新生儿课件：Premature newborn infant

1、Premature newborn infant Prematurity GA 259 days (37 weeks) (Low birth weight infants.)Preterm infants Slight 32-36 weeks Feeding and temperature problems, some have immature lungs Moderate 28-31 weeks Immature lungs, temperature control, feeding problems, apneas Severe 28 weeks Immature organ syste

2、ms, intensive careTerminology Low birth weight 2.5 kg Very Low Birth Weight 1.5 kg Extremely Low birth Weight 1.0 kg Premature 37 weeks (Immature 28 weeks ELGAN: Extremely Low Gestational Age Newborn 26 weeks)General problems in premature infants Feeding: (IV Gavage) Temperature control: (Incubator-

3、heated bed) Respiratory control: Apneas, Respiratory support CPAP, Artificial ventilation Immature lungs lack of surfactant: Oxygen suppl, Respiratory support (CPAP, Ventilator) Immature brain: Brain hemorrhage and cysts Immunology: risk of infections (Antibiotics) Organ injury (Brain, Eye, Lung, In

4、testine, Skin) Long term consequencesCurrent situationIn 2007, there were 546,602 preterm births in the United States, representing 12.7% of live births or 1 in eight babies. Preterm birth costs the United States more than $26 billion annually according to the Institute of Medicine. Prematurity is t

5、he leading cause of New born death. Between 1997 and 2007, the rate of infants born preterm in the United States increased more than 11%.Source: National Center for Health Statistics, final natality data. Retrieved March 01, 2011, 90% infants with BW 1500-2500 gram survive The VLBW infants accounts

6、for over 50% of neonatal deaths and 50% handicapped neonates. SurvivalGestational age weeks Survival % 21 0-4 22 0-12 23 8-36 24 12-62 25 31-79 26 53-85NFRs Consensus report 1999SequelsFrom 1979 to 1994 survival among preterm infatns with BW 501-800 g increased from 20 to 59%. The percentage of chil

7、dren with severe neurosensory injury was however, unchanged (OShea 1997)Injury of ELGANs 1972-1990 26 uker 4000 children)Injury of preterm infants Eye ( Retinopathy of prematurity ROP Stage 1-5) Brain injury (Intracranial hemorrhage (grade 1-4) Periventricular leukomalacia (PVL). Immature capillarie

8、s (plexus Choroides), hemodynamic changes, intrauterine inflammation Pulmonary ( Bronchopulmonary dysplasia - BPD, Chronic lung disease - CLD) Intestinal (necrotizing enterecolitis - NEC)Development and pathogenesis of ROPImpact of BPD, Brain Injury & ROP on 18 m Outcome of ELBW InfantsSchmidt B et

9、al. JAMA. March 2003;289:1121-29“ A simple count of 3 common neonatal morbidities strongly predicts the risk of later death or disability ”Overall probability of a poor outcome 18 m (35%)School problems A Dutch study showed that 50% with BW girls Low Socioeconomic conditionsFuture challenges Prevent preterm birth Understand relation between intrauterine conditions and postnatal injury Im