新生儿英用药.ppt

Neonatal Medicine--Introduction 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 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 Historical Perspectives Emergence of neonatal Intensive Care (1971~1989) - 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 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