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儿科必备知识之新生儿特点及护理新生儿分类方法1.根据出生时胎龄分类（1）足月儿：是指出生时胎龄满37周~41周的新生儿。
（2）早产儿：是指出生时胎龄<37周的新生儿。
早产儿可再分为：胎龄34周~36周者为晚期早产儿；胎龄28周~31周者为极早产儿；胎龄<28周者为超早产儿。
（3）过期产儿：是指出生时胎龄≥42周的新生儿。
2.根据出生体重分类（1）正常出生体重儿：是指出生体重在2500~3999g的新生儿。
（2）低出生体重儿：是指出生体重<2500g新生儿。
极低出生体重儿：是指出生体重<1500g的新生儿。
超低出生体重儿：是指出生体重<1000g的新生儿。
（3）巨大儿：是指出生体重≥4000g的新生儿。
足月小样儿：是指胎龄满37周~41周，出生体重低于2500g的新生儿。
3.根据出生体重与胎龄关系分类（1）适于胎龄儿：是指出生体重在同胎龄平均体重的第10~90百分位的新生儿。
（2）小于胎龄儿：是指出生体重在同胎龄平均体重的第10百分位以下的新生儿。
（3）大于胎龄儿：是指出生体重在同胎龄平均体重的第90百分位以上的新生儿。
4.根据出生后周龄分类早期新生儿是指出生后1周以内的新生儿。
晚期新生儿是指出生后第2~4周末的新生儿。
5.高危新生儿：是指已发生或可能发生危重疾病而需要监护的新生儿正常足月儿特点1.外观特点：正常足月儿外貌成熟，神态自若。
2.呼吸系统：胎儿肺内充满肺液。
足月儿肺液约30~35ml/kg，出生时经产道挤压排出和由肺血管及淋巴系统吸收和转运。
正常新生儿呼吸频率较快，约为40~50次/min，主要靠膈肌运动，呈腹式呼吸。
3.循环系统：正常新生儿出生后血液循环发生显著变化：①脐带结扎，胎盘-脐血液循环终止；②随着呼吸建立、肺膨胀，肺循环阻力下降，肺血流增加；③从肺静脉回流到左心房的血量显著增加，压力增高，使卵圆孔关闭；④由于PaO2增高，动脉导管收缩，继而关闭，完成胎儿循环向成人循环的转变，现称新生儿持续肺动脉高压。
极早产儿与超早产标准英文回答：Premature babies, also known as preemies, are infants who are born before 37 weeks of gestation. They can be further categorized into extremely premature and very premature based on their gestational age. Extremely premature babies are those born before 28 weeks, while very premature babies are born between 28 and 32 weeks.The classification of premature babies is important as it helps healthcare professionals determine the level of care and support needed for these infants. Extremely premature babies, for example, require intensive care in a neonatal intensive care unit (NICU) due to their underdeveloped organs and higher risk of complications. They may need assistance with breathing, feeding, and maintaining body temperature. On the other hand, very premature babies still require specialized care but may have a better chance of survival and fewer long-termcomplications compared to extremely premature babies.To determine the gestational age of a premature baby, healthcare providers use different methods such as ultrasound, physical examination, and maternal history. These methods help estimate the baby's development and guide the appropriate management and interventions.It is important to note that the classification of premature babies is not a rigid definition, and there can be variations in different healthcare settings and countries. For example, some countries may consider babies born at 36 weeks as premature, while others may consider them full-term. The classification also depends on factors such as the baby's weight, overall health, and medical conditions.In my personal experience, my niece was born at 30 weeks gestation, making her a very premature baby. She spent several weeks in the NICU, where she received specialized care and support. She required assistance with breathing and feeding initially but gradually improved overtime. Today, she is a healthy and active toddler, showingno significant long-term complications from her premature birth.中文回答：极早产儿，也被称为早产儿，是指在孕期不满37周时出生的婴儿。
（超）早产儿临床救护十大问题南方医科大学深圳妇幼保健院新生儿科朱小瑜据全国新生儿学组2008年报告47个城市62家分娩医院调查，早产儿（prematureinfant）发生率已达8.1%，较以前5-6%明显上升，且占新生儿科住院26.2%（过1/4），较前19.7（不足1/5）。
但临床上更注重胎龄＜32周，或出生体重＜1500克的小早产儿或极不成熟儿（very immature），若出生体重小于（VLBWI），或超早产儿，其发生率亦升达0.7%，占新生儿科住院2.9%，而且各地仍有上升趋势，逐渐接近国外。
因为他们出生一般仅在早产儿中占8-10%左右，但死亡却在早产儿中占一半以上，而且往往发生在早期，一旦发病易加重、易恶化、易夭折，显然应是我们的防止重点，故本节讨论主要放在这类超早产儿的医学认识及正确管理上。
超早产儿完全缺乏自稳、自存、自我维持生命的能力，没有细心、周到的呵护及多重管理措施就很难助其生存和成长，而科学正确的哪怕是很简单的措施也是基于对其各系统或器官脆弱的生理状态的充分的了解和认识。
归纳起来讲，这类早产儿存在着以下十大生理特点或弱点（也称十大问题）：这些特点与生俱来，容易演变成病态，带来许多临床问题，甚至使生命过程变得垂危和不幸，所以我们的防治措施和对策也应该由此入手，称为核心技术，下面分述之。
一、呼吸功能未成熟表现为哭声低微或不哭，呼吸浅快，节律不规则，常出现呼吸暂停（apnea）和阵发性青紫，对氧的依赖明显大于其他婴儿，有时停氧过早过急会诱发apnea（但无指征给氧和血氧分压高又会引起早产儿视网膜病，均需仔细观察择吉实施），奶后（特别是喂得过多过快）也容易发生青紫，因为：1.呼吸中枢未臻成熟：发放冲动不强，呼吸运动弱，节律会时快时慢（快时居多），甚至一过性呼吸停止，十多秒内又自行恢复或刺激后恢复，这种现象甚至可持续到生后一二十天，曾遇一例小早产儿控制了早期HMD和感染后，已停氧输液仅单纯喂养，精神好，体重每日增长，但却不定时一日数次突发apnea，全身青紫，心率减慢（或至停），立即予以拍打刺激和/或正压通气救护后每每缓解，一切恢复正常，以后随着其成熟不治而愈。
早产临床防治指南（完整版）摘要早产是常见的妊娠并发症，是围产儿及5岁以下婴幼儿死亡和残疾的重要原因。
随着我国传统生活方式的改变，生育政策调整后高龄孕妇增加，妊娠间隔改变，妊娠合并内外科疾病发生率增高等因素的影响，我国早产率呈上升趋势。
为降低我国早产率，提高早产儿存活率，减少早产相关严重并发症，中华医学会妇产科学分会产科学组在上一版的基础上更新了《早产临床防治指南（2024版）》（以下简称“本指南”），以期为临床实践提供参考。
本指南更新内容主要包括早产定义的讨论、识别早产高危人群的方法、预防策略、新的循证证据及治疗方法。
适用范围：单胎妊娠、胎膜完整的自发性早产的防治。
本指南标出的证据质量和推荐强度采用GRADE分级。
证据质量等级分为：✦高级（Ⅰ）：非常确信真实的效应值接近效应估计值；✦中级（Ⅱ）：对效应估计值有中等度信心，真实值有可能接近估计值，但仍存在两者大小不同的可能性；✦低级（Ⅲ）：对效应估计值的确信程度有限，真实值可能与估计值大小不同；✦极低级（Ⅳ）：对效应估计值几乎没有信心，真实值很可能与估计值大不相同。
推荐强度等级分为3级，强烈推荐（A）：明确显示干预措施利大于弊或弊大于利；弱推荐（B）：利弊不确定或无论质量高低的证据均显示利弊相当；良好实践声明（C）：基于非直接证据或专家意见、经验形成的推荐。
01早产的定义及分类早产定义的上限全球统一，即妊娠不满37周分娩；而下限设置各国不同，受社会经济状况、文化、教育、遗传、医疗保健水平及早产儿救治能力等多种因素影响。
根据中华医学会妇产科学分会产科学组的两次Delphi调查结果，本指南早产下限采用妊娠满28周或新生儿出生体重≥1000g的标准；但是，提倡积极救治≥26周胎龄的超早产儿，有条件的地区在产妇及家属充分知情同意的前提下，不放弃对24~＜26周有生机儿的救治。
根据发生的原因不同，早产可分为自发性早产和治疗性早产。
前者包括早产和胎膜早破后早产；后者是因妊娠合并症或并发症，为母儿安全需要提前终止妊娠。
极早产儿与超早产标准英文回答：Premature babies, also known as preemies, are born before 37 weeks of gestation. However, there are different categories within the premature birth classification based on the gestational age of the baby. Two commonly used categories are extremely preterm and very preterm.Extremely preterm babies are born before 28 weeks of gestation. These babies are at the highest risk for complications and may require intensive medical interventions to survive. They often have underdeveloped organs and may face long-term health issues. For example, my friend's baby was born extremely preterm at 24 weeks and had to spend several months in the neonatal intensive care unit before being able to go home.On the other hand, very preterm babies are born between 28 and 32 weeks of gestation. While they still facesignificant challenges, their prognosis is generally better compared to extremely preterm babies. They may stillrequire specialized care and support, but their chances of survival and long-term health outcomes are improved. For instance, my cousin's baby was born very preterm at 30 weeks and had to stay in the hospital for a few weeks to gain weight and develop before being discharged.It is important to note that these categorizations are not fixed and may vary depending on the healthcare provider or country. Some healthcare providers may use different gestational age cut-offs to define extremely preterm and very preterm babies. Additionally, other factors such as birth weight and overall health condition also play a rolein determining the level of prematurity and the required medical interventions.中文回答：极早产儿，也被称为早产儿，是指在孕期不到37周出生的婴儿。
超早产护理案例宝宝在妈妈肚里仅待了26周，出生时体重只有1080克，经过医护人员78天的精心治疗和护理，宝宝闯过呼吸关、感染关、喂养关……呼吸关、感染关、喂养关……日前，胎龄仅26周、出生时体重只有1080克的早产宝宝，经过市一医院医护人员78个日日夜夜的精心治疗和护理，“闯关”成功，体重增至1800克，各项生命体征平稳，达到了出院标准，这位宝宝的出院刷新了该院建院以来成功救治胎龄最小患儿的记录。
据了解，该名超早产儿出生后的反应极差，全身皮肤嫩薄，呈现胶冻状，血管清晰可见，四肢肌张力低，脑袋只有鹅蛋大小，小腿只有成人手指粗细。
当时宝宝没有自主呼吸，患有新生儿肺透明膜病、败血症、贫血、肺炎、硬肿症、低钙血症、低蛋白血症等10多种病症，每一样病症都足以致命。
为了挽救这个幼小的生命，市一医院新生儿重症医学科制定了详细的救治和护理方案，呼吸机辅助呼吸、气管内滴入肺表面活性物质、静脉营养支持、维持内环境稳定、输血……经积极抢救，宝宝暂时脱离了生命危险，但还有呼吸关、感染关、喂养关等难关需要去闯，住院的每一天都是挑战。
该院新生儿重症医学科主任王秀娟说，胎龄小于28周，就属于超早产儿。
“这种情况非常危险，因为婴儿的各种器官发育严重不成熟，尤其是呼吸中枢发育不成熟，无法自主呼吸，离开母体后只能靠呼吸机以及各种仪器维持生命，救治难度很大。
早产儿体重越轻存活率越低，除了先进的设备，还需要非常细致的护理。
”这名胎龄仅26周的小宝宝发育更不成熟，期间多次出现频繁的呼吸暂停，市一医院新生儿重症医学科医护人员经过多次调整呼吸支持方案，最终让宝宝脱离了呼吸机。
同时，宝宝胎龄小，吸吮吞咽功能、胃肠道发育也极不成熟，护士们从一滴一滴喂奶开始，逐步锻炼患儿的吸吮吞咽功能，出院时宝宝每次可以吃奶40毫升。
极早产儿与超早产标准英文回答：Premature babies, also known as preemies, are babies who are born before the 37th week of pregnancy. They are categorized into different levels depending on how early they are born. Extremely premature babies are those who are born before 28 weeks, while very premature babies are born between 28 and 32 weeks.The classification of premature babies is important because it helps healthcare professionals determine the level of care and support these babies need. It also helps in predicting the potential complications and long-term outcomes for these babies.For extremely premature babies, they are at a higher risk of developing various health issues due to their underdeveloped organs and systems. These babies often require intensive care in a neonatal intensive care unit(NICU) and may need assistance with breathing, feeding, and maintaining body temperature.On the other hand, very premature babies have aslightly higher chance of survival and fewer complications compared to extremely premature babies. They may still require some assistance with breathing and feeding, but their overall prognosis is generally better.To illustrate the difference between extremely premature and very premature babies, let's consider two hypothetical cases. Baby A is born at 25 weeks gestation, making him an extremely premature baby. He requires immediate intubation and placement on a ventilator to help him breathe. He also needs to be fed through a feeding tube as he is not yet able to coordinate sucking and swallowing.Baby B, on the other hand, is born at 30 weeks gestation, making him a very premature baby. While he still needs assistance with breathing, he is able to breathe on his own with the help of nasal continuous positive airway pressure (CPAP). He is also able to take some feeds bymouth, although he still requires some supplementalnutrition through a feeding tube.中文回答：极早产儿，也被称为早产儿，是指在孕期不满37周出生的婴儿。
