(精选)新生儿病例分析教学课件.pptxVIP

新生儿病例讨论首都儿科研究所附属儿童医院米荣Case 1---historyThe girl was born in Beijing obstetrics and Gynecology hospital. The mother was a primipara and previously healthy with an uneventful pregnancy. The parents were nonconsanguineous（无血缘关系的）. Spontaneous labour occurred in gestational age 38 weeks. Due to slow progress, green amniotic fluid, polyhydramnion（羊水过多）, and a pathological cardiotocography（分娩监护仪） , an acute caesarean section（剖宫产） was performed. Apgar scores were 3.6and 9 in 1 ,5, and 10minutes,respectively.Birh weight was 3,510g. K-vitamin was administered. The mother remained afebrile during and after delivery.?The child had a normal physical examination, except from a petechial rash(瘀点). She was suspected for sepsis and started on piperacillin sodium and tazobactam sodium(特治星) and cefotaxime sodium（头孢噻肟钠）. Abdominal ultrasound showed an enlarged liver with a normal structure .Within the first 24 hours, she became icteric and was transferred to specialized neonatal care in Capital Institute of Pediatrics.Case 1---Lab testTable 1Investigations performed in the neonatal periodExamination Test resultsBone marrow aspiration No malignancyCMV serology –CMV IgM positiveCMV PCR in blood and urine positive in urine after three weeks EBV serology negativeUrine metabolic screen normalX-ray thorax bilateral pneumonia X-ray abdomen normalUS abdomen marked hepatomegalyCase 1---Lab testCT thorax and abdomen hepatomegalyUS cerebrum normalCT cerebrum Haemorragia in posterior fossaElectrocardiogram normalLumbar puncture WBC 156 /mm3 RBC 4/mm3 Protein 1800 Glucose 0.5 Chloride 121 Case 1---lab testHaemoglobin(range) 9.5 g/LLeucocytes（highest） 46X10 9/LThrombocytes(lowest) 21x1012/LCRP(highest) 120g/dLBilirubin total(highest) 380μmol/LBilirubin conjugated(highest)