第七章 新生儿与新生儿疾病The seventh chapter neonatal and neonatal diseases.docx

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