Disturbances in Newbowns Neonates and Disturbances in Newbowns

Cold Injury Syndrome

Etiology relate 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 center relative large body surface cold, lack of intaking infection, anoxia Insufficient heat produce of brown fat Rich of saturated fatty acid at high fusioon point coagulation of subcutaneous fat hard skin , slow blood flow Body T anoxia, acidosis spasm of skin vassal tissue hypoxia microcirculation disturbance Capillary permeability blood vulume edema shock DIC 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 Manifestation onset 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 extremities 3.2 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%

Treatment 1. rewarming 2. supplement heat and fluid energy need: 50kcal→100~120kcal/kg.d fluid need: 1ml/kcal 3. 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

Prognosis T<30℃, HR<100/min Weight<2500g, sclenema area>50% bad prognosis Fatal reason: peumorrhagia, circulation failure, respiratory failure.

Neonatal Septicemia (Sepsis)

Neonatal Septicemia(Sepsis) Neonatal systemic infection caused by bacterial reproduction and toxin of angioinvasive bacteria, with a incidence of 1~10 per 100 live births.

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

Pathogenesis 1. nonspecific immunity 1.1 poor barrier function Immature 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↓.

Pathogenesis 2. 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 2.1 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 culture 2. blood smear for bacteria 3. detect Ag of bacteria 4. 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. history 2. CM 3. Blood culture

Treatment 1. antibiotics 1.1 use early 1.2 combined therapy, intravenous 1.3 course of treatment:10~14 d 1.4 select antibiotics depend on drug sensitive test 1.5 notice the side-effects

Treatment 2. supporting treatment 2.1 correct acidosis and imbalance of electrolytes (hypocalcemia, hyponatremia) 2.2 antishock: plasma, albumin, dopamine 5~20μg/kg.min

Treatment 3. others: 3.1 warming, correct hypoxia, prevent nuclear jaundice; 3.2 neutrophils infusion; 3.3 exchange transfusion 3.4 intravenous immune globin