新生儿医学-简介(英文)课件

,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Neonatal Medicine-Introduction,Xiaoping Luo,MD,Professor and Chairman,Department of Pediatrics,Tongji Hospital,Director,Center for the Diagnosis of Genetic Metabolic Diseases,Tongji Medical College,Huazhong University of Science and Technology,Adjunct Professor,Department of Paediatrics,Faculty of Medicine,University of Toronto,Toronto,Canada,Neonatal Medicine-Introducti,1,Historical Perspectives,Early History of Care of Infants (1900,-small infants were not expected to live,-temperature:hot-water bottles,heated cribs,-feeding:tube feeding,diluted cow milk,-separated facilities,isolation,washing hands,-hyaline membrane diseases-respiratory distress syndrome,-1940s,modernized incubator,more oxygen,-1940s,retrolental fibroplasia,-1945,The Physiology of the Newborn Infant-,C.Smith,Historical PerspectivesEarly H,2,Historical Perspectives,Rapid Advances in Neonatal Care (19551970),-1959,surfactant deficiency,Avery ME,Mead J.Am J Dis Child,-1960,Disease of the Newborn-,Neonatology,-,A.Schaffer,-,culture,blood counts,urinalyses,radiographs,biopsies,-milk formulas,breast milk bank,-iv glucose&bicarbonate,-blood gas analysis,-improved incubators,-early attempts of mechanical ventilation,Historical PerspectivesRapid A,3,Historical Perspectives,Emergence of neonatal Intensive Care (19711989),-1971,continuous positive airway pressure(CPAP)-,Gregory,-neonatal intensive care unit(NICU),-designated by level according to the intensity of service,I:normal birthing and NB care,II:common obstetric complications&intermediate NB care,III:high risk maternal care and NICU,-transferring of high risk infants or mothers,-high risk and long term outcome,-1980s,extracorporeal membrane oxygenation(ECMO),Historical PerspectivesEmergen,4,Historical Perspectives,Expansion of Clinical Trials to Assess Therapy:,the Surfactant Era (19801996),-1970s1990s,glucocorticoids to accelerate lung maturation,-1980,first surfactant replacement therapy in humans,-total parenteral nutrition(TPN),-high frequency oscillators,-inhaled nitric oxide,-prenatal diagnosis and genetic counseling,-prospective,controlled clinical trials for intervention,-“quiet premature nursery”to“a bustling space station”,Historical PerspectivesExpansi,5,Le Tour dabandon,(Decertion Tower),Le Tour dabandon,6,Century of Progress International ExpositionChicago Worlds Fair,Chicago,Illinois,Century of Progress Internatio,7,新生儿医学-简介(英文)课件,8,The Dionne quintuplets,May 28,1934,13 pounds 6 ounces,All together!,Emelie,Cecile,Marie,Annette,Yvonne,Julius Hess,“quiet premature nursery”,The Dionne quintuplets Emelie,9,新生儿医学-简介(英文)课件,10,How small is too small?,How much is too much?,Life support:,To continue or discontinue?,How small is too small?How muc,11,Definitions of Terms,Newborn or neonate,refers to a infant period from birth to 28 days.,Neonatologyhealth care,pathophysiology and management,Early Neonate,refers to the first 7 completed days of life.,Late Neonate,refers to a period between 8 to 28 days of life.,Perinatal period,extends from the 28,th,completed week of pregnancy to the 7,th,day of life.,Perinatology or Perinatal Medicine,Definitions of Terms Newborn o,12,Definitions of Terms,Term,defines births that occur from 37,th,to less than 42 completed weeks,measured from the day of onset of the last normal menstrual period(259293 days,with an average of 280 days).,Preterm,is defined as less than 37 completed weeks,or 259 days,gestation.(37weeks of gestation birth weight of 3000g),Post-term,refers to births that occurs at 42 or more completed weeks(294 days).,Definitions of Terms Term defi,13,Stillbirth and Fetal Death.,Early fetal death,occurs at 20 and 28 completed weeks,late fetal death,occurs after 28weeks,or termed as,stillbirth.,Live Birth.WHO defines,live birth,as,The complete expulsion or extraction from its mother of a product of conception,irrespective of the duration of pregnancy,which after such separation,breathes or any other evidence of life,such as beating of the heart,pulsation of the umbilical cord,or definite movement of voluntary muscles,whether or not the umbilical cord has been cut or the placenta is attached;each product of such a birth is considered liveborn.,Definitions of Terms,Stillbirth and Fetal Death.,14,Birth Weight(BW),BW 2500g-,Low Birth Weight(LBW);,1500g-,Very Low Birth Weight(VLBW);,4000g-,Fetal Macrosomia,(Beckwith-Wiedemann syndrome,Infant of Diabetic Mother,IDM),Definitions of Terms,Birth Weight(BW)Definitions,15,Birth Weight vs Gestational Age(GA),BW the 90,th,percentile,-large for gestational age(LGA),ponderal index=BW(g)X100/Length,3,(cm,3,),(22.2),Length/Head Circumference(HC),(1.36),symmetric or unsymmetric SGA,Definitions of Terms,Birth Weight vs Gestational Ag,16,Birthweight Curves,California male singleton Caucasian non-Hispanic birthweights by gestational age:10th,50th,and 90th percentiles.,Birthweight Curves California,17,Pregnancies in which factors exist that increase the likelihood of mat