新生儿医学-简介（英文）课件

1、Neonatal Medicine-IntroductionXiaoping Luo, MDProfessor and ChairmanDepartment of Pediatrics, Tongji HospitalDirector, Center for the Diagnosis of Genetic Metabolic Diseases Tongji Medical CollegeHuazhong University of Science and TechnologyAdjunct ProfessorDepartment of PaediatricsFaculty of Medici

2、neUniversity of TorontoToronto, CanadaHistorical PerspectivesEarly 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 d

3、iseases-respiratory distress syndrome - 1940s, modernized incubator, more oxygen - 1940s, retrolental fibroplasia - 1945, The Physiology of the Newborn Infant-C. Smith Historical PerspectivesRapid Advances in Neonatal Care (19551970) - 1959, surfactant deficiency, Avery ME, Mead J. Am J Dis Child -

4、1960, Disease of the Newborn-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 ventilationHistorical PerspectivesEmergence of neona

5、tal Intensive Care (19711989) - 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 materna

6、l care and NICU - transferring of high risk infants or mothers - high risk and long term outcome - 1980s, extracorporeal membrane oxygenation (ECMO)Historical PerspectivesExpansion of Clinical Trials to Assess Therapy: the Surfactant Era (19801996) - 1970s1990s, glucocorticoids to accelerate lung ma

7、turation - 1980, first surfactant 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 spa

8、ce station” Le Tour dabandon(Decertion Tower)Century of Progress International ExpositionChicago Worlds Fair, Chicago, IllinoisHow small is too small?How much is too much?Life support:To continue or discontinue?Definitions of Terms Newborn or neonate refers to a infant period from birth to 28 days.

9、Neonatologyhealth 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 life. Perinatal period extends from the 28th completed week of pregnancy to the 7th day of life. Perinatology or Perinatal Medici

10、neBirth Weight vs Gestational Age (GA) BW the 90th percentile - large for gestational age (LGA) ponderal index = BW(g)X100/Length3 (cm3) (22.2) Length/Head Circumference (HC) (1.36) symmetric or unsymmetric SGA Definitions of TermsBirthweight Curves California male singleton Caucasian non-Hispanic b

11、irthweights by gestational age: 10th, 50th, and 90th percentiles.Pregnancies in which factors exist that increase the likelihood of maternal or fetal diseasesEconomic, cultural-behavioral, biologic-genetic, reproductive and medical factors1020% of pregnant patient can be identified as high risk50% o

12、f all perinatal mortality and morbidity is associated with high risk pregnancyHigh Risk PregnancyAn infant who should be under close observation by experienced physicians and nurses. 9% of all births require intensive careFetal or neonatal factors: premature labor, postdates, fetal distrass, breech

13、presentation, meconium-stained fluid, nuchal cord, Cesarean section, forceps low Apgar score, BW4000, SGA or LGA, congenital malformation, tachypnea, cyanosis, pallor, plethora, petechiaeHigh Risk InfantPhysical Criteria Skin Lanugo hair Plantar surface Breast Hair Finger nail Ear/Eye Genitals Neuro

14、muscular Criteria Posture 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; 119:417Physical and Neuromuscular Criteria for MaturityDubowitz/Ballard Exam for Gestational Age Sucking Palmar grasp Respo

15、nse to traction Moro 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 metaboli

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

17、 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 1st hour, 40/min after brief pauses in respiratio

18、n (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

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

20、enal causes: 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

21、/L, change with age Fetal hemoglobin: HbF 70%, HbA 30% WBC:1520X109/L for term baby 68X109/L for preterm baby Platelet: 150250X 109/L Blood volume: 50100ml/kg for term baby 89105ml/kg for preterm babyPhysiological Characteristics Neurological System brain: 300400g, 1020% of body weight (adult 2%) head circumference: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 signPhysiological Cha