[医疗保健]新生儿疾病_11586.pptVIP

Neonatal Septicemia Dr. Hei Mingyan Pediatric Department Pathogen Mainly bacteria and fungus In China, Stephylococcus and E.Coli Diagnostic points history； Clinical manifestation； Lab examination。 History Perinatal factors (amniocentesis, premature delivery, low birth weight, premature rupture of fetal membrane, prolonged labor, birth trauma, sick mother, sick nursery) Clinical manifestations General manifestations Poor general conditions, lathergy, no crying, inactive, hypothermia, zero or negative weight gain Indicating symptoms 以下哪项是新生儿败血症的特征性表现？ a. 发热、拒奶 b. 皮肤感染灶 c. 白细胞计数增多 d. 反应稍差 e. 无特征性表现 杨泽，男，7天，因皮肤黄染4天，加重伴发热1天，于2003年1月5日9pm 入院。系第一胎足月平产，出生后一般情况良好，混合喂养，生后第三天发现皮肤黄染，眼睛也黄，1月4日开始发热，皮肤黄染似有加深。近2天来吃奶少，嗜睡，有时哭吵，大便2-3次/日，黄色软便，有少许粘液，尿量正常，无呕吐及抽搐。母孕期体健，加重无类似患者。PE：T 38.9 oC，R 54 次/分钟，P 152次/分钟，新生儿貌，发育营养可，精神欠佳，呼吸平稳，皮肤中度黄染，弹性好，未见皮疹及出血点，前囟1.2 x 1.2 cm，平软，张力不高，巩膜黄染，口腔粘膜稍干，双肺呼吸音清，心（-），脐轮红，少许脓性分泌物，肝右肋下1cm， 质软，四肢肌张力不高，吸吮反射、觅食反射存在，肛门外生殖器无异常，双大腿外侧有少许硬肿。Hb 210g/L, WBC 205 x 109/L, L 0.20, N 0.75, M 0.05, Pt 100 x 109/L. 问题： 1）. 该患儿的诊断及诊断依据是什么？ 2）. 如何治疗？ 3）. 还应做那些检查以确诊? * * Definition After invasion, the pathogen grows, proliferates and releases toxin in the blood circulation of a neonate, causing severe multi-systemic problems. Meanwhile, other non-infectious factors which may cause similar symptoms are excluded. Stephylococcus aureus E.Coli Infection pathways Antepartum: through placenta, amniotic biopsy During delivery: ascending infection Postpartum: Infection pathways Through blood Through amniotic fluid Lower immunity in neonates Non-specific immunity Specific immunity Two types of neonatal septicemia Early type Late type Early type 4-7 days after birth, multiple perinatal factors, organic fulminant manifestations, high mortality Late type 5-7 days after birth, staphylococcus aureus, Pseudomonas aeruginosa Atypical manifestations in the early stage Jaundice hepatosplenomegaly Skin infection Omphalitis Skin problems Shock Complications meningitis ost