新生儿疾病neonatal disease.ppt

1、Neonatal Problems,Arrangement 今日安排,1. Review the associated knowledge (25 ) 2. Clinical probation in neonatal department (75 ) 3. Summary (20 ),Familia with the difference of preterm neonate and term neonate Get hold of clinical manifestation of neonate pnemonia Get hold of difference of physiologic

2、al and pathological jaundice,目的要求 Objective and Request,Defination,Neonate- 新生儿 028 days Infant-婴儿 01 years old.,Definition of Neonate(1): related to GA,Preterm/ premature neonate:37 w 早产儿 Term neonate: 3742 w 足月儿 Post-term neonate: 42 w 过期产儿,How to identify 怎样识别,skin head and hair ear thenar galact

3、ophore genitalia,Difference of term and preterm skin 皮肤,Difference of term and preterm thenar 足纹,Difference of term and preterm galactophore乳腺,Difference of term and preterm ear conch耳壳,Difference of term and preterm genitalia 生殖器,Difference of term and preterm head and hair头部及毛发,Definition of Neona

4、te(2): related to BW,（measure within 1st hour after birth） Tiny baby BW4000g,Definition of Neonate(3): related to both GA & BW,Small for gestational age SGA 小于胎龄儿 Appropriated for gestational age AGA 适于胎龄儿 Large for gestational age LGA 大于胎龄儿,Definition of Neonate(4): related to age,Early baby (perin

5、atal baby):早期新生儿 neonate in first 7 days Late baby : 晚期新生儿 above 7 days,Definition of Neonate(5): High risk baby 高危新生儿,Is the baby who have severe conditions and need intensive care after birth, usually are those with maternal disease or abnormal delivery history. e.g, preterm baby, asphyxia （窒息）, c

6、ongenital disease（先天性疾病），ect.,Some Common Diseases,Hyaline Membrane Disease (HMD) Asphyxia Hypoxic ischaemic encephalopathy(HIE) Pneumonia Pulmonary Hemorrhage Jaundice,新生儿黄疸 (Neonatal Jaundice),Definition,The yellow skin and mucus because of too high concentration of bilirubin in the blood.,Two typ

7、es of neonatal jaundices,neonatal jaundices physiological pathological 生理性黄疸 病理性黄疸,case 1,李X,10 days, female,preterm neonate onset of jaundice, 3 days after birth total bilirubin:13.5mg/dl direct bilirubin:1.4mg/dl birth weight:2.4kg, now weight:2.8kg fed well, sleep well no fever, no cyagnosis, no

8、diarrhea.,Comparison,Pathological jaundice（remember）,Onset too early 出现早 Bilirubin level too high 水平高 Increase too fast 发展快 Disappear too late 消褪晚 D.bilirubin level too high 直接高 Return 易反复 （很重要，要记住）,Classification of jaundice,Unconjugated hyperbilirubinemia (avoid kernicterus) Conjugated hyperbiliru

9、binemia (early diagnosis of biliary atresia),Management,Unconjugated hyperbilirubinemia Phototherapy：wavelength 450nm Albumin therapy Activator of enzyme：phenobarbital 5mg, nikethamide 100mg，tid for 35d Blood transfusion,Management,Conjugated hyperbilirubinemia usually need etiological treatment or

10、surgery operation,新生儿肺炎 Neonate Pneumonia,Diagnosis,Antepartum pneumonia : early-onset within 24 h after birth, CMV, TOX, Ecoli, GBS are usual pathogens Postpartum pneumonia: same as pneumonia in children but usually severe , Virus, bacterium, fungus all can be the pathogen,Manifestation,Irregular b

11、reathing Apnea Tachypnea Nasal flaring three depression sign(sternal, intercostal, subcostal) Cyanosis,Diagnosis,Clinical Manifestation: irregular breathing,dyspnea,tachypnea etc Radiological Findings: some patchy shadows,empyema, atelectasis,pneumothorax can be seen,X-ray,pneumonia,atelectasis,X-ray,pneumothorax,pleural effusion,Treatment,Respiratory tract management (slap back, suction,nebulization) Oxygen therapy(avoid ROP) Antibiotics Others: balance of energy & acid- base, electrolytes, etc,What diseases we will see in clinic?,Asphyxia of newborn Neonatal jaundice Neonatal hypoxic-i