儿保留学生见习新生儿department of neonatology

DepartmentofNeonatologyTheChildren'sHospitalZhejiangUniversitySchoolofMedicineWith60yearsofhistory,isthelargestcomprehensivecenterforpediatricmedicalcareinZhejiangProvince.Oneofthelargestandbestchildren’shospitalsinChina.Involvedinthefieldsofpediatricmedicalcare,medicaltraining,teaching,research,andpreventivehealthcare.20inpatientwardswithatotalcapacityof850beds.Theannualoutpatientvisitssumuptomorethan1,520,000.Theannualinpatientvisitsarenearly35,000andannualsurgerycasesareover14,000.NEWHOSPITALDepartmentofNeonatologyNeonatalIntensiveCareUnit(NICU)andtheneonatologywards.Nationalkeydiscipline.Sevenchiefphysicians(twoofthemprofessors),fiveassociatechiefphysicians,Morethan30papersindexedbySCIhavebeenpublished.TheNICU,foundedin1984withthesupportofProjectHOPE.Asaprovincialreferralcenter,thedistanttransportteamwasestablishedin2005.Thesmallestpretermbaby562grams.Survivalrateofverylowbirthweightinfantsabove90%.PioneeringonesinChina,suchasnitricoxideinhalationandECMO.Focusingonneonatalrespiratoryfailure,persistentpulmonaryhypertension,managementofverylowbirthweightinfants,andbraindamageinpreterminfants.

LizhongDuMD,PHDChiefofthedepartmentofneonatology.PresidentoftheChildren’sHospital.MemberofSocietiesforPediatricResearch(SPR)(USA)ChairmanofChineseNeonatalSocietySince2007.Editorialmemberofmorethan10internationalorChinesejournalsincludingBMCPediatrics,ResearchandReportinNeonatology,andWorldJournalofPediatrics.InternationalPartnershipCincinnatiChildren’sastheNo.1neonatologyprograminthenation.LomaLindaUniversityChildren’sHospitalNICUOneofthelargestandmostadvancedneonatalcentersintheworld,withnearly90bedsdedicatedtocaringforsomeofthetiniestbabies.

Aspecialareaforinfantswhohaveundergonetransplantsandprematurebabieswhoneedtheaidofspecialmachines.RespiratoryDistress

of

NewbornFocusedrespiratoryhistoryAntepartumgestationandaccuracyofdatesantenatalultrasoundfindingsmaternaldiabetesmaternalGroupBstreptococcus(GBS)statusadministrationofantenatalsteroidsmaternalsubstanceusefamilyhistoryofneonatalrespiratorydisordersFocusedrespiratoryhistoryIntrapartumfetaldistressduringlabouranddeliverypresenceofmeconiumstainedliquordurationofruptureofmembranesevidenceofchorioamnionitis(maternalfever)natureoflabourandrouteofdeliverymedicationsadministrationofintrapartumantibioticsforGBSprophylaxisFocusedrespiratoryhistoryNeonatalumbilicalcordbloodgasconditionatbirth,includingApgarscoreresuscitationeffortsrequiredandresponsetimeofonsetofsymptoms,i.e.,presentfrombirthordevelopedafteraperiodofnormalrespiratoryfunctiongestationalageandbirthweightPhysicalexaminationObservationsymmetryofchestmovementindicatorsoflabouredrespirationskincolourandmucousmembranesforevidenceofcentralcyanosisrespiratorysupportvitalsigns:RR,HR,T,BP,SpO2PhysicalexaminationExaminationAuscultationofbreathsoundspresenceofgrunting,inspiratorystridor,audibleexpiratorywheeze,crackles)presenceofcleftpalateormicrognathia(smalljaw)DiagnostictestsChestradiographBloodgasesCase1Bornat30weeksgestationApgarscore61,85Birthweight1500gramsDevelopedsignsofrespiratorydistressat30minutesCase1PinkRR88/minandregular,HR140bpmLabouredrespirationWellperfused,BP47/25mean33TonenormalTemperature36.4°CCase1RespiratoryDistressSyndrome(RDS)HealthylungRespiratorydistresssyndromeLackofsurfactant,resultinginprogressivecollapseofthealveoliPrimarilyadiseaseofpretermbabies;itsincidenceincreaseswithdecreasinggestationalage.SurfactantadministrationCase1postsurfactantCase1VentilationsettingunchangedBabydeterioratedrapidly,increaseoxygenconcentrationfrom40%to100%,

mottled,heartrateis188bpm,airentryonleftsidedecreasedCase1CausesofsuddendeteriorationinaventilatedbabyD…displacedendotrachealtube?accidentallyextubatedorthetubetoofarin?O…obstructedairwayorendotrachealtube?P…pneumothoraxorothercriticaldiagnosis?E…equipmentworkingandventilationoptimized?Case1Managementofsymptomaticpneumothorax:ChesttubeinsertionNeedleaspirationCase2Unremarkablepregnancy38weeks’gestationElectiveCaesarianSectionPresentedrespiratorydistressimmediatelyafterbirthNeedoxygenCase2TransientTachypneaofthe

Newborn(TTN)/WetlungClearanceofresiduallungfluidisdelayedafterbirthCommonintermornear-termbabies,particularlyinnewbornsbornbyC/SMildtomoderaterespiratorydistressUsuallyresolveoverfewminutestohoursafterbirthaslungfluidisreabsorbedCase342weeksgestationWithfetalcompromiseMeconiumstainedamnioticfluidSevererespiratorydistressIntubatedandventilatedCase3Case3Banygettingworse,significantcyanosis,increasedO2reqirementBloodgas:pH7.185,PCO265,PO236,BE-18ECHO:R-to-Lshuntingthroughtheductusarteriosusandforamenovale,tricuspidregurgitationPPHNUsuallytriggeredbyrespiratoryconditionssuchasRDS,MAS,pneumonia,orcongenitaldiaphragmaticherniaPresentswithhypoxicrespiratoryfailure,pooroxygenation,andfrequentlywithdifferentialcyanosis.ThediagnosisshouldbeconfirmedbyechocardiographytoruleoutabnormalcardiovascularanatomyManagementofPPHNDecreasePVR,raiseSBPVentilationsupportCorrectionofmetabolicacidosisHemodynamicsupportiNOECMO(extracorporealmemberaneoxygenation)Case5Terminfantbornat39weeksgestationApgarscore5at1min,7at5minDifficultresuscitationwithbagandmask,pinkupafterintubationScaphoidabdomen,precordiumshifttorightCongenitaldiaphragmaticherniaCancomplicatedwithlunghypoplasia,IncreasedriskofPPHNandpneumothoraxShouldbeintubatedimmediatelyafterbirthCase5Preterminfantbornat30weeksgestationStartedfrequentlydesaturationandbradycardiaat2weeksofage,SpO2downto70%,HRdownto80RecoveredbyO2andstimulationApneaofprematurityCessationofbreathingfor>20secondsCessationofbreathingfor<20secondsifassociatedwithbradycardia,cyanosisorpallorEpidemiology59-78%ofallpreterminfantswithincreasinggestationalage>50%ofinfants<1500grequireinterventionforapneaPersistslongerwithGAMostinfantsreachrespiratorymaturityby42-44weeksCGAApneaofprematurityCentral(10-20%)NonasalairflowNoobservablerespiratoryeffortObstructive(10-25%)NonasalairflowObservablechestwallmotionObstructionintheupperairwayMixed(50-75%)ApneaofprematurityCausesofapnea:CNSRespiratoryCVSGIMetabolicIdiopathicManagementofApneaStimulationCPAPMedication

NeonatalAsphyxia&Its

ComplicationsDefinition

Birthasphyxiaisdefinedasareductionofoxygendeliveryandanaccumulationofcarbondioxideowingtocessationofbloodsupplytothefetusaroundthetimeofbirth.Etiology—HighRiskFactors

•Maternalfactor:hypoxia,anemia,diabetes,hypertension,smoking,nephritis,heartdisease,toooldortooyoung,etcDeliverycondition:Abruptionofplacenta,placentaprevia,prolapsedcord,prematureruptureofmembranes,etcFetalfactor:-Multiplebirth,congenitalormalformedfetus,etcClinicalmanifestationsFetalasphyxiafetalheartrate:tachycardiabradycardiafetalmovement:increasedecreaseamnioticfluid:meconium-stainedApgarscore:A:appearance(skincolor)P:pulse(heartrate)G:grimace(reactiveability)A:activity(musculartension)R:respirationDegreeofasphyxia:Apgarscore8~10:noasphyxiaApgarscore4~7:mild/cyanosisasphyxiaApgarscore0~3:severe/paleasphyxiaComplications:CNS:HIE,ICHRS:MAS,RDS,pulmonaryhemorrhageCVS:heartfailure,cardiacshockGIS:NEC,stressgastriculcerOthers:hypoglycemia,hypocalcemia,hyponatremiaDiagnosis1/Evidenceoffetaldistress2/Fetalmetabolicacidosis3/Abnormalneurologicalstate4/MultiorganinvolvementManagement•ABCDEresuscitation•A(airway)•B(breathing)•C(circulation)•D(drug)•E(evaluation)HypoxicIschemic

Encephalopathy(HIE)DefinitionThebraindamageafterperinatalasphyxiaandthemostsevereconditionshowedhighmo