新生儿英用药

pregnancy to the 7th day of life. Perinatology or Perinatal Medicine
Definitions of Terms
Term defines births that occur from 37th to less than 42 completed
Neooping 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
Historical Perspectives
➢ Early History of Care of Infants
Emelie, Cecile, Marie, Annette, Yvonne
The Dionne quintuplets
May 28, 1934, 13 pounds 6 ounces,
All together!
How small is too small? How much is too much?
Le Tour d’abandon (Decertion Tower)
Century of Progress International Exposition Chicago World's Fair, Chicago, Illinois
Julius Hess
“quiet premature nursery”
Historical Perspectives
➢ Expansion of Clinical Trials to Assess Therapy:
the Surfactant Era (1980~1996) - 1970s~1990s, 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 Perspectives
➢ Rapid Advances in Neonatal Care (1955~1970)
- 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
10~20% of pregnant patient can be identified as high risk
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 28th completed week of
- hyaline membrane diseases---respiratory distress syndrome
- 1940s, modernized incubator, more oxygen
- 1940s, retrolental fibroplasia
- 1945, 《The Physiology of the Newborn Infant》--C. Smith
(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
weeks, measured from the day of onset of the last normal menstrual period (259~293 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
10 ~ 90th percentile --- appropriate for gestational age (AGA) >the 90th percentile --- large for gestational age (LGA)
ponderal index = BW(g)X100/Length3 (cm3) (>2~2.2)
Life support: To continue or discontinue?
Definitions of Terms
Newborn or neonate refers to a infant period from birth to 28
days. Neonatology—health care, pathophysiology and management
Length/Head Circumference (HC)
(>1.36)
symmetric or unsymmetric SGA
Birthweight Curves
California male singleton Caucasian non-Hispanic birthweights by gestational age: 10th, 50th, and 90th percentiles.
Definitions of Terms
Birth Weight vs Gestational Age (GA)
BW <the 10th percentile --- small for gestational age (SGA) intrauterine growth restriction (IUGR)
Stillbirth and Fetal Death.
Early fetal death occurs at < 20 completed weeks of gestation, intermediate fetal death occurs >20 and < 28 completed weeks, late fetal death occurs after 28weeks, or termed as stillbirth.
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)
High Risk Pregnancy
Pregnancies in which factors exist that increase the likelihood of maternal or fetal diseases
Economic, cultural-behavioral, biologic-genetic, reproductive and medical factors
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.