新生儿疾病neonatal disease.ppt

NeonatalProblems,Arrangement今日安排,1.Reviewtheassociatedknowledge(25)2.Clinicalprobationinneonataldepartment(75)3.Summary(20),FamiliawiththedifferenceofpretermneonateandtermneonateGetholdofclinicalmanifestationofneonatepnemoniaGetholdofdifferenceofphysiologicalandpathologicaljaundice,目的要求ObjectiveandRequest,Defination,Neonate-新生儿028daysInfant-婴儿01yearsold.,DefinitionofNeonate(1):relatedtoGA,Preterm/prematureneonate:37w早产儿Termneonate:3742w足月儿Post-termneonate:42w过期产儿,Howtoidentify怎样识别,skinheadandhairearthenargalactophoregenitalia,Differenceoftermandpretermskin皮肤,Differenceoftermandpretermthenar足纹,Differenceoftermandpretermgalactophore乳腺,Differenceoftermandpretermearconch耳壳,Differenceoftermandpretermgenitalia生殖器,Differenceoftermandpretermheadandhair头部及毛发,DefinitionofNeonate(2):relatedtoBW,（measurewithin1sthourafterbirth）TinybabyBW4000g,DefinitionofNeonate(3):relatedtobothGA&BW,SmallforgestationalageSGA小于胎龄儿AppropriatedforgestationalageAGA适于胎龄儿LargeforgestationalageLGA大于胎龄儿,DefinitionofNeonate(4):relatedtoage,Earlybaby(perinatalbaby):早期新生儿neonateinfirst7daysLatebaby:晚期新生儿above7days,DefinitionofNeonate(5):Highriskbaby高危新生儿,Isthebabywhohavesevereconditionsandneedintensivecareafterbirth,usuallyarethosewithmaternaldiseaseorabnormaldeliveryhistory.e.g,pretermbaby,asphyxia（窒息）,congenitaldisease（先天性疾病），ect.,SomeCommonDiseases,HyalineMembraneDisease(HMD)AsphyxiaHypoxicischaemicencephalopathy(HIE)PneumoniaPulmonaryHemorrhageJaundice,新生儿黄疸(NeonatalJaundice),Definition,Theyellowskinandmucusbecauseoftoohighconcentrationofbilirubinintheblood.,Twotypesofneonataljaundices,neonataljaundicesphysiologicalpathological生理性黄疸病理性黄疸,case1,李X,10days,female,pretermneonateonsetofjaundice,3daysafterbirthtotalbilirubin:13.5mg/dldirectbilirubin:1.4mg/dlbirthweight:2.4kg,nowweight:2.8kgfedwell,sleepwellnofever,nocyagnosis,nodiarrhea.,Comparison,Pathologicaljaundice（remember）,Onsettooearly出现早Bilirubinleveltoohigh水平高Increasetoofast发展快Disappeartoolate消褪晚D.bilirubinleveltoohigh直接高Return易反复（很重要，要记住）,Classificationofjaundice,Unconjugatedhyperbilirubinemia(avoidkernicterus)Conjugatedhyperbilirubinemia(earlydiagnosisofbiliaryatresia),Management,UnconjugatedhyperbilirubinemiaPhototherapy：wavelength450nmAlbumintherapyActivatorofenzyme：phenobarbital5mg,nikethamide100mg，tidfor35dBloodtransfusion,Management,Conjugatedhyperbilirubinemiausuallyneedetiologicaltreatmentorsurgeryoperation,新生儿肺炎NeonatePneumonia,Diagnosis,Antepartumpneumonia:early-onsetwithin24hafterbirth,CMV,TOX,Ecoli,GBSareusualpathogensPostpartumpneumonia:sameaspneumoniainchildrenbutusuallysevere,Virus,bacterium,fungusallcanbethepathogen,Manifestation,IrregularbreathingApneaTachypneaNasalflaringthreedepressionsign(sternal,intercostal,subcostal)Cyanosis,Diagnosis,ClinicalManifestation:irregularbreathing,dyspnea,tachypneaetcRadiologicalFindings:somepatchyshadows,empyema,atelectasis,pneumothoraxcanbeseen,X-ray,pneumonia,atelectasis,X-ray,pneumothorax,pleuraleffusion,Treatment,Respiratorytractmanagement(slapback,suction,nebulization)Oxygentherapy(avoidROP)AntibioticsOthers:balanceofenergy&acid-base,electrolytes,etc,Whatdiseaseswewillseeinclinic?,AsphyxiaofnewbornNeonataljaundiceNeonatalhypoxic-ischae