第七章 新生儿与新生儿疾病The seventh chapter neonatal and neonatal diseases.docx
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第七章 新生儿与新生儿疾病The seventh chapter neonatal and neonatal diseases.docx
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第七章新生儿与新生儿疾病Theseventhchapterneonatalandneonataldiseases
第七章新生儿与新生儿疾病(Theseventhchapter,neonatalandneonataldiseases)
Theseventhchapterofthenewbornandneonataldisease.Txtyoucan'tchangeothers,butyoucanchangeyourself;youcan'tchangetheweather,butyoucanchangethemood;youcan'tchangethelengthoflife,butyoucanexpandthewidthofit.Theseventhchapter,neonatalandneonataldiseases
Thefirstsectionisanoverview
Newborn(neonate)referstoababywhoisligatedfromtheumbilicalcordto28daysafterbirth.Neonatologyisthestudyofphysiology,pathology,diseasepreventionandhealthcareofthenewborn.WhichcategoryofPediatricsneonatology,
Ithasdevelopedrapidlyinrecentdecadesandhasgraduallybecomeanindependentdiscipline.Thenewbornisacontinuationofthefetus,whichiscloselyrelatedtoobstetricsand,therefore,ispartofperinatology.
.Perinatalmedicineisthestudyoffetalbirthaffectfetalandneonatalhealthbeforeandafteracourse,obstetrics,neonatologyandrelatedtogenetic,biochemical,immunological,biomedicalengineeringandotherfields,isaninterdisciplinarysubject,andimprovethequalityofthepopulationandreducetheperinataldeathrateiscloselyrelatedto.Perinatalperiod(perinatalperiod)referstoaparticularperiodofprenatal,postnatal,andpostnatalperiod.
Ascountriesvarywidelyinhealthcare,theirdefinitionsaredifferent.Therearefourkindsofdefinitionsofcurrentinternational:
since28weeksofpregnancy(thefetalweightabout1000grams)to7daysafterbirth;fromthe20weeksofpregnancy(thefetalweightabout500grams)to28to28daysofpregnancyafterbirthafter28days;theembryoformationto7daysafterbirth.Thefirstdefinitionisadoptedinourcountry.Perinatalbabiesarereferredtoasperinatalinfantsbecauseoftheirrapidintrauterinegrowthanddevelopment,
Aswellasthetransitionfromtheuterustotheextrauterineenvironment,themortalityandmorbidityareatthetopofthehumanlife,especiallywithin24hoursafterbirth.
[neonatalclassification]
Therearedifferentmethodsforneonatalclassificationaccordingtotherelationshipbetweengestationalage,birthweight,birthweight,gestationalage,andgestationalage.
1,accordingtogestationalage,thegestationalage(gestationalage,GA)rangesfromthelast1normalmenstrualperiodstofirstdaysbeforedelivery,usuallyexpressedinweeks.Thefull-terminfants(fullterminfant)lessthanGA<42weeks:
37weeks(259~293days)ofthenewborn;thepreterminfants(preterminfant):
GA<37weeks(<259days)ofthenewborn;theposttern(postterminfant):
GAover42weeks(294days)ofthenewborn.
2,accordingtobirthweight,birthweight(birthweight,BW)referstobirthweightwithin1hours.Lowbirthweight[(lowbirthweight,LBW):
BW<2500g,whichBW<1500gsaidverylowbirthweight(verylowbirthweight,VLBWBW<1000g),saidtheextremelylowbirthweight(extremelylowbirthweight,ELBW).MostoftheLDWinfantswereprematureandfull-termorhasexpiredforgestationalage;thenormalbirthweight(normalbirth,weight,NBW):
BWismorethan2500gandlessthanorequalto4000g;thegreat(macrosomia):
BW>4000g.
3,accordingtotherelationshipbetweenbirthweightandgestationalage,(small,for,gestational,age,SGA),,BWinthesamegestationalage,andinfantsundertenthpercentileoftheaverageweightofinfantsofthesamegestationalage,areclassifiedasfollows(Figs7-1);
②适于胎龄(适于胎龄,艾贾)儿:
BW在同胎龄儿平均体重的第10至90百分位之间的婴儿;③大于(胎龄,1argeLGA)儿:
BW在同胎龄儿平均体重的第90百分位以上的婴儿。
我国15城市不同胎龄新生儿出生体重值见表7-1。
4。
根据出生后周龄分类①早期新生儿(早期新生儿):
生后1周以内的新生儿,也属于围生儿。
其发病率和死亡率在整个新生儿期最高,需要加强监护和护理;②晚期新生儿(晚期新生儿):
出生后第2周至第4周末的新生儿。
5。
高危儿(高风险婴儿)指已发生或可能发生危重疾病而需要监护的新生儿。
常见于以下情况:
①母亲疾病史:
母有糖尿病、感染、慢性心肺疾患、吸烟、吸毒或酗酒史,母亲为RH阴性血型,过去有死胎、死产或性传播病史等;②母孕史:
母年龄>40岁或<16岁,孕期有阴道流血、妊娠高血压、先兆子痼、子痼、羊膜早破、胎盘早剥、前置胎盘等;③分娩史:
难产、手术产、急产、产程延长、分娩过程中使用镇静和止痛药物史等;④新生儿:
窒息、多胎儿、早产儿、小于胎龄儿、巨大儿、宫内感染和先天畸形等。
[新生儿病房分级]
Accordingtothemedicallevelandtheneonatalwardconditionswillbedividedintothreegrades:
gradeIinneonatalward(1evellnursery):
ordinarynursery,suitableforhealthynewborns,themaintaskistoguideparentsnursingskillsandmethods,andscreeningforcommongeneticandmetabolicdiseases.Inordertobematernal,breastfeedingandmaternalandchilddependentfeelings,promoteinfantphysicalandmentalhealth.LevelIIneonatalward(1evelIInursery):
ordinaryneonatalward,appropriateforgestationalage>32weeks,birthweightwas1500g(developedfor>30weeksofgestationalage,birthweightmorethan1200g)ofsmallpreterminfantsandvariousdiseaseswithoutcirculatoryorrespiratorysupport,babycare.LevelIIIneonatalunit(1evelnursery)isaneonatalintensivecareunit(neonatalintensivecareunit,NICU),isconcentratedinsevereneonatalwards,shouldhaveahigherlevelofmedicaltechnology,nursingstaffandmanyoftheadvancedmonitoringandtreatmentequipment,andisequippedwithneonatalemergencytransportsystem,isresponsibleforreceivingI,gradeIItotheneonatalwardtothechildren.
Characteristicsandnursingcareofsecondnormalfull-terminfantsandprematureinfants
Thenormalfull-terminfants(normalterminfant)referstothegestationalageover37weeksand<42weeks,birthweightmorethan2500gramsandlessthan4000grams,nodeformityordiseaselivebirths.Prematureinfantsarealsocalledimmatureinfants(preterminfant;prematureinfant).TheincidenceofprematureinfantsinChinaisabout5%to10%.Themortalityrateisabout12.7%to20.8%,andthesmallerthegestationalage,thelightertheweightandthehigherthemortalityrate,especiallytheprematureinfantsunder1000grams,andtherateofdisabilityishigher.
Therefore,thepreventionofprematurebirthisofgreatsignificanceforreducingneonatalmortalityandreducingthedisabilityrateofchildren.Maternalinfection,smoking,alcoholabuse,druguse,trauma,genitaldeformities,excessivefatigueandmultiplebirthsarethecausesofprematurebirth.Inaddition,raceandgeneticfactorsarealsoassociatedwithpretermbirth.
Thenormalfull-terminfantsandprematureinfantsand1.normalterminfantsandprematureinfantsatdifferentgestationalagesofthedifferentappearancecharacteristicsinappearancecharacteristics(seeTable7-2),soaccordingtothephysicalfeaturesandneuraldevelopmentalmaturityofthenewbornbabytoassessthegestationalage.Atpresent,thereareseveralscoringmethodsintheworld,suchastheDubowitzscoringmethodandtheBallardscoringmethod.
Table7-2characteristicsoffullmoonandprematureinfants
Preterminfants
Redskin,edemaandmultiplevellushairruddy,plumpandvellushairlesssubcutaneousfat
Headlargerhead(1/3ofthebodyratio),hairthinandmessy,bighead(accountingfor1/4ofbodyproportions),hairclear
Auricularcartilage,soft,lackofscaphaunclearcartilagedevelopment,scaphaforming,straight
Oforreachingorbeyondtheendsofthefingersandtoes
Plantarveinswithlessfootlinesthroughoutthefoot
Nonodulesornodulesinbreast,<4mmnodules,4mm,average7mm
Congenitalabsenceofthetestisintheexternalgenitalorgans,
Thebaby'slabiaminoracannotcoverthelabiaminora,testicleshavebeenreducedtothescrotum,
Thelabiaminoracoversthelabiaminora
2.physiologicalcharacteristicsofnormalfull-terminfantsandpreterminfants
(1)therespiratorysystem:
fetallungsfilledwithfluid,catecholaminereleaseduringchildbirthtoreducesecretionoflungfluid,full-terminfantsabout30-35ml/kg,birthbybirthcanalextrusion,
About1/3ofthelungfluidisexpelledbythenoseandmouth,andtherestisabsorbedbythecapillariesandlymphaticvesselsofthepulmonaryinterstitiumaftertheestablishmentofrespiration.Iftheabsorptionisdelayed,thesymptomsofwetlungappear.Respiratoryrateisfast,quietabout40times/minuteorso,suchasmorethan60~70times,calledshortnessofbreath,oftencausedbyrespiratoryorothersystemicdiseases.Thechestiscylindrical,intercostalmusclesweak,breathingmainlybyliftingthediaphragm,withabdominalbreathing.Therespiratorytractstenosis,mucosaandsoft,richinbloodvessels,theciliarymovement,causeinfection,airwayobstruction,dyspneaandmilkrefusal.
Prematureinfantrespiratorycenterandorgandevelopmentisnotmature;thelackofcarbonicanhydraseinredbloodcells,reducingthenumberofcarbonateisdecomposedintocarbondioxide,whichcaneffectivelystimulatetherespiratorycenter;asmallnumberofalveolarepithelialcellswereflat,respiratorycube,alargedistancebetweencapillariesandalveolargasexchangerate,low;respiratorymusclehypoplasia,coughweakreflection.Asaresult,prematurebreathingisrapid,irregular,pronetoperiodicbreathingandapneaorcyanosis.Apneareferstostopbreathingfor>20seconds,withheartrate<100andcyanosis.Theincidencewasrelatedtothegestationalage,thesmallerthegestationalage,thehighertheincidence,andoftenoccurredonthefirstdayafterbirth.Becauseoflowpulmonarysurfactant,respiratorydistresssyndromeispronetooccur.Chroniclungdisease(chroniclungdiseaseCLD)iscausedbyprematurelungdevelopment,highsensitivity,highpressure,highcapacityandhighconcentrationofoxygen.
(2)circulatorysystem:
significantchangesoccurredinthehemodynamicsofthebloodcirculationafterbirth:
terminationofplacentalcordbloodcirculation;decreasedpulmonarycirculationresistanceandincreasedpulmonarybloodflow;
Thebloodvolumereturnedtotheleftatriumincreasedsignificantly,andthesystemiccirculationpressureincreased.Theforamenovaleandtheductusarteriosus
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