neonatology新生儿学周五译

Neonatalperiod新生儿•inhumansfirst4在人类此期为出生后4•inNeonatalperiod新生儿•inhumansfirst4在人类此期为出生后4•indogsandcatsfirst2-3在犬猫为出生后2-3theperiodinwhichthemostrapidchangescompletedependenceontheincompleteneurologicalfunctions,suchasauditoryandvisualabilitiesandproperspinalreflexes•••Firstexamination•••malformations(cleftpalateatresiaani)畸形（腭裂，锁肛Firstexamination•••malformations(cleftpalateatresiaani)畸形（腭裂，锁肛genderweightsucking,pressing,rightingshouldbe•bodytemperatureatbirth36°C(34.7-respiratoryratesmaybeirregluar:10-40beats/min,gaspingmaybenormalwithinthefirst30minutes;noabdominalcomponentheartratesmaybeirregular160-200••Gender•determinethegendercanbechallenginginkittens对于小猫Gender•determinethegendercanbechallenginginkittens对于小猫的性别区分往往较为困anogenitaldistanceisshorterinfemalesthaninmales雌性小猫肛门与生殖器间距离较•femalekittenafter•thegenitalopeninginthefemalekittenisagrooveandinthemalekittenacircle雌性小猫生殖器是一个槽状而雄性小猫为圆形隆malekittenshavedecendedtesticlesat雄性小猫出生时有睾•Development发1stweek（第一周theDevelopment发1stweek（第一周theumbilicalcorddriesoutwithinthefirstdayandfallsoffuntilday4,flexortoneuntilday3andafterwardsextensortone,abletolifttheirheadonday32ndweek（第二周begintocrawl,doubelingtheirbirthweightaroundday7-10,openingoftheeyesaroundday7-10,somebreedsopentheireyesearliersomeevenatbirth3rdand4thweek（第3-4周3rdand4thweek（第3-4周begintoorientateitselfbysound,openingoftheexternalearcanalsaroundday14-16,irishasablue-greycolour,corneaiscloudyowingtoincreasedwatercontent,mayhavedivergentstrabismus,bytheendofthe3rdweektheycanstandandhavegoodposturalreflexes,bytheendofthe4thweektheycanwalkandregulatetheirbodyNeurologicalNeurologicalpresentattrytosuckorchewonapesentatpressistheadagainstNeurologicalNeurologicalpresentattrytosuckorchewonapesentatpressistheadagainstabowedpresentatplacedonthebackitattempttorightforcefullyrubbinginthelumbarregionwillresultinvocalizationandgreatactivitybirthuntil3dorsalrecumbency;thetoeofahindlimbispinchedthekittenwilladducttheotherhindlimbbirthuntil3dorsalrecumbency;thekittensheadisbenttooneside,thekittenwillstretchistlegsonthesidetowhichtheheadisbentandbendistlegsontheothersidebirthuntil3heldbythethorax;itsneckisbenttowardsonesideanditshouldstretchthelimbstothesameside;iftheheadisbentdorsallytheforelimbsshouldbestretchedandthehindlimbsadductedNeurological顶出生后3;出生后3仰卧小猫的头会向一侧弯曲且其头弯曲方向同Neurological顶出生后3;出生后3仰卧小猫的头会向一侧弯曲且其头弯曲方向同出生后3Neurologicalat2-4daysofuntil3-4weeksofAssoonastheeyesareopeniftheanogenitalregionisstimulateditshouldurinate/defecateNeurologicalat2-4daysofuntil3-4weeksofAssoonastheeyesareopeniftheanogenitalregionisstimulateditshouldurinate/defecateNeurologicaluntile-4daysofheldbytheneckitwillrolupandadductitsafter4daysofheldbytheneckitwillstretchitshindlegsandback2-43-4周才会出4第4Neurological2-43-4周才会出4第4NeurologicalThermoregulationThermoregulationincompletelydeveloppedin••almostnosubcutaneousfatinbodyincompletelydeveloppedin••almostnosubcutaneousfatinbodyheatisproducedbymetabolismofbrownfatunderthesympatheticnervoussystemheatlossmuchgreaterthaninanolderanimal,duetobodysizetosurfacearearatioshiveringandvasoconstrictivemechanismsbeginaroundday6-8••••••••••••Thermoregulationtemperature(°C)birthuntilday731–Thermoregulationtemperature(°C)birthuntilday731–day8to1426–day15to28day20to35Hydrationandrenalwatermakesup82%ofistbodyHydrationandrenalwatermakesup82%ofistbody•waterturnoveristabouttwicethatofanincreasedlosses:skinismorepermeable,bodysizeto•arearatioishigherthaninfluidrequirementsarehighat13-22ml/100gbodyweightper•theglomerularfiltrationrateincreasesfrom21%atbirthtoby8weeksofHydrationandrenal水合作用与肾功•immatureHydrationandrenal水合作用与肾功•immaturetubularsecretioninthefirst8weeks:lowspecificgravitiy(1.006-1.017),increasedconcentrationofaminoacidsandproteinsandglucosuria(upto2weeks)=>medicationthataffectedkidneydevelopmentshouldbeavoidedanddosagesofthosethatareexcretedthroughthekidneymustbeadjustedGainingenergy能量获onlylessglucosestorageGainingenergy能量获onlylessglucosestorageinthethisiswhyregularenergygainingisbestcontrolisweight（最好的控制指标是体重增长gaining5-10%ofbodyweightdailyor70-100gramstwicethebirthweightonday7(-第7-10GainingGainingenergykittensshouldbeabletotakeupGainingenergykittensshouldbeabletotakeuptheirdailyrequirementsin4-5mealsperdaytheyingest10-15%oftheirbodyweightinthefirstweekand20-25%fromthe2ndweekonkittensgettheirenergyfrompoteins•••GainingPhysical•body•oralmucousmembrance(hydration),hyperaemicduringthefirst2-4daysoflifePhysical•body•oralmucousmembrance(hydration),hyperaemicduringthefirst2-4daysoflifelackofhair:abnormalityorprematurebirthnormalabdominalskin:darkpink;bluishordarkred:or正常腹部皮肤：深粉色•••head,body,limb,normalno----Physicalexamination•flatormalformedswimmerpectus-泳者症候-Physicalexamination•flatormalformedswimmerpectus-泳者症候-漏斗•stimulationofurinationandnormalroundabdomenshouldneverbebloated正常圆润的腹部，绝不该肿•dryumbilicus脐区干•Malformationdueto导致畸形的原Malformationdueto导致畸形的原Griseofulvin灰黄霉Benzofuranderivatfortherapyoftrichophytonandmicrosporum香豆酮衍生物用来治疗毛癣菌与小孢子microphtalmus,cleft小眼畸形，腭Progestagenemasculinisationofthefemalegenitaltract(enlargedclitoris阴蒂变大)雌性生殖道男性Corticosteroids皮质类固Anasarcaandskeletalmalformations全身水肿以及骨骼Antikonvulsivdrugs抗癫痫药Heartfailure,cleftpalate,microcephalus,sceletal心衰，腭裂，小头畸形，骨骼畸Malformationdueto导致畸形的原…feedingHypervitaminoseMalformationdueto导致畸形的原…feedingHypervitaminoseVA过多症(>125betweenday17and22ofpregnancy怀孕第17-22Cleftpalate,bendtail,jointHypervitaminoseVDcalcinosisofthetissue,toclosureofthehypoplasiaoftheadamantina,valvular…environmentalpoisonsometimesteratogen,buthardlytoCleftpalate腭Cleftpalate腭Cleftpalate腭Causes原因congenitalCleftpalate腭Causes原因congenitalenvironmentalinfluencetoxichormonelmechanicalAetiology病因学incompleteadnationofbothsidesduringthedevelopment,criticaltimebetween25and28of在胚胎发育时两边没有完全合生，怀孕的第25-28EuthanasiatubefeedinguntilthekittenisbigenoughforAnasarca全身水Aetiology病因学oftenunclear,infectiousAnasarca全身水Aetiology病因学oftenunclear,infectiouscauseslikeparvovirus,KidneyConjunctivitis新生儿结膜infectionduringpregnancymostlypurulentStaphylococciConjunctivitis新生儿结膜infectionduringpregnancymostlypurulentStaphylococciarethemainopeningoftheeyelidsAtresiaaniAtresiaaniOpenabdomen腹腔未闭Openabdomen腹腔未闭Diagnostic诊断方Blood血液canbeobtainedfromDiagnostic诊断方Blood血液canbeobtainedfromthejugularnomorethan10%ofthebodyweighte.g.:2,5mlifUrine尿液stimulationtothebladdercanbeexpressedcystocentesisshouldbe->urineinthenormalneonateiscolourless,presenceofsignificantcolourusuallyindicatesdehydrationImaging影像学x-ray:comparisonwithanormallittermateisusefullCri=calCriticalcare•Hypothermia•Hypoglycaemia•Dehydration•HypoxiaCri=calCriticalcare•Hypothermia•Hypoglycaemia•Dehydration•HypoxiaCri=calHypothermiaheatlossbyHypothermiaheatlossbyconductionofheat,heattransfer,heatradiationorneonateshavelimitedpossibilitiesforsavingheatbecauseof:smallamountofsubcutaneousfat,smallinternalorgnasbodytemperaturdecreasesbelow34.4°Catbirth,below35.6°Cat1-3daysofage,below37.2at1weekofage体温出生时低于34.4C，1-3天时低于35.6C一周时低于Cri=calHypothermiagutmotilityslows,ultimatelycausing•Hypothermiagutmotilityslows,ultimatelycausing•milkmyberegurgitatedandaspiratedresultingin••ingestacanfermentresultinginabloatedneonateandpressureonthethorax•inhibitionofcellularimmunefunction,increasedrisktobacterialinfectionsCri=calHypothermia:clinical低温：临床症bodytemperatureaboveHypothermia:clinical低温：临床症bodytemperatureabove体温在31.1℃以上Restlessness,lossofappetite,crying,redmucousmembranes,coolskin,goodmuscletone,不安，食欲废绝，哭闹，粘膜红，皮肤凉，肌张力良respiratoryrate呼吸40b/minheartrate200bodytemperaturebetween28-体温在28-thekittenislethargicanduncoordinatedbutresponsive,moisturearoundthelips小猫精神沉郁，不协调但是有反应，双respiratoryrate呼吸:>20-25b/min,heartrate心率>50b/min,noabdominalsoundsmetabolismisimpairedhypoglycaemiabodytemperaturebelowtheneonateappearstobedead新生儿即将Cri=calHypothermia:低温：治•slowlyreheatingoftheneonate,only1°CHypothermia:低温：治•slowlyreheatingoftheneonate,only1°Cperhourrapidreheatingcausedelayedorganfailure(heart,kidney),increasedrespiratoryrates,cyanosis,diarrhoeaandseizurestherightambienttemperature,humiditylevel55-合适的环境温度,空气湿度55-heatingpads,heatinglampsorwarmwaterbottelscanbeused可以小心的使用取暖垫,加热灯或者热水oxygenandwarmairaspresentinoxygencagesorincubatorswouldbe富含氧气与热空气的氧气箱或者育成箱是最好shiftingthebodypositionfrequentlyreducesthetendencyto经常改变体位以减少其呕warmfluids(<1°Cofbodytemperature),including温水输液(比体温低<1°C),包括右旋糖•••••Cri=calClinical<30mg/dl:tremors,Clinical<30mg/dl:tremors,crying,irritability,increasedappetite,dullness,lethargy,coma,stupor,seizuresmostoftenstarvation(i.e.biglitter,agalactiae)orothers:sepsis,poorenvironmentalconditions,congenitalmetabolicdefects(glycogenstoragedisease,portosystemicshunts),toybreedhypoglycaemia,hypopituitarydwarfism-placentalinsufficiencyand=>hypoglycaemiaimmediatelyafter5-10%solutionofdextrose0,5-1g/kgmonitoringofbloodglucoseconcentrationisimportantbecauseoftheriskofhyperglycaemiaCri=cal低血30mg/dl颤抖喊叫低血30mg/dl颤抖喊叫兴奋食欲增加迟钝，嗜睡，昏迷，迟钝，原因病，门体循环短路),玩具犬低血糖，垂体性侏儒症治疗Cri=calDehydration脱occursquicklyinneonatesReasons原因-highbodyDehydration脱occursquicklyinneonatesReasons原因-highbodywatercontent-inabilitytoconcentrateurine不能浓缩尿Clinicalsigns临床症状5-mucousmembranesbecometackyormucousmembranesareverydrynoticeabledecreaseinskinelasticity<12%:circulatorycollapse<12%:Cri=calDehydration:脱水：治mildcasesfluidsgivenorallyorDehydration:脱水：治mildcasesfluidsgivenorallyorSC脱水情况不严重的：喝水或皮IV:jugularvein,cephalicveinor静脉注射：颈静脉，头静脉或者骨髓腔注PicturesfromBSAVAManualofCanineandFelineReproductionandmaintenancefluidrequirements维持液体需求:80-givenrate补液速度3-4abolusof:30-40ml/kgin5-10minis快速静推：30-40ml/kg在5-10分钟内推注是可以signsofoverhydration:labourdbreathing,pulmonaryoedema,Cri=cal水中毒症状：喘气，肺水肿，外Hypoxia•noteasilyrecognizedbecausetheyHypoxia•noteasilyrecognizedbecausetheydon‘thyperventilateinthefirstdaysofliferespiratoryandmetabolicacidosisisnormalinthefirst1-2hoursafterbirth刚出生的第1-2treatmentnecessaryifacidosislastslongerthan3如果酸中毒持续在3hypoxialeadtorespiratorydepression,translocationofintestinalbacteriaandchilling=>higherriskofbacterial•••Cri=calHypoxiaClinicalsigns临床症状increasedrespiratoryeffortanddistendenHypoxiaClinicalsigns临床症状increasedrespiratoryeffortanddistendenabdomencausedbymayleadtodecreasedorabsentgutdecreasedheartrateandbloodTreatment治疗OxygenCri=calFadingkittens21sickatbirthbornFadingkittens21sickatbirthbornsmallorweakorwithbirthdefectsunabletoorfailto出生时小或弱或者有先天性缺陷，导致无法护理或者护理失2.initiallyhealthykittensbecomeweak,depressedandanorexicduringthe1stweek出生时健康，但在第一周逐渐变虚弱，沉郁以dehydration,hypothermia,hypoglycaemia脱水，低温，低血deathwithinafewdays几天之内死bacterialinfectionsandrespiratorydistressarethemainreasonsfordeath细菌感染以及呼吸窘迫常常是引起死亡的主要原especiallyinkittensdeathmayalsooccuraround尤其是小猫，在断奶时死亡的情况也经Cri=calFading凋谢的小猫：诊History病史vaccination(status,timing,Fading凋谢的小猫：诊History病史vaccination(status,timing,supplements/medicationsduringtrauma/activitiesduringinformationaboutthe-informationaboutpreviouslittersandcurrentageofonset,exactsexesofaffectedhousingandCri=calFading凋谢的小猫：Fading凋谢的小猫：诊Clinicalexamination临床检查physicalexaminationbloodcellcounts,serumbiochemistry,血细胞计数,血清生化,尿=>comparingresultswithanormal与同窝正常新生儿比radiographsX线影=>comparingresultswithanormal与同窝正常新生儿比 specializedtests:screeningforinheritiedorcongenitalmetabolicdefectsdetectionofspecificenzymedefectsortherproteindeficiencies特殊检查:筛选遗传性或者先天性代谢性缺陷，检查特殊酶缺陷或者蛋白质post-mortemexaminationofafreshdead尸检新鲜死去Cri=calFading凋谢的小猫：诊Infectious传染病Fading凋谢的小猫：诊Infectious传染病microbialcultureandsensitivitytestingfromsamplesofadeadanimalstissue从死去的动物身上取样做细菌培养以及药敏实queensshouldbetestedfor母猫需要做一下检查felineleukaemiavirus猫白血病felineimmunodeficiencyvirus猫免疫缺陷病antibodiesagainstfelinecoronavirus冠状病otherinfectousagents:roundworms,neosporacaninum,toxoplasmagondii,felineparvovirus,fleasandticks其他感染源:蛔虫，新孢子虫，绦虫，刚地弓形虫，猫细小跳蚤septicaemiafrequentlycausedbyBstreptococci,clicalsigns:redand/orpurulentumbilicalstump,redtopurple败血症常由B型链球菌、大肠杆菌引起临床症状:脐带处发红或者溃脓，脚趾呈红色Cri=calFading凋谢的小猫：Fading凋谢的小猫：诊Congenitalandgeneticdiseases先天性或遗传性pedigreeinformationbiochemicaltestsinspecializedscreeningofurineforabnormalsamplesoflivershouldbefrozenimmediatelyformetabolicortoxicologytestingsamplesofkidneyshouldbefrozenimmediatelyforDNAtestingforspecificgeneticdiseases肾脏样本须立即冷冻，以进行DNA或者特殊基因检karyotypingCri=calDeworming•Toxocaraspeciespre-natallactogenororalinfectionDeworming•Toxocaraspeciespre-natallactogenororalinfectiondevelopmentcycleofthelarvaelastsaround14daysdewormingofthemotherattheendofpregnancytominimizelactogeninfectiondewormingofkittenandmotherevery2weeksupto10to12weekscollectionofdejectionforexmamintiontoavoidunnecessarytreatmentispossible••••ImmunedefenseveryweakatImmunedefenseveryweakatbirth5%ofmaternalantibodiescrossthewithinthefirst12-16hoursafterbirthantibodiesaregatheredfromcolostrum,mainlyIgGandIgAIgMcanbeproducedbythekittensaroundIghavedifferenthalflifeswhatcaninterferewithserumcanbefedtoorphankittenswithinthefirst12ImmuneImmunedefensemotherisImmunedefensemotherisregularilyvaccinatedandthelastvaccinationwasatleast6monthbeforebirth:=>vaccinationofthekittensnotbeforethe8thvaccinationofthemotherearlierthan6monthsbefore=>vaccinationofthekittenswith6passiveimmunisationofillImmuneNeonatal••bloodtypeAkittensborntoNeonatal••bloodtypeAkittensborntobloodtypeBqueensarecatswithbloodtypeBhavenaturallyoccuringantibodiesagainstbloodtypeA•duringthefirst12to16hoursafterbirththesealloantibodiesinduceincompatibilityreactionsinthekittenaftercolostrumingestion•Symptomes:pigmenturia,suddendeath,fading,anaemia,•••Diagnoses:positiveCoombstestPrognoses:fürdieWelpeninfaustAim:breedingshouldnotleedtothesecases,thereforebloodtypetestingbeforebreeding,toseperatethekittensandthemotherfor24hoursafterbirth,itmaybeusefulltogiveserumorcolostrumfromabloodtypeAqueentotheseperatedNeonatal••••••症状尿液染色，突然死亡逐渐消弱，贫血，黄疸诊断:抗球蛋白实验阳性••••NeonatalSupplementarynutritioninorphanedkitten,iftheySupplementarynutritioninorphanedkitten,iftheydon‘tgainweightorlose对于孤儿小猫，当其体重不增加也不减少overfeedingoftenresultsindiarrhoea,underfeedingin过食易导致腹泻，摄入不够会导itisrecommendedonlytousespecialmilkreplacerforusein建议只用特殊的奶饲喂小themilkshouldbewarmaround奶温需为37℃左itiseasiertocoverthedailycaloricrequirementsthanthefluid满足其每天的卡路里需要比满足其体液需要更sometimesitisnecessarytogivesuplementaryfluidtheraphySCortodilutethemilkreplacer有时给予液体疗法（皮下）或者稀释乳制品是很必要SupplementarySupplementarynutrition•shouldonlybeperformedifbodytempertaureSupplementarynutrition•shouldonlybeperformedifbodytempertaureisatleast35.6°Cintestinalsoundsare1stweek12-13ml/100gperdayfeedingevery2hours2ndweek14ml/100gperday,feedingevery2-3第二周：每天14ml/100g，每2-3个小时一3rdweek18ml/1