1. Neonate and Neonatal Diseases (Introduction) Rongxiu Zheng, MD Pediatric Dpt. General Hospital of Tianjin Medical University

4. The two periods are highly vulnerable for life with the highest morbidity and mortality.

6. Classification of the neonates By both GA and BW By birth weight By gestational age

9. 早产儿 足月儿 过期产儿

12. macrosomia NBW VLBW ELBW

15. Point A represents a premature infant. Point B indicates an infant of similar birth weight who is mature but small for gestational age. Weight for gestational age chart

20. Characteristic and nursing care of neonate An infant’s intrauterine to extrauterine transition requires many biochemical and physiologic changes. Many of a newborn’s special problems are related to poor adaptation due to asphyxia, premature birth, life-threatening congenital anomalies, or adverse effects of delivery .

21. Features in appearance of normal term neonate and preterm neonate pink ， well-nurished ， Less fine-hair term Dark-red,edema ， transparent ， more fine-hair preterm Skin

22. ear soft ear stick to the skull, poor figuration preterm Good ear figuration, well-developed cartilage term

23. Galactophore node 早产儿 乳腺无结节或结节 ＜ 4mm 足月儿 乳腺结节 ＞ 4mm ，平均 7mm

24. preterm Under-developed, no testes in the sac genitalia （ male ） term Well-developed, testes decend

25. preterm the labia majora don’t cover the labia minus term the labia majora cover the labium minus; genitalia （ female ）

26. preterm Shallow and less Sole markings term Obvious, over all the sole

30. Urinary system Renal function: does not meet the standards of later life GFR(glomerular filtration rate): is lower, about one fourth to one half of that in an adult. Urine often contains protein in small amounts. . Urine may contain an abundance of urates which may give the diaper a pink stain during the first week of life. The ability to dilute urine is good. but the time taken to reach the maximal ability is relatively long , so newborns are apt to become water overloaded . Urine pH ranges from 5 to 7, specific gravity ranges from 1.006 to 1.020. The first urination occurs within 24 hrs. It ranges from 4 to 6 times/day in the first day and 20 times or so /day in later days of the neonatal period.

31. Hemotological system Blood volume: ranges from 80 to 100 ml/kg . Hemoglobin: ranges around 15~22g/dL. RBC: RBCs range from 5000 to 7000 thousand/mm 3 . WBC: Leukocyte number may be about 18000/ mm 3 or so at birth, and generally increase in number for the first 24 hrs with relative neutrophilia . Counts as high as 25000 to 35000/ mm 3 may be encountered. After the first few days (5 days or so ) the white cell count is likely to be below 14000/ mm 3 with characteristically relative lymphocytosis of infancy and early childhood.

32. Alimentary system The first stool will generally be passed within 12 hr of life and consists of meconium. Meconium stools begin to be replaced by transitional stools on the third or fourth day with the establishment of milk feeding. Typical milk stool follows after an interval of 3 or 4 days. The frequency of stools in newborn infants averages 3 to 5 times a day by the end of the first week. It is unusual for an infant to have as many as 6 or 7 stools after the 2 nd day. The first feeding should be at 6 hrs of postnatal age for a full term baby, 12 hrs for a premature body.

36. Nervous system Head: is relatively large, i.e. from 10 to 12% of body weight . Spinal cord: relatively long. The end of it reaches the level of the third or forth lumbar vertebra . Physiological reflex: There are some physiological reflexes which appear at birth, then disappear at 4 months of life.

37. neonate sucks on the finger place a finger in the neonate’s mouth Sucking neonate makes walking motions with both feet hold the neonate in an upright position and touch one foot lightly to a flat surface (such as the bed) stepping neonate turns the head toward the stimulus, opens the mouth and searches for the stimulus touch a finger to the neonate’s cheek or the corner of mouth. Rooting neonate grasps the finger place a finger in the neonates palm Grasp Neonate extends and abducts all extremities bilaterally and symmetrically Suddenly but gently drop the neonate  s head backward (relative to the trunk) Moro NORMAL RESPONSES TESTING METHOD REFLEX

38. Moro Suddenly but gently drop the neonate  s head backward (relative to the trunk) Neonate extends and abducts all extremities bilaterally and symmetrically

41. Grasp place a finger in the neonates palm neonate grasps the finger

43. Rooting touch a finger to the neonate’s cheek or the corner of mouth. neonate turns the head toward the stimulus, opens the mouth and searches for the stimulus

44. Sucking place a finger in the neonate’s mouth neonate sucks on the finger

46. stepping hold the neonate in an upright position and touch one foot lightly to a flat surface (such as the bed) neonate makes walking motions with both feet

47. Immune system Normal or slightly higher level of IgG is due to active transfer from the mother to fetus via the placenta, but IgM and IgA are low (they cannot pass through the placenta); therefore the newborns are at high risk for gram negative bacterial infection . T lymphocyte functions are somewhat reduced in newborn infants. White blood cells display low function in killing microorganisms.

50. Temperature control for newborn infants is important to avoid the excess stress which hypo- or hyperthermia imposes on a newborn. To provide a neutral thermal environment, the incubator temperature should be kept at the temperatures shown in the followingtables.

52. Skin At birth the infant is generally covered with vernix caseosa , a cheesy - white substance adherent to the skin. It is helpful for protecting the baby against infections, and should not be taken off. Keeping the skin of the baby clean is very important because it is apt to be infected.

53. Umbilical cord After the ligation of the umbilical cord, it comes off from 1 to 7 days of postnatal age. It has to be prevented against contamination and be kept it from bleeding .

57. Water metabolism Water may contribute up to 75% of body weight (40% extracellular). During the first few days there are a loss of fluid leading to about 6% loss of body weight (physiologic) and usually do not exceed 10%. Insensible water loss is about 40ml/100cal.

59. High risk neonates The term designates infants who should be under close observation by experienced physicians and nurses.

60. Neonatal Intensive Care Unit, (NICU) The special medical unit which take special care for those high risk babies with modern medical equipments and techniques such as purified air ward, resuscitation technique, mechanical ventilator, color Doppler mapping, radiated heater and so on.

76. Several physiological states of the newborn

77. Physiologic jaundice Mild jaundice may occur in most newborns, this is due to the immaturity of the baby's liver, which leads to a slow processing of bilirubin. It generally appears at 2 to 4 days of age and disappears by 1 to 2 weeks of age. The appearance of visible jaundice before 48 hrs , or a serum concentration of bilirubin exceeding 12 mg/dL at any time of neonatal period are considered to be abnormal. For premature infants, the serum bilirubin concentration exceeding 15 mg/dL is abnormal.

79. Pseudomenstration Vaginal bleeding may occur at the age of 5 to 7 days in some newborn girls and lasts for 1 to 2 days. Placentally transmitted and withdrawn maternal hormones are responsible for temporary vaginal bleeding.

81. Enlargement of the breasts Enlargement of the breasts, and production of milk may occur at the age of 3 to 5 days in some newborn boys or girls. This stops at the postnatal age of 2 to 3 weeks. This is also caused by transmission and withdraw of maternal hormones. This no requires management.