeks,or termed as,stillbirth.,?,Live Birth.WHO defines,live birth,as,The complete expulsion or extraction from its mother of a product,of conception,irrespective of the duration

12、 of pregnancy,which after,such separation,breathes or any other evidence of life,such as,beating of the heart,pulsation of the umbilical cord,or definite,movement of voluntary muscles,whether or not the umbilical cord,has been cut or the placenta is attached;each product of such a birth,is considere

13、d liveborn.,Definitions of Terms,?,Birth Weight(BW),BW 2500g-,Low Birth Weight(LBW);,1500g-,Very Low Birth Weight(VLBW);,1000g-,Extremely,Low Birth Weight(ELBW);,4000g-,Fetal Macrosomia,(Beckwith-Wiedemann syndrome,Infant of Diabetic Mother,IDM),Definitions of Terms,?,Birth Weight vs Gestational Age

14、(GA),BW the 10,th,percentile,-,small for gestational age(SGA),intrauterine growth restriction(IUGR),10 90,th,percentile,-,appropriate for gestational age(AGA),the 90,th,percentile,-,large for gestational age(LGA),ponderal index=BW(g)X100/Length,3,(cm,3,),(22.2),Length/Head Circumference(HC),(1.36),s

15、ymmetric or unsymmetric SGA,Definitions of Terms,Birthweight Curves,California male singleton Caucasian non-Hispanic birthweights,by gestational age:10th,50th,and 90th percentiles.,?,Pregnancies in which factors exist that increase,the likelihood of maternal or fetal diseases,?,Economic,cultural-beh

16、avioral,biologic-genetic,reproductive and medical factors,?,1020%of pregnant patient can be identified as,high risk,?,50%of all perinatal mortality and morbidity is,associated with high risk pregnancy,High Risk Pregnancy,?,An infant who should be under close observation by,experienced physicians and

17、 nurses.,?,9%of all births require intensive care,?,Fetal or neonatal factors:,premature labor,postdates,fetal distrass,breech presentation,meconium-stained fluid,nuchal cord,Cesarean section,forceps,low Apgar score,BW4000,SGA or LGA,congenital,malformation,tachypnea,cyanosis,pallor,plethora,petechi

18、ae,High Risk Infant,?,Fetal Growth and Maturity,embryonic period(18 wks):early embryogenesis,fetal period(9 wksbirth):growth and maturation,?,Factors Affecting Fetal Growth,genetic,geographic,social and economic factors,maternal conditions:stature,age,disease and medication,fetal:sex,multiple pregna

19、ncy,genetic disease,infection,?,Fetal Monitoring,maternal serum,chorion villi,amniotic fluid,placenta,fetal heart rate,ultrasound,blood gas and pH,Fetal Growth and Monitoring,?,Physical Criteria,Skin Lanugo hair,Plantar surface Breast,Hair Finger nail,Ear/Eye Genitals,?,Neuromuscular Criteria,Postur

20、e Square window(wrist),Arm recoil Popliteal angle,Scarf sign Heel to ear,New Ballard Score(NBS)for Maturity Rating,Ballard JL,et al,J Pediatr 1991;119:417,Physical and Neuromuscular,Criteria for Maturity,Dubowitz/Ballard Exam,for Gestational Age,?,Sucking,?,Palmar grasp,?,Response to traction,?,Moro

21、 reflex,?,Crossed extension,?,Automatic walking,?,Roof reflex,?,Pupillary response,Neurological Reflexes,?,Body temperature,heat loss by evaporation,radiation and convection,?,Neutral thermal enviroment,The range of ambient temperature and humidity at,which heat loss is minimal and metabolic demands

22、 and,oxygen consumption are the lowest.,?,Depends on body weight and age,?,31 to 34 o,C,at 50%humidity for undressed normal term infant,?,Skin temperature vs central or core temperature(rectal),?,Re-warming a hypothermic infant at moderate rate(24hrs),?,Thermal regulation,Physiological Characteristi

23、cs,?,Cardiopulmonary Function,heart rate:120130bpm,tachycardia/bradycardia;transition from FC,blood pressure:6595/3060mmHg,lower in preterm,PDA in preterm,lung fluid:3035ml/kg,“excretion/re,-,absorption”,“wet lung”,respiratory rate:6080/min in the 1,st,hour,40/min after,brief pauses in respiration(5

24、9s),apnea(20s,with bradycardia 100bpm),Physiological Characteristics,?,Gastrointestinal Function,vomiting and abdominal distension,swallowed maternal blood,GI malformation,infection,first feeding,nutritional issues,tracheo-esophageal fistula,jaundice,passage of meconium,70%within 12h,25%in 1224h,5%b

25、y 48h,distal intestinal obstruction,meconium plug syndrome,Hirschsprungs disease,sepsis,hypothyroidism,nacortic,necrotizing enterocolitis(NEC),premature,hypoxia and ischemia,infection,feeding,Physiological Characteristics,?,Urinary Function,urinate,68%within 12h,25%in 1224h,7%by 48h,pre-renal causes

26、:dehydration,shock,renal abnormality:renal agenesis,tubular necrosis,obstruction of urinary outflow:urethral valves,late onset metabolic acidosis in premature infant,cow milk feeding with high protein load,Physiological Characteristics,?,Hematological System,hemoglobin:,cord blood 170g/L,change with

27、 age,Fetal hemoglobin:,HbF 70%,HbA 30%,WBC:,1520X10,9,/L for term baby,68X10,9,/L for preterm baby,Platelet:,150250X 10,9,/L,Blood volume:,50100ml/kg for term baby,89105ml/kg for preterm baby,Physiological Characteristics,?,Neurological System,brain:,300400g,1020%of body weight(adult 2%),head circum

28、ference:,3334cm,increase by 1cm/month,spinal cord:,ends at L34,caution for lumbar puncture,physiological reflexes:,rooting,sucking,grasp,Moro,Pathological reflexes:,Kernig,Babinski,Chvostek sign,Physiological Characteristics,?,Immunological System-,immaturity,skin and mucous membrane,complements and

29、 chemokine,T cell function,Immunoglubulins,Physiological Characteristics,?,Fluid requirement(ml/kg),BW(kg)Day 1 Day 2 Day 37,1.0,70100 100120 120180,1.01.5,70100 100120 120180,1.52.5,6080 80100 110140,2.5,6080 80100 100140,Physiological Characteristics,?,Apgar score,?,Maintenance of body heat,?,Anti

30、septic skin and cord care,?,Eyes protection,?,Respiratory management,Routine Care,?,Feeding,?,Vitamin K1,?,Vaccination,?,Neonatal screening,?,Parent-infant bonding,?,Mechanical ventilation,?,Cardiopulmonary Disorder,?,Post surgery(24h),?,GA30,VLBWI,?,TPN,?,Sustained convulsion,?,Central tubing,Neonatal Intensive Care Unit,(NICU),?,Heart,?,Respiration,?,Blood pressure,?,Body temperature,?,Blood Gas,?,Biochemistry,?,Imaging,Tongji Hospital,Thanks for,learning,Doc!,