儿科学课件：五年制neonate总论

1、General Considerations of NeonatesGeneral ConsiderationsNeonate, Newborn 新生儿是指从出生到生后28天内的婴儿。 Perinatology 围产（生）期是指胎龄满28周到出生后7天。Neonatology 新生儿学是研究新生儿保健生理病理和疾病防治的一门学科。 WHO standard live birth: Any infant whose birth weight larger than 500g with one or more of the manifestations below: respiration, he

2、art beat, pulsation of umbilical vessel or muscle contraction.Classifications of neonatesSpecial features & nursing of full-term and preterm infantsClassificationsofneonates1 by gestational age(GA): term infant: 37 we and 42 we 足月儿 preterm infant: 37 we 早产儿 post-term infant: 42 we 过期产儿2 by birth wei

3、ght（BW）: extremely low birth weight (ELBW): BW 1000g 超低出生体重儿 very low birth weight (VLBW): BW 1500g 极低出生体重儿 low birth weight infant (LBW): BW 4000g 巨大儿2 by birth weight（BW）: 3 by the relationship between birth weight and gestational age: small for gestational age infant(SGA)* 小于胎龄儿（足月小样儿） appropriat

4、e for gestational age infant(AGA) 适于胎龄儿 large for gestational age infant(LGA) 大于胎龄儿4 by the weeks age after birth: early newborn: within 1w 早期新生儿 late newborn: 2-4w 晚期新生儿5 high risk infant: 高危儿 had suffered or may suffer from severe diseases.High risk factors: maternal factors, abnormal pregnant and

5、 labor, neonatal diseases Lever nursery Lever nursery Lever nursery neonatal intensive care unit,NICU6 Grading of the neonatal wardneonatal intensive care unit,NICUNeonatal Transport SystemSpecial Features & Nursing of term and Preterm InfantsNormal term infant Any live infant whose gestational age

6、is from 37 to 42 weeks with birth weight 2.5kg and 4kg, mature systems and organs and no malformation or disease.Preterm infant(premature infant) Any live infant whose gestational age is before 37 weeks with birth weight 2.5kg and immature systems and organs.1 Comparisons of the outlooks of the pret

7、erm and full-term infantsComparisons of the outlooks of the preterm and full-term infants足月儿早产儿1.Skin红润、皮下脂肪丰富。毳毛少发亮、水肿，毳毛 多2. Hair分条清楚、粗黑头发细Comparisons of the outlooks of the preterm and full-term infantsComparisons of the outlooks of the preterm and term infantsComparisons of the outlooks of the p

8、reterm and full-term infants足月儿早产儿3. Ears软骨发育良好，耳舟成形直挺发育差，软、紧贴颅骨，耳舟不清楚（不能直挺）4.Nail达到或超过指尖未达指尖5. HeadBig, 1/4 to the body lengthRelatively bigger, 1/3 to the body lengthComparisons of the outlooks of the preterm and term infantsComparisons of the outlooks of the preterm and full-term infants足月儿早产儿6.f

9、ootprint足纹遍及整个足底足底纹理少7. breast结节明显4mm无结节/结节4mm8.External malegenitalorgans female男婴睾丸下降，阴皱裂形成 女婴大阴唇发育好，覆盖小阴唇男婴睾丸未下降，阴皱裂少女婴大阴唇发育差，未盖小阴唇Comparisons of the outlooks of the preterm and full-term infantsComparisons of the outlooks of the preterm and full-term infantsComparisons of the outlooks of the pre

10、term and full-term infantsComparison of the features between preterm and term infantComparison of the features between preterm and term infantComparisons of the outlooks of the preterm and full-term infants足月儿早产儿9.crying响亮，反应好哭声弱，反应差10.Muscular tension正常降低2 physiologic features 2.1 Respiratory syste

11、m 呼吸系统2.2 Cardiovascular system 心血管系统2.3 Digestive system 消化系统2.4 Urinary system 泌尿系统2.5 Hematologic system 血液系统2.6 Neurological system 神经系统2.7 Body temperature 体温调节2.8 Immunity system 免疫系统2.9 Energy & body fluid metabolism 能量及体液代谢2.1 Respiratory system first cry fluid in the lung respiratory rate a

12、nd rhyme respiratory tract pulmonary surfactant2.2 Cardiovascular system: changes of the blood circulation: *deligation of the umbilical artery and vein *foundation of the pulmonary circulation *pressure of the systemic circulation *shutting of the foramen ovale *shutting of the arterial duct persis

13、tent fetal circulation,PFC heart rate and blood pressure2.2 Cardiovascular system: 2.3 Digestive systemsuck and swallowstomach sphincter of the esophagus and pyloricIntestinedigestive enzymeMeconiumhepatic enzyme2.3 Digestive system2.4 Urinary system urine concentration and dilution micturition and

14、urine volume exclude sodium acid-base balance renal glucose threshold later metabolic acidosis2.5 Hematology system HGB, HbF, physiological anemia Ret WBC PLT total blood volume coagulation factors(II VII IX X)2.6 Neurological system GAGA:24-28wGA:12wGA:1w2.6 Neurological system2.6 Neurological syst

15、em brain weight head circumference spinal cord primary reflex: rooting reflex, sucking reflex, grasp reflex, Moro reflex nervous reflex2.6 Neurological system2.7 Body temperature body temperature regulation neutral temperature2.8 Immunity system non-specific immunity specific immunity 2.9 Energy & b

16、ody fluid metabolism calorie demand fluid demand electron demand 2.10 Special physiologic condition physiologic jaundice 生理性黄疸 epithelial ball 上皮珠 fat pad 脂肪垫、螳螂嘴 hyperplasic of mammary glands 乳腺肿大 pseudomenstruation 假月经 skin rash 新生儿红斑、粟粒疹 physiologic loss of body weight 生理性体重下降 2.10 Special physiologic condition 3 Nursing of fullterm & preterm infants Nursing of fullter