Chapter 5
Neonate and Neonatal diseases
1,Neonatal outline
2,Neonatal respiratory diseases
3,Neonatal jaundice and hemolysis
4,Neonatal brain diseases
5,Neonatal infection
陈 超
复旦大学儿科医院 新生儿科主任
复旦大学上海医学院 儿科学系副主任
54524666 X 2041
chenchao115@hotmail.com
N I CU
Dept,of Neonatology
Children`s Hospital,Fudan University
Beds,100
Doctors,23
Nurses,38
One of most big neonatal center in China
N I CU
Neonatal Intensive Care Unit
(NICU)
N I CU
Neonatal outline
1,development of neonatology
Important branch of pediatrics
Rapid development
Expectation and danger
Challenge extremity of life
N I CU
neonatal period (新生儿期 )
neonate,newborn (新生儿 )
Neonatology (新生儿学 )
perinatal period (围产期 )
perinatal infant (围产儿 )
Perinatology (围产医学 )
2,Concepts
N I CU
3,Classification of Newborn
１,gestational age ( 胎龄 )
足月儿,fullterm infant,mature infant
≥37w ～ < 42w
早产儿,preterm infant,premature infant
< 37w
过期产儿,postterm infant
? 42w
N I CU
Postterm infant
N I CU
Thin,loosely skin,like old man
Postterm infant
N I CU
２,birth weigh (出生体重 )
normal birth weigh,2500-3999g
low birth weigh(LBW),<2500g
very low birth weigh(VLBW),<1500g
extremely low birth weigh(ELBW),< 1000g
macrosomia,? 4000克
N I CU
ELBW (超低出生体重儿 )
N I CU
３,relation of birth weigh and gestational age
Appropriate for gestational age (AGA)：
10－ 90 percentage
Small for gestational age (SGA),< 10 percentage
Large for gestational age (LGA),> 90 percentage
N I CU
Curve of growth in fetus
500
750
24 26 28 30 32 34 36 38 40 42 44 46 48 （ 周）
1000
1250
1500
1750
2000
2250
2750
3000
3500
3750
2500
4000
4250
4500
4750
5000
3250
小于胎龄
第 10 百分位
适于胎龄
平均体重
大于胎龄
第 90 百分位
N I CU
４,day after birth
Early newborn,during１ week
70% death is during １ week
Lately newborn,during 2 - 4 week
N I CU
５,high risk newborns
High risk factors
monitor
N I CU
4,characteristics of normal
newborn
(1)appearance
7 signs,skin,hair,ear、
nail,planta,breast,genitals
Assessment of growth
and gestational age
Plantar crease
in normal newborn
2.respiratory system
Respiratory center
Pulmonary surfactant
(肺表面活性物质 )
Respiratory rate,40-45/min
Abdomen respiratory
N I CU
3.cardiovascular system
PDA
Heart rate
4.gastrointestinal system
Stomach,loosely Lower esophageal sphincter
Air in intestine
Meconium
葡萄糖醛酸转移酶
N I CU
5,Blood system
polycythermia,FHb70%
leukocyte
Low coagulation factors
N I CU
6,Urinary system
浓缩功能差
24小时排尿
N I CU
7,Nervous system
reflexes,Moro,rooting,sucking、
N I CU
8,Immuno- system
IgG from mother
IgM no through placenta
IgA
细胞免疫功能低
N I CU
9,Regular of temperature
产热, 依靠棕色脂肪组织
无颤抖产热
散热, 体表面积大
皮下脂肪层薄
姿势
N I CU
neutral temperature （适中温度 ）
指在这一 room temperature下，机体耗氧量、代
谢率最低，散热量最少，而又能保持正常体温。
适中温度随胎龄而不同：
newborn,33－ 35oC
adult, 25－ 26oC
N I CU
出生体重
（ kg ）
暖 箱 温 度
35 ℃ 34 ℃ 33 ℃ 32 ℃
1.0
初生 10 天
10 天以后
3 周以后
5 周以后
1.5
－
初生 10 天
10 天以后
4 周以后
2.0
－
初生 2 天
2 天以后
3 周以后
2.5
－
－
初生 2 天
2 天以后
neutral temperature
N I CU
10,Special physiology
physiologic jaundice
breast greater
N I CU
1１, Neonatal behaviour
5,care of normal newborn
roting care
Special care
Neonatal Intensive Care Unit
NICU
N I CU
Care of normal newborn
1,ward,room temperature,22－ 26oC，
humidity 40－ 50 ％
2,infection,sterilizing,wash hand
3,keeping temperature,incubator
4,skin care,wash with water
5,umbilical cord,sterilizing,keep dry
N I CU
6.feeding
breast feeding,bottle feeding
7.vaccine,BCG, Hepatitis B vaccine
8.neonatal screening：
PKU,hypothyroidism,hearing
N I CU
6,characteristics of
premature infants
1,appearance
哭声低，肌张力低，皮肤嫩，
胎毛 多,耳壳软，足纹少。
2,Respiratory system
Premature of respiratory center
Respiratory irregulation
abdomenrespiratory
apnea,RDS
N I CU
3,gastrointestinal system
Vomiting and aspiration
Gastroesphageal reflux
Feeding difficulty
NEC
N I CU
4,Nervous system
Development and gestational age
IVH and PVL
5,体温调节
产热少
散热多
N I CU
6,Cardiovascular system
delay close of PDA
7,other
Hypoglycemian
hypocalcemia
Difficincy vitaming A,E
葡萄糖醛酸转移酶缺乏
N I CU
Problems of premature infants
temperature
hypoglycemia
Cardiovascular system
Respiratory system
Water,
kedney
bloodsystem
infections
gastrointestinal
system
jaundice
Nervou ssystem
ROP
feeding
N I CU
Temperature
respiratory
feeding
jaundice
infections
……
N I CU
7,care of premature infants
1,ward,sterilizing,wash hand
2,feeding,milk，
3,Keeping permperature
4,Monitor,
N I CU
incubator
N I CU
Neonatal transport
N I CU
ventilator
N I CU
SGA, small for gestational age
1,etiology
factors of mother,fetus
2,manifestation
1.匀称型：
2.非匀称型：
N I CU
small for gestational age
3,complications
hypoglycemia,hypocalcemia
polycythemia(RBC增多症 )
aspiration,NEC
development delay
N I CU
term infant
SGA
N I CU
LGA, Large for gestational age
factors
1,physiology：
parents
over nutrition
2,diabetes mother：
high insulin，
rapid growth
N I CU
Complications
1.NRDS,high insulin,low surfactant
2.birth injury,bone fracture,airleak
3.hypoglycemia,high insulin
N I CU
Neonate and Neonatal diseases
1,Neonatal outline
2,Neonatal respiratory diseases
3,Neonatal jaundice and hemolysis
4,Neonatal brain diseases
5,Neonatal infection
陈 超
复旦大学儿科医院 新生儿科主任
复旦大学上海医学院 儿科学系副主任
54524666 X 2041
chenchao115@hotmail.com
N I CU
Dept,of Neonatology
Children`s Hospital,Fudan University
Beds,100
Doctors,23
Nurses,38
One of most big neonatal center in China
N I CU
Neonatal Intensive Care Unit
(NICU)
N I CU
Neonatal outline
1,development of neonatology
Important branch of pediatrics
Rapid development
Expectation and danger
Challenge extremity of life
N I CU
neonatal period (新生儿期 )
neonate,newborn (新生儿 )
Neonatology (新生儿学 )
perinatal period (围产期 )
perinatal infant (围产儿 )
Perinatology (围产医学 )
2,Concepts
N I CU
3,Classification of Newborn
１,gestational age ( 胎龄 )
足月儿,fullterm infant,mature infant
≥37w ～ < 42w
早产儿,preterm infant,premature infant
< 37w
过期产儿,postterm infant
? 42w
N I CU
Postterm infant
N I CU
Thin,loosely skin,like old man
Postterm infant
N I CU
２,birth weigh (出生体重 )
normal birth weigh,2500-3999g
low birth weigh(LBW),<2500g
very low birth weigh(VLBW),<1500g
extremely low birth weigh(ELBW),< 1000g
macrosomia,? 4000克
N I CU
ELBW (超低出生体重儿 )
N I CU
３,relation of birth weigh and gestational age
Appropriate for gestational age (AGA)：
10－ 90 percentage
Small for gestational age (SGA),< 10 percentage
Large for gestational age (LGA),> 90 percentage
N I CU
Curve of growth in fetus
500
750
24 26 28 30 32 34 36 38 40 42 44 46 48 （ 周）
1000
1250
1500
1750
2000
2250
2750
3000
3500
3750
2500
4000
4250
4500
4750
5000
3250
小于胎龄
第 10 百分位
适于胎龄
平均体重
大于胎龄
第 90 百分位
N I CU
４,day after birth
Early newborn,during１ week
70% death is during １ week
Lately newborn,during 2 - 4 week
N I CU
５,high risk newborns
High risk factors
monitor
N I CU
4,characteristics of normal
newborn
(1)appearance
7 signs,skin,hair,ear、
nail,planta,breast,genitals
Assessment of growth
and gestational age
Plantar crease
in normal newborn
2.respiratory system
Respiratory center
Pulmonary surfactant
(肺表面活性物质 )
Respiratory rate,40-45/min
Abdomen respiratory
N I CU
3.cardiovascular system
PDA
Heart rate
4.gastrointestinal system
Stomach,loosely Lower esophageal sphincter
Air in intestine
Meconium
葡萄糖醛酸转移酶
N I CU
5,Blood system
polycythermia,FHb70%
leukocyte
Low coagulation factors
N I CU
6,Urinary system
浓缩功能差
24小时排尿
N I CU
7,Nervous system
reflexes,Moro,rooting,sucking、
N I CU
8,Immuno- system
IgG from mother
IgM no through placenta
IgA
细胞免疫功能低
N I CU
9,Regular of temperature
产热, 依靠棕色脂肪组织
无颤抖产热
散热, 体表面积大
皮下脂肪层薄
姿势
N I CU
neutral temperature （适中温度 ）
指在这一 room temperature下，机体耗氧量、代
谢率最低，散热量最少，而又能保持正常体温。
适中温度随胎龄而不同：
newborn,33－ 35oC
adult, 25－ 26oC
N I CU
出生体重
（ kg ）
暖 箱 温 度
35 ℃ 34 ℃ 33 ℃ 32 ℃
1.0
初生 10 天
10 天以后
3 周以后
5 周以后
1.5
－
初生 10 天
10 天以后
4 周以后
2.0
－
初生 2 天
2 天以后
3 周以后
2.5
－
－
初生 2 天
2 天以后
neutral temperature
N I CU
10,Special physiology
physiologic jaundice
breast greater
N I CU
1１, Neonatal behaviour
5,care of normal newborn
roting care
Special care
Neonatal Intensive Care Unit
NICU
N I CU
Care of normal newborn
1,ward,room temperature,22－ 26oC，
humidity 40－ 50 ％
2,infection,sterilizing,wash hand
3,keeping temperature,incubator
4,skin care,wash with water
5,umbilical cord,sterilizing,keep dry
N I CU
6.feeding
breast feeding,bottle feeding
7.vaccine,BCG, Hepatitis B vaccine
8.neonatal screening：
PKU,hypothyroidism,hearing
N I CU
6,characteristics of
premature infants
1,appearance
哭声低，肌张力低，皮肤嫩，
胎毛 多,耳壳软，足纹少。
2,Respiratory system
Premature of respiratory center
Respiratory irregulation
abdomenrespiratory
apnea,RDS
N I CU
3,gastrointestinal system
Vomiting and aspiration
Gastroesphageal reflux
Feeding difficulty
NEC
N I CU
4,Nervous system
Development and gestational age
IVH and PVL
5,体温调节
产热少
散热多
N I CU
6,Cardiovascular system
delay close of PDA
7,other
Hypoglycemian
hypocalcemia
Difficincy vitaming A,E
葡萄糖醛酸转移酶缺乏
N I CU
Problems of premature infants
temperature
hypoglycemia
Cardiovascular system
Respiratory system
Water,
kedney
bloodsystem
infections
gastrointestinal
system
jaundice
Nervou ssystem
ROP
feeding
N I CU
Temperature
respiratory
feeding
jaundice
infections
……
N I CU
7,care of premature infants
1,ward,sterilizing,wash hand
2,feeding,milk，
3,Keeping permperature
4,Monitor,
N I CU
incubator
N I CU
Neonatal transport
N I CU
ventilator
N I CU
SGA, small for gestational age
1,etiology
factors of mother,fetus
2,manifestation
1.匀称型：
2.非匀称型：
N I CU
small for gestational age
3,complications
hypoglycemia,hypocalcemia
polycythemia(RBC增多症 )
aspiration,NEC
development delay
N I CU
term infant
SGA
N I CU
LGA, Large for gestational age
factors
1,physiology：
parents
over nutrition
2,diabetes mother：
high insulin，
rapid growth
N I CU
Complications
1.NRDS,high insulin,low surfactant
2.birth injury,bone fracture,airleak
3.hypoglycemia,high insulin
N I CU
