新生儿医学简介（英文）

Neonatal Medicine -Introduction Xiaoping Luo, MD Professor and Chairman Department of Pediatrics, Tongji Hospital Director, Center for the Diagnosis of Genetic Metabolic Diseases Tongji Medical College Huazhong University of Science and Technology Adjunct Professor Department of Paediatrics Faculty of Medicine University of Toronto Toronto, Canada Historical Perspectives Early History of Care of Infants (1900Early History of Care of Infants (1900 - small infants were not expected to live - small infants were not expected to live - temperature: hot-water bottles, heated cribs - temperature: hot-water bottles, heated cribs - feeding: tube feeding, diluted cow milk - feeding: tube feeding, diluted cow milk - separated facilities, isolation, washing hands - separated facilities, isolation, washing hands - hyaline membrane diseases-respiratory distress syndrome - hyaline membrane diseases-respiratory distress syndrome - 1940s, modernized incubator, more oxygen - 1940s, modernized incubator, more oxygen - 1940s, - 1940s, retrolental fibroplasiaretrolental fibroplasia - 1945, - 1945, The Physiology of the Newborn InfantThe Physiology of the Newborn Infant- -C. SmithC. Smith Historical Perspectives Rapid Advances in Neonatal Care Rapid Advances in Neonatal Care (19551970) (19551970) - 1959, surfactant deficiency, - 1959, surfactant deficiency, Avery ME, Mead J. Am J Avery ME, Mead J. Am J Dis Dis ChildChild - 1960, - 1960, Disease of the NewbornDisease of the Newborn- -NeonatologyNeonatology - -A. SchafferA. Schaffer - - culture, blood counts, urinalyses, radiographs, biopsiesculture, blood counts, urinalyses, radiographs, biopsies - milk formulas, breast milk bank - milk formulas, breast milk bank - iv glucose 119:417 Physical and Neuromuscular Criteria for Maturity Dubowitz/Ballard Exam for Gestational Age Sucking Palmar grasp Response to traction Moro reflex Crossed extension Automatic walking Roof reflex Pupillary response Neurological Reflexes F Body temperature heat loss by evaporation, radiation and convection F Neutral thermal enviroment The range of ambient temperature and humidity at which heat loss is minimal and metabolic demands and oxygen consumption are the lowest. Depends on body weight and age 31 to 34 C at 50% humidity for undressed normal term infant Skin temperature vs central or core temperature (rectal) Re-warming a hypothermic infant at moderate rate (24hrs) F Thermal regulation Physiological Characteristics F 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 respiration (20s, with bradycardia 2.5 6080 80100 100140 Physiological Characteristics F Apgar score F Maintenance of body heat F Antiseptic skin and cord care F Eyes protection F Respiratory management Routine Care F Feeding F Vitamin K1 F Vaccination F Neonatal screening F Parent-infant bonding F Mechanical ventilation F Cardiopulmonary Disorder F Post surgery (24h) F GA30, VLBWI F TPN FSustained convulsion FCentral tubing Neo