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General Consideration of Newborns

General Consideration of Newborns. 华中科技大学同济医学院协和医院儿科徐崇民. 一 .General consideration ㈠Some related conception 1.Neonate(newborn) 2.Neonatology ： study on neonate care, physiology, pathology and prevention and cure of diseases. 3.Perinatal period ：

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General Consideration of Newborns

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  1. General Consideration of Newborns 华中科技大学同济医学院协和医院儿科徐崇民

  2. 一.General consideration ㈠Some related conception 1.Neonate(newborn) 2.Neonatology：study on neonate care, physiology, pathology and prevention and cure of diseases. 3.Perinatal period： 4.Perinatology： study on all kinds of healthy problem of pregnancy woman, fetus and neonates during perinatal period. ㈡Classification of neonates 1.According to gestational ages ⑴Term infant： ＞37wks,but＜42full wks(260一293days) ⑵Premature：＞28wks to＜37full wks(196—259days) ⑶Post term infant：＞42wks(294days) 2. According to birth weight ⑴LBW：birth weight during the first hours <2500g，birth weight <1500g(VLBW)，<1000g(VVLBW,or tiny baby)； ⑵NBW：birth weight within2500—4000g ⑶GBW：birth weight >4000g.

  3. 3.According birth weight and gestational age ⑴SGA：below the mean of same gestational age infants by the tenth percentile. ⑵AGA： between the mean of same gestational age infants from the tenth percentile to the ninetieth. ⑶LGA： above the mean of same gestational age infants by the ninetieth percentile. 4.According to weeks after birth ⑴early neonate the first week after birth. ⑵lately neonate the second to fourth weeks after birth. 5.According to risk degree of disease High risk infant,e.g. ⑴Mother’s history of illness; ⑵Abnormal labor history(preeclampsia、eclampsia，difficult labor); ⑶abnormal at labor(Apgar score＜7 etc.)

  4. 二Growth and development of fetus anditsaffected agents (一)Divide embryo growth and development into two periods 1．Embryo period：the first wk to eighth wks, simply to form the main organs and system,and high sensitivity to environment，abnormal easily occur. 2．Fetus period：from the ninth wk to birth,growth quickly and all organs and system setup.the growth depend on two factory：A.fetus itself growth potential：inheritance and infection can affect it;B.intro-uterine milieu： (l)body weight: the important marker for fetus growth..Normal fetus increase its body weight by 1.5% daily from 24wks一37wks,but after 37wks increase slowly,only 1％ body weight daily. (2) head circumference the marker for cerebric growth,if increase too fast may be abnormal (hydrocephalus).26—28wks it grows rapidly and arrives its peak at 32wks.(about 1.2mm daily),but 0.2 mm daily after 40wks. (3) body length At 25wks it increases 1.0cm weekly,from31—34wks ,1.3cm weekly,then slowly by and by，at 40wks only 0.5cm weekly.

  5. (二)Influence agent on fetus growth and developmant 1.Common agent: e.c race,region(altitude above the sea)and economic status. 2. Maternal agent: maternal figure,ages, disease, pregnancy time, nutritional status and if smoking, drinking, abuse drug. 3.Fetus agent: sex and fetus number, Heredity and metabolism congenital anomaly, TORCH syndrome,endocrine anomaly(cretinism, diabetes mellitus)

  6. (三) Fetal monitoring 1．Antepartum custodial ⑴Earlier period：If there is genetic disease in its kindred, villi cell detect should be taken to clear-cut diagnosis,then abortion； ⑵Metaphase：Antenatal diagnosis of heredity and metabolic disease could be made by amniotic fluid and amniocyte detect. congenital malformation could be discovered by B-supersonics detect. ⑶Late period: Placental function, embryocardia for intra-uterus distress;B- supersonics for fetus size; lecithin/sphingomyelin in amniotic fluid for fetal lung maturity.

  7. 2．Intrapartum custodial ⑴B-supersonics：for fetal breathing exercise and movement. ⑵Fetal heart rate moniter：for relation maternaluterine contractionto fetal heart rate. ⑶Detect blood gas andpHfromfetal scalp vessel: If pH is 7.20，should be observed closely, if pH＜7.15 , birth process should be conclusive.

  8. 三、The behavior and nursing of normal term infant and premature ㈠normal term infant and premature Appearance characteristic

  9. normal term infant and prematureappearance characteristic ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Premature Full term neonate ━──────────────────────────────── Skin shine,edema, Lanugo hair↑ red, Subcutaneous fat full Lanugo hair↓ Hair chaos and as velvet divide clearly external soft,less cartilage,folding Cartilage develop well ear scapha not clearly scapha formation and erect nail not arrival finger tip arrival or exceed finger tip breast no node or node＜4mm node＞4mm，mean is 7mm Sole less excess wrinkles external male testis not drop， testis drop genitals scrotum crease less scrotum crease deep and more female labium majus labium majus can cover labium can not cover labium minus and clitoris minus and clitoris ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━

  10. ㈡The physiologic behavior of normal term infant and premature １.Respiratory system　①at 3－5wk,lung bud appears,at 24wk, ending vesicle has been setup,most fetus could survival from 26wks on after birth;②fetal lung fill with fluid,at term,there are 30—35ml／kg,at birth,l／3 lung fluid were output from nose and mouth,the rest could be resorpted,if resorpted poorly, transient tachypnea may occur.③alveolus surfactant is produced by alveolar epithelium typeⅡ.there is less till 35wks;④full term neonate may suffer from respiratory distress within the first hour after birth, but do not last too long. Premature often has irregular respiration,even more apnea because of its immaturity respiratory center.(no respiration for 20 seconds,heart rate slow down,＜100times /minuts; cyanosis occur)；and easily suffer from hyaline membrane disease.

  11. 2. Circulatory system Primitive heart tube is formation at 4 wks,and begin beating.at 8一12 wks development implementation,After birth great change has been occurred result of blood circulation pathway and kinetics. Term neonates’ mean heart rates are 120pem at sleep，if awake ,may increase 140一160pem; Prematures’ mean heart rates slight fast at sleep(120一140pem.term baby blood pressure is average 9.3/6.7kPa. premature is related lower.

  12. 3. Alimentary system oesophagus,stomach and intestines tube are setup at 4一ll wks. Swallowing occur at 12 wks,the gas that was swallowed after birth arrive ileum within 2 hrs, arrive colon at 3—6 hrs.。Term baby spill milk sometimes within 2 wks,premature more often occur.Term baby has all digest enzyme except amylopsin， but premature had less digest enzyme and cholalic acid.(so easily occur necrotizing enterocolitis). Meconium discharge within 24 hrs after birth and go over for 3—4 days.but premature’meconium discharge usually delay. Term baby has low vigor of liver glucuronic acid transferase,even lower for premature(so physiologic jaundice more severe and last for more time).As there is less glycogen storage and poor protein synthesis in the liver, hypoglycemia and hypoproteinemia more easily occur in the premature.

  13. 4. Urinary system Neonate easily suffer from edema and dehydration and high sodium diet may result in sodium retention ( because of low glomerular filtration rate and poor concintration function). premature easily suffer from hyponatremia if not suppl enough sodium. Late metabolic acidosis occur more often in premature (especially in milk-fed). There may be sugar in premature’ urine if glucose enter too fast by IV (as the renal tubule has poor resorption for glucose. 5. Blood systemdescribe in related lesson

  14. 6. Nervous system Neonate has a related large brain(weigh about 300—400g and is 10％一20％ of body weight). Head circumference increase 1.1cm monthly,after birth;The end of spinal cord locate at third to fourth lumbar vertebrae . Primitive reflex such as rooting reflex,sucking reflex,grasp reflex and Moro reflex related to gestation age and nervous system diseases. Kernig sign,Babinski Sign and Chvostek sign may be positive,but abdominal reflex, Cremasteric reflex may be Lability during the neonatal period.

  15. 7.Thermoregulation Poor thermoregulation,thin Subcutaneous fat, related big body surface area, easily thermolysis, especially for premature. Thermogenesis depend on brown fat, but premature has less brown fat(so hypothermia more often seen). Neutral temperature is a suitable ambient temperature ,it can maintain neonate’s normal temperature, and little oxygen consumption. Premature easilly occur dehy- dration fever as its sweat gland developed poorly

  16. Neutral temperature for premature of various birth weight ━━━━━━━━━━━━━━━━━━━━━━━━━ birth temperature in incubator weight ━─────────────────────── (kg) 35℃ 34℃ 33℃ 32℃ ───────────────────────── 1.0 in first 10 days→after first 10days→ 3wks late→ 5wks late 1.5 一 in first 10days→after first 10days→4wks late 2.0 一 in first 2 days → 2 days late → 3wks late ＞2.5 一 一 in first 2 days→ 2days late ━━━━━━━━━━━━━━━━━━━━━━━━━

  17. 8. Energy and body fluid metabolism The calorie needed for neonate depend on energy expenditure of maintain basal metabolism and growth(aabout 418—502kJ/kg or 100 一120kca1/kg) . Term baby need sodium l一2mmol／kg，premature(＜32 wks), about 3—4mmoI／kg; No necessary for suppl potassium within the first 10 days. Premature easily suffer from hypocalcemia .

  18. Fluid needed for neonate of various body weight after birth(ml／kg) ━━━━━━━━━━━━━━━━━━━━━━ BW(kg) day 1 day 2 day 3—7 ────────────────────── ＜1.0 70－100 100－l20 120－180 1.0-1.5 70－100 100－120 120－180 1.5-2.5 60－ 80 80－100 110－l40 ＞2.5 60－ 80 80－100 100－140 ━━━━━━━━━━━━━━━━━━━━━━

  19. 9. Immune system Specific and non-specific immunity of neonates are not maturity; Skin and mucosa are thin and tender; umbilical part is open wound; the level of serum complement is very low; Chemokine is poor; T cells do not do well to response to foreign antigen ; although IgG could pass placent, premature has low level. Lacking of sIgA may result in suffering from various infection. 。

  20. 10. Some common special physiologic status (l) Physiologic jaundice (2)Pithelial pearl disappear at several weeks to months ． (3)Breast swellen occur at 3—5 days after birth, disappear at 2—3 wks (4)False menstruation occur at 5—7 days after birth,last for l一3 days.

  21. (三)Nursing for the term and premature baby To support, advance and protect breast feeding Is very important work in child care.

  22. 1. Keep warm 2. Feeding

  23. 3. Respiration management Keep airway unobstructed; Pad neonate shoulder; Intermission suppl oxygen if cyanosis; Cure for apnea in premature baby; Severe apnea should use machine positive pressure ventilation.

  24. 4.Nursing for the skin and mucosa 5. Vaccination 6.Neonatal screening If possible, Neonatal screening for congenital hypothyroidism phenylketonuria Etc. should be carried out.

  25. Thank you for your listening !!!

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