1、Neonatal Medicine-IntroductionXiaoping Luo,MDProfessor and ChairmanDepartment of Pediatrics,Tongji HospitalDirector,Center for the Diagnosis of Genetic Metabolic Diseases Tongji Medical CollegeHuazhong University of Science and TechnologyAdjunct ProfessorDepartment of PaediatricsFaculty of MedicineU
2、niversity of TorontoToronto,CanadaHistorical PerspectivesHistorical PerspectivesHistorical PerspectivesHistorical PerspectivesLe Tour dabandon(Decertion Tower)Century of Progress International ExpositionChicago Worlds Fair,Chicago,IllinoisThe Dionne quintupletsMay 28,1934,13 pounds 6 ounces,All toge
3、ther!Emelie,Cecile,Marie,Annette,YvonneJulius HessHow small is too small?How much is too much?Life support:To continue or discontinue?Definitions of TermsF Newborn or neonate refers to a infant period from birth to 28 days.Neonatologyhealth care,pathophysiology and managementF Early Neonate refers t
4、o the first 7 completed days of life.F Late Neonate refers to a period between 8 to 28 days of life.F Perinatal period extends from the 28th completed week of pregnancy to the 7th day of life.Perinatology or Perinatal MedicineDefinitions of TermsF Term defines births that occur from 37th to less tha
5、n 42 completed weeks,measured from the day of onset of the last normal menstrual period(259293 days,with an average of 280 days).F Preterm is defined as less than 37 completed weeks,or 259 days,gestation.(37weeks of gestation birth weight of 3000g)F Post-term refers to births that occurs at 42 or mo
6、re completed weeks(294 days).F Stillbirth and Fetal Death.Early fetal death occurs at 20 and 28 completed weeks,late fetal death occurs after 28weeks,or termed as stillbirth.F Live Birth.WHO defines live birth as The complete expulsion or extraction from its mother of a product of conception,irrespe
7、ctive of the duration of pregnancy,which after such separation,breathes or any other evidence of life,such as beating of the heart,pulsation of the umbilical cord,or definite movement of voluntary muscles,whether or not the umbilical cord has been cut or the placenta is attached;each product of such
8、 a birth is considered liveborn.Definitions of TermsFBirth Weight(BW)BW 2500g-Low Birth Weight(LBW);1500g-Very Low Birth Weight(VLBW);4000g-Fetal Macrosomia (Beckwith-Wiedemann syndrome Infant of Diabetic Mother,IDM)Definitions of TermsFBirth Weight vs Gestational Age(GA)BW the 90th percentile-large
9、 for gestational age(LGA)ponderal index=BW(g)X100/Length3(cm3)(22.2)Length/Head Circumference(HC)(1.36)symmetric or unsymmetric SGA Definitions of TermsBirthweight Curves California male singleton Caucasian non-Hispanic birthweights by gestational age:10th,50th,and 90th percentiles.FPregnancies in w
10、hich factors exist that increase the likelihood of maternal or fetal diseasesFEconomic,cultural-behavioral,biologic-genetic,reproductive and medical factorsF1020%of pregnant patient can be identified as high riskF50%of all perinatal mortality and morbidity is associated with high risk pregnancyHigh
11、Risk PregnancyFAn infant who should be under close observation by experienced physicians and nurses.F9%of all births require intensive careFFetal or neonatal factors:premature labor,postdates,fetal distrass,breech presentation,meconium-stained fluid,nuchal cord,Cesarean section,forceps low Apgar sco
12、re,BW4000,SGA or LGA,congenital malformation,tachypnea,cyanosis,pallor,plethora,petechiaeHigh Risk InfantFFetal Growth and Maturity embryonic period(18 wks):early embryogenesis fetal period(9 wksbirth):growth and maturationFFactors Affecting Fetal Growth genetic,geographic,social and economic factor
13、s maternal conditions:stature,age,disease and medication fetal:sex,multiple pregnancy,genetic disease,infectionFFetal Monitoring maternal serum,chorion villi,amniotic fluid,placenta,fetal heart rate,ultrasound,blood gas and pH Fetal Growth and MonitoringFPhysical Criteria Skin Lanugo hair Plantar su
14、rface Breast Hair Finger nail Ear/Eye GenitalsF Neuromuscular Criteria Posture Square window(wrist)Arm recoil Popliteal angle Scarf sign Heel to ear New Ballard Score(NBS)for Maturity Rating Ballard JL,et al,J Pediatr 1991;119:417Physical and Neuromuscular Criteria for MaturityDubowitz/Ballard Exam
15、for Gestational Age Sucking Palmar grasp Response to traction Moro reflex Crossed extension Automatic walking Roof reflex Pupillary response Neurological ReflexesF Body temperature heat loss by evaporation,radiation and convectionF Neutral thermal enviroment The range of ambient temperature and humi
16、dity at which heat loss is minimal and metabolic demands and oxygen consumption are the lowest.Depends on body weight and age 31 to 34 C at 50%humidity for undressed normal term infant Skin temperature vs central or core temperature(rectal)Re-warming a hypothermic infant at moderate rate(24hrs)F The
17、rmal regulation Physiological CharacteristicsF Cardiopulmonary Function heart rate:120130bpm tachycardia/bradycardia;transition from FC blood pressure:6595/3060mmHg,lower in preterm,PDA in preterm lung fluid:3035ml/kg “excretion/re-absorption”,“wet lung”respiratory rate:6080/min in the 1st hour,40/m
18、in after brief pauses in respiration(20s,with bradycardia 100bpm)Physiological CharacteristicsF Gastrointestinal Function vomiting and abdominal distension swallowed maternal blood,GI malformation,infection first feeding nutritional issues,tracheo-esophageal fistula,jaundice passage of meconium 70%w
19、ithin 12h,25%in 1224h,5%by 48h distal intestinal obstruction,meconium plug syndrome,Hirschsprungs disease,sepsis,hypothyroidism,nacortic necrotizing enterocolitis(NEC)premature,hypoxia and ischemia,infection,feedingPhysiological CharacteristicsF Urinary Function urinate 68%within 12h,25%in 1224h,7%b
20、y 48h pre-renal causes:dehydration,shock renal abnormality:renal agenesis,tubular necrosis obstruction of urinary outflow:urethral valves late onset metabolic acidosis in premature infant cow milk feeding with high protein load Physiological CharacteristicsF Hematological System hemoglobin:cord bloo
21、d 170g/L,change with age Fetal hemoglobin:HbF 70%,HbA 30%WBC:1520X109/L for term baby 68X109/L for preterm baby Platelet:150250X 109/L Blood volume:50100ml/kg for term baby 89105ml/kg for preterm babyPhysiological CharacteristicsF Neurological System brain:300400g,1020%of body weight(adult 2%)head c
22、ircumference:3334cm,increase by 1cm/month spinal cord:ends at L34,caution for lumbar puncture physiological reflexes:rooting,sucking,grasp,Moro Pathological reflexes:Kernig,Babinski,Chvostek signPhysiological CharacteristicsF Immunological System-immaturity skin and mucous membrane complements and c
23、hemokine T cell function ImmunoglubulinsPhysiological CharacteristicsF Fluid requirement(ml/kg)BW(kg)Day 1 Day 2 Day 37 2.5 6080 80100 100140Physiological CharacteristicsF Apgar scoreF Maintenance of body heatF Antiseptic skin and cord careF Eyes protectionF Respiratory managementRoutine CareF Feedi
24、ng F Vitamin K1F VaccinationF Neonatal screening F Parent-infant bondingF Mechanical ventilationF Cardiopulmonary DisorderF Post surgery(24h)F GA30,VLBWIF TPNFSustained convulsionFCentral tubing Neonatal Intensive Care Unit(NICU)F HeartF RespirationF Blood pressureF Body temperatureF Blood GasFBiochemistryFImaging Tongji HospitalThanks for Thanks for learning,Doc!learning,Doc!
