新生兒疾病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- 新生兒 028 days Infant-嬰兒01 years old.Definition of Neonate(1): related to GAnPreterm/ premature neonate:37 w 早產(chǎn)兒n Term neonate: 3742 w 足月兒n Post-term neonate: 42 w 過(guò)期產(chǎn)兒 How to identify 怎樣識(shí)別nskinnhead and hairnearnthenarngalactophoreng

3、enitaliaDifference of term and preterm skin 皮膚Difference of term and preterm thenar 足紋Difference of term and preterm galactophore乳腺Difference of term and preterm ear conch耳殼Difference of term and preterm genitalia 生殖器Difference of term and preterm head and hair頭部及毛發(fā)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 小于胎齡兒Appropriated for gestational age AGA 適于胎齡兒Large for gestational age LGA 大于胎齡兒Definition of Neonate(

5、4): related to agelEarly baby (perinatal baby):早期新生兒早期新生兒 neonate in first 7 days lLate baby : 晚期新生兒晚期新生兒 above 7 daysDefinition of Neonate(5): High risk baby 高危新生兒高危新生兒 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?。?，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 生理性黃疸生理性黃疸 病理性黃疸病理性黃疸 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 出現(xiàn)早出現(xiàn)早nBilirubin level too high Bilirubin level too high 水平高水平高nIncrease too fast Increase too fast 發(fā)展快發(fā)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 易反復(fù)易反復(fù) （很重要，要記?。┖苤匾?，要記?。〤lassification

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 新生兒肺炎新生兒肺炎 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