1. Disturbances in Newbowns
Neonates
and
Disturbances in Newbowns

2. Cold Injury Syndrome

3. 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.

4. Pathogenesis

5. 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

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

7. 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.

8. 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%

9. 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

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

11. Neonatal Septicemia
(Sepsis)

12. 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.

13. 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

14. 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↓.

15. 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.

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

17. 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.

18. 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.

19. 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

20. Diagnosis
1. history
2. CM
3. Blood culture

21. 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

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

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