常见的高危婴儿

1、Common High Risk Infants常见的高危婴儿 Marcy Mallouf RN, IBCLC, RLCLucile Packard Childrens Hospital/Stanford University/M. Mallouf, 2010 Identifying the Common High Risk Infant辨认常见的高危婴儿Caesarian Sectioned Infants剖腹产儿Late Pre-Term Infants (34 37 weeks gestation晚期早产儿（产龄在34-37周）Low Birth Weight (less than 2.

2、7 kg or 6 lbs)低体重儿（出生体重低于2.7公斤）Multiples多胎Infants Born by Caesarian Section剖腹产儿Minor / transient respiratory distress轻度或过渡性呼吸困难Anesthesias effect on infant and mom麻醉对婴儿和母亲的影响Mom not able to breastfeed without assistance母亲哺乳需要帮助Delayed lactogenesis III (milk coming in)延缓泌乳期Tongue movement anomalies i

3、n infant婴儿舌头运动异常Lactation Support after Caesarian Delivery剖腹产后的哺乳指导与帮助Initiate breastfeeding early breastfeeding 早期启动母乳喂养Involve family members鼓励家族成员参与 sit by bedside during skin to skin 鼓励母婴肌肤接触 assist mom in positioning 协助母亲找到最舒适的姿式Maintain pain control 止痛Late Pre-Term and Low Birth Weight Infants

4、晚期早产儿与低体重儿The “great pretenders”是最容易被忽视的群体The Late Pre-Term Infant晚期早产儿 “Looks” like a term infant看起来像足月婴儿Considered “not really” premature 认为他们不是真正的早产儿 Considered “almost full term”认为他们接近足月May look like they are breastfeeding well 看起来哺乳没有问题 Make up 70% of all pre-term births 占所有早产儿的70%Late Pre-Term

5、 Infants“An expert panel has suggested that the phrase “Late Pre-Term Infant” conveys the sense that infants that are born between 34 through 36 weeks of gestation are immature and vulnerable and need close monitoring, evaluation, and follow-up.”专家建议：晚期早产儿是指胎龄介于34-36+6周的早产儿，这些早产儿是不成熟儿，高危儿，需要严密观察，评估与

6、随访。Raju TNK, Pediatrics 2008 “Late-Preterm Birth: Challenges and OpportunitiesInfants born at 37 weeks gestation胎龄37周的婴儿比胎龄大于38周的have higher morbidity rates婴儿患病率高compared to infants born at 38 weeksThe Risks for the Late Pre-Term Infant 晚期早产儿的风险因素Respiratory distress呼吸困难Hypoglycemia低血糖Hypothermia低体温

7、Lower Suck Pressure 弱吸吮力Sleepiness嗜睡Hyperbilirubinemia高胆红素血症Higher risk for readmission再入院率高Susceptibility to Sepsis易于感染Higher Incidence of SIDS高突发性婴儿死亡综合症发生率Dehydration脱水Poor Weight Gain体重增长缓慢Susceptibility to SepsisOther Issues of the Late Pre-Term Infant晚期早产儿的其他问题GI tract: immature which may lead

8、 to difficulty in coordinating sucking and swallowing消化道：不成熟的消化道可导致吸吮困难吞咽困难Brain weight only 60% that of term infants大脑的重量仅为足月婴儿的60%Readmission mainly due to jaundice, sepsis, feeding difficulties and FTT (failure to thrive)再入院的原因：黄疸，感染，喂养困难，婴儿生长缓慢Have a higher metabolic rate and limited energy stor

9、es较高的代谢率及有限的能量贮存Breastfeeding Risks for the Late Pre-Term Infant and Mother晚期早产婴儿与母亲的哺乳风险I. Delayed Lactogenesis III: 泌乳期延迟 a. Immature development of breasts- less amount of glandular tissue (secretory cells) 乳腺腺泡组织发育不成熟 b. Less Colostrum removal- decreased suck pressures decreased number of breast

10、feedings sleepiness at breast decreased coordination of suckle 初乳排空不够，吸吮力弱,哺乳次数少，哺乳时睡觉，吸吮不协调。Breastfeeding Risks for the Late Pre-Term Infant and Mother晚期早产儿与母亲的哺乳风险因素 2. Higher Morbidity Readmission to Hospital 高发病率 - 再入院 a. Stress 思想负担 b. Maternal/Infant Separation 母亲与婴儿分开 c. Higher use of Bottles/Pacifiers 人工喂养增加 d. Decreased number of Breastfeedings 母乳喂养次数减少FOUR GOLDEN RULES黄金定律1. Always feed the Baby 坚持母乳喂养2. Always keep something happening at the breast 坚持在乳房上做工作3. Always protect milk supply 维持乳汁产量Always normalize