新生儿疾病neonatal disease

1、 Neonatal Problems Arrangement 今日安排1. Review the associated knowledge (25 )2. Clinical probation in neonatal department (75 ) 3. Summary (20 )nFamilia with the difference of preterm neonate and term neonatenGet hold of clinical manifestation of neonate pnemonianGet hold of difference of physiologica

2、l and pathological jaundiceObjective and Request DefinationNeonate- 新生儿 028 days Infant-婴儿01 years old.Definition of Neonate(1): related to GAnPreterm/ premature neonate:37 w 早产儿n Term neonate: 3742 w 足月儿n Post-term neonate: 42 w 过期产儿 How to identify 怎样识别nskinnhead and hairnearnthenarngalactophoreng

3、enitaliaDifference of term and preterm skin 皮肤Difference of term and preterm thenar 足纹Difference of term and preterm galactophore乳腺Difference of term and preterm ear conch耳壳Difference of term and preterm genitalia 生殖器Difference of term and preterm head and hair头部及毛发Definition of Neonate(2): related

4、to BW （measure within 1st hour after birth）Tiny baby BW1000gVery low birth weight BW1500gLow birth weight BW4000gDefinition of Neonate(3): related to both GA & BWSmall for gestational age SGA 小于胎龄儿Appropriated for gestational age AGA 适于胎龄儿Large for gestational age LGA 大于胎龄儿Definition of Neonate(

5、4): related to agelEarly baby (perinatal baby):早期新生儿早期新生儿 neonate in first 7 days lLate baby : 晚期新生儿晚期新生儿 above 7 daysDefinition of Neonate(5): High risk baby 高危新生儿高危新生儿 Is the baby who have severe conditions and need intensive care after birth, usually are those with maternal disease or abnormal de

6、livery history. e.g, preterm baby, asphyxia （窒息）, congenital disease（先天性疾病），ect. Some Common DiseasesnHyaline Membrane Disease (HMD)nAsphyxianHypoxic ischaemic encephalopathy(HIE) nPneumonianPulmonary HemorrhagenJaundice Definition The yellow skin and mucus because of too high concentration of bilir

7、ubin in the blood. Two types of neonatal jaundicesneonatal jaundices physiological pathological 生理性黄疸生理性黄疸 病理性黄疸病理性黄疸 case 1 n李X,10 days, female,preterm neonatenonset of jaundice, 3 days after birthntotal bilirubin:13.5mg/dlndirect bilirubin:1.4mg/dlnbirth weight:2.4kg, now weight:2.8kgnfed well, sl

8、eep wellnno fever, no cyagnosis, no diarrhea.Comparison ItemPhysiologicalPathologicalonset time2-3 d1 dbilirubin level12.9mg/dl term12.9mg/dl term15mg/dl pretermincrease velocity5mg/dldirect bil level2mg/dldisappear time2 w term2 w term4 w pretermreturnnot commoncommonPathological jaundice（remember）

9、nOnset too early Onset too early 出现早出现早nBilirubin level too high Bilirubin level too high 水平高水平高nIncrease too fast Increase too fast 发展快发展快nDisapDisapp pear too late ear too late 消褪晚消褪晚 nD.bilirubin D.bilirubin level too highlevel too high 直接高直接高 nReturn Return 易反复易反复 （很重要，要记住）很重要，要记住）Classification

10、 of jaundicenUnconjugated hyperbilirubinemia (avoid kernicterus)nConjugated hyperbilirubinemia (early diagnosis of biliary atresia)ManagementnUnconjugated hyperbilirubinemiaqPhototherapy：wavelength 450nmqAlbumin therapy qActivator of enzyme：phenobarbital 5mg, nikethamide 100mg，tid for 35dqBlood tran

11、sfusion ManagementnConjugated hyperbilirubinemia usually need etiological treatment or surgery operation 新生儿肺炎新生儿肺炎 Neonate PneumoniaDiagnosisnAntepartum pneumonia : early-onset within 24 h after birth, CMV, TOX, Ecoli, GBS are usual pathogensnPostpartum pneumonia: same as pneumonia in children but

12、usually severe , Virus, bacterium, fungus all can be the pathogen ManifestationnIrregular breathingnApneanTachypneanNasal flaringnthree depression sign(sternal, intercostal, subcostal)nCyanosisDiagnosisnClinical Manifestation: irregular breathing,dyspnea,tachypnea etcnRadiological Findings:some patc

13、hy shadows,empyema,atelectasis,pneumothorax can be seen X-raypneumoniaatelectasis X-raypneumothoraxpleural effusionTreatment nRespiratory tract management (slap back, suction,nebulization)nOxygen therapy(avoid ROP)nAntibiotics nOthers: balance of energy & acid- base, electrolytes, etc What diseases we will see in clinic?nAsphyxia of newbornnNeonatal jaundicenNeonatal hypoxic-i