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Neonates
and
Disturbances in Newbowns
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Cold Injury Syndrome
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Etiologyrelate to cold, premature, hypoxia and infection
1. endopathic causes 1.1 poor regulate function of body temperature; 1.2 subcutaneous fat are rich of saturated fatty acid; 1.3 less “brown fat”→produce heat↓2. exopathic cause: cold, premature, hypoxia & infection, etc.
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Pathogenesis
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Immature thermotaxic centerrelative large body surfacecold, lack of intaking infection, anoxia Insufficient heat produce of brown fat
Body T anoxia, acidosis
spasm of skin vassal
tissue hypoxia
microcirculation disturbance
Rich of saturated fatty acid
at high fusioon point
coagulation of subcutaneous fat
hard skin
, slow blood flow
Capillary permeability
blood vulume edema
shockDIC
Systemic organic injury
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Prevention
more important than treatment.1. neonatal nursing.2. pregnant women health care, avoid preterm labor, dystoxia, birth trauma and infection
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Clinical Manifestationonset within 1 we after birth, in cold season.
1. history: cold season, premature, anoxia, birth trauma, infection, lack of heat.2. Symptoms: typical type—poor reaction, no suck no cry, unrised body temperature, sclenema.3.1 sclenema: hard skin, edema, cold, dark red; order: leg→upper extremities3.2 hypothermia: often<35 , severe case<30℃ ℃3.3 multi-organic dysfunction: diminished heart sound, slow HR,microcirculation dysfunction; serious case: shock, DIC, renal failure, pneumorrhagia.3.4 Complicated infection: e.g. pneumonia, sepsis.
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Graduation of Scleredema Neonatorum
Grade Scleredema Axillary-rectal Organic Dysfunction
area T Difference
Mild <20% Positive No or slightly
Middle ~50% Zero or negative Marked
Marked, DIC, Pneumorrhagia
Severe >50% Negative
*head & neck 20%; upper extremities 18%; prothorax & abdomen 14%; back & lumbosacral portion 14%; buttock 8%; lower extremities 26%
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1. rewarming2. supplement heat and fluid energy need: 50kcal→100~120kcal/kg.d fluid need: 1ml/kcal3. correct organic dysfunction 3.1 correct acidosis 3.2 DIC 3.3 Antishock, improve circulation 3.4 Hemorrhagic tendency 3.5 Cortical hormone, cautious use unless shock. 3.6 control infection
Treatment
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Prognosis
T<30℃, HR<100/minWeight<2500g, sclenema area>50% bad prognosis
Fatal reason: peumorrhagia, circulation failure, respiratory failure.
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Neonatal Septicemia
(Sepsis)
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Neonatal systemic infection caused by bacterial reproduction and toxin of angioinvasive bacteria, with a incidence of 1~10 per 100 livebirths.
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Etiology
1. pathogen: Staphylococci, enteric bacilli, e.g. E.coli group B streptococcus, opportunistic pathogen, e.g. Staphylococcus epidermitis.
2. Infectious pathway 2.1 infection before birth 2.2 infection at birth 2.3 infection after birth: most cmmon, staphylococcus aureus
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PathogenesisImmature immunity can’t localize infection, and invasive infection will cause sepsis.1. nonspecific immunity
1.1 poor barrier function 1.2 lymph node are lack of phagocytic function, poor blood brain barrier(BBB),sepsis→ meningitis 1.3 low level of complements (C1q, C2~ C7, C9, C3, preactive factor) 1.4 less storage of neutrophils, poor chemotaxis, phagocytic function and bactericidal power↓.
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Pathogenesis2. specific immunity
2.1 only IgG can pass placenta; 2.2 IgM↓→susceptible to G- bacilli 2.3 SIgA↓→bacteria via respiratory tract or degestive tract→blood 2.4 Immune response of T cell↓→lack of interleukin & lymphokine 2.5 Macrophage & natural killer lymphocyte(NK cell) dysfunction 2.6 Cellular immunity↓→susceptible to fungus, virus & intracellular bacteria.
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Clinical Manifestation
1 clssification: early type within 7d; late type: after 7d.
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Clinical Manifestation
2. Manifestation:
2.1 general manifestation early stage: lack of vigour & appetide, cry weakly, unstable body temperature. developed stage: listlessness, lethargy, no suck, no cry, no move, looked bad, fever or hyperthermia.
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Clinical Manifestation
2.2 Special manifestation: jaundice( delayed dispel or relapse) hepatosplenomegaly (late onset) hemorrhagic tendency (petechia, ecchymosis, DIC) shock (poor perfusion, fast and weak pulse, oliguria, BP<4~6kpa) others: toxic enteroparalysis, meningitis, osteomyelitis, suppurative arthritis.
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Laboratory Examination
1. blood culture2. blood smear for bacteria3. detect Ag of bacteria4. others: blood cell count: WBC<5×109/L, or stab cell>=20 per 100 neutrophils C-reaction protein(CRP)>15μg/ml ESR>15m
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Diagnosis
1. history2. CM3. Blood culture
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Treatment
1. antibiotics1. antibiotics 1.1 use early1.1 use early 1.2 combined therapy, intravenous 1.2 combined therapy, intravenous 1.3 course of treatment:10~14 d1.3 course of treatment:10~14 d 1.4 select antibiotics depend on drug sensitive test1.4 select antibiotics depend on drug sensitive test 1.5 notice the side-effects1.5 notice the side-effects
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Treatment
2. supporting treatment2. supporting treatment 2.1 correct acidosis and imbalance of electrolyt2.1 correct acidosis and imbalance of electrolyteses (hypocalcemia, hyponatremia)(hypocalcemia, hyponatremia) 2.2 antishock: 2.2 antishock: plasma, albumin, dopamine 5~20μg/kg.minplasma, albumin, dopamine 5~20μg/kg.min
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Treatment3. others:3. others: 3.1 warming, correct hypoxia, prevent nuclear 3.1 warming, correct hypoxia, prevent nuclear jaundice;jaundice; 3.2 neutrophils infusion;3.2 neutrophils infusion; 3.3 exchange transfusion3.3 exchange transfusion 3.4 intravenous immune globin3.4 intravenous immune globin