Neonates

and

Disturbances in Newbowns

Cold Injury Syndrome

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.

Pathogenesis

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

Prevention

more important than treatment.1. neonatal nursing.2. pregnant women health care, avoid preterm labor, dystoxia, birth trauma and infection

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.

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%

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

Prognosis

T<30℃, HR<100/minWeight<2500g, sclenema area>50% bad prognosis

Fatal reason: peumorrhagia, circulation failure, respiratory failure.

Neonatal Septicemia

(Sepsis)

Neonatal systemic infection caused by bacterial reproduction and toxin of angioinvasive bacteria, with a incidence of 1~10 per 100 livebirths.

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

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↓.

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.

Clinical Manifestation

1 clssification: early type within 7d; late type: after 7d.

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.

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.

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

Diagnosis

1. history2. CM3. Blood culture

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

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

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