1、Neonatal Cold Injury Syndrome (sclerema neonatorum),Etiology and pathophysiology Characteristics of temperature regulation and subcutaneous fatty composition in newborn immaturity of temperature regulation center relative large surface area and rich blood flow cause poor thermal insulation, limited

2、storage of energy, heat production mainly by brown fatty metabolism, lacking shivery thermogenesis more quantity of saturated fatty acid with higher melting point Imbalance between heat production and loss,Distribution of neonatal brown fat,Cold injury Cold environment increase heat loss, low body t

3、emperature causes constriction of peripheral blood vessels, dysfunction of microcirculation Low body temperature and cold environment cause anoxia, metabolic disturbance and acidosis even multiple organ dysfunction (MOD),Other Factors, severe infection, premature, asphyxia, ICH, erythroblastosis,Imb

4、alance between heat production and loss,Heat production,Non-enough intake,Imbalance between heat production and loss,Heat loss,cold,relative larger surface,cold,immature of temperature center,immature of temperature center relative larger surface,cold、non-enough intake infection、asphyxia,heat produc

5、tion of brown fat,anoxia, acidosis,higher saturated fatty acid,higher melt point,body temperature ,coagulation of subcutaneous fat,Pathogenesis of Neonatal Scleredema,Anoxia, acidosis,coagulation of subcutaneous fat,constriction of skin vessels,anoxia of tissue,hardening of skin,Slowly blood flow,di

6、sturbance of microcirculation,capillary permeability ,edema,circulating volume,shock,multiple organs dysfunction,DIC, usually occur in cold season during first 3 days or any time in preterm infants Low body temperature Scleredema MOD in severe case,Clinical Manifestations, feature: skin and subcutan

7、eous tissue become indurated, woody, non-pitting, cold to touch, involved area may with edema, redness, cyanosis; symmetrical Sequence: calvesthighslow extremitiesbuttockcheeksupper extremitieswhole body,Scleredema,Neonatal scleredema,multiple organ dysfunction bradycardia, dyspnea, microcirculation

8、 disturbance, shock, DIC, acute renal failure, pulmonary hemorrhage,Evaluation of body surface area,Head and neck 20% Upper limbs 18% Anterior part of trunk 14% Posterior part of trunk 14% Buttock 8% Lower limbs 26%,Degrees of NCIS Body temperature() involved area change of organic anus T axil anus

9、T (%、color) function I0 35 positive 50 shock、DIC、 (severe) or 30 cyanotic PH or ARF,nonspecific examination for diagnosis. blood gas analysis, CT, PT, blood glucose level, platelet, electrolytes, BUN, fibrogen, etc. EKG, X - ray,Laboratory Examination,Differential diagnosis,Neonatal edema Localized

10、edema Premature infant edema -hypoalbuminemia, hyponatremia Hemolytic disease of newborns - anemia, splenohepatomegaly or Jaundice Congenital nephrosis -abnormal in urine,Neonatal edema,Differential diagnosis,Subcutaneous gangrene - staphylococcus aureus -compressive site or impaired site -swelling,

11、 blush, hard -darkening, bleed, ulcer -obscure boundary,Neonatal Subcutaneous Gangrene,treatment,Heat loss,Heat production,Correction of organ dysfunction,normal body temperature organs function,Treatment Restoration of body temperature Energy supply and fluid infusion Correction of organ dysfunctio

12、n correction of acidosis and volume expansion treatment of pulmonary hemorrhage arrangement of ARF and DIC Others: antibiotics, symtomatic therapy,Treatment,Rewarming TR 30 , TA-R0 -Placed in a neutral thermal environment -Returned to normal temperature during 612 hours,Treatment, TR 30 , TA-R0 Plac

13、ed in a incubator where environmental temperature higher 12 than body temperature( 0.5-1/h ) Kept in a neutral thermal environment when TR 35 Returned to normal temperature during 1224 hours,Treatment,Ways of re-warming Incubator Open radiant warmer bed Others water bath, electric blanket , Kangaroo

14、 Care, etc,Incubator,Open radiant warmer bed,Huge omphalocele(巨大臍膨出）,kangaroo care,Prevention Neonatal care: warm environment, enough clothes Encourage early breast feeding Prevent high risk factors: premature, infection, asphyxia,Conclusion and Review How to diagnose neonatal sepsis? Which marker c

15、an indicate neonatal infection? How many factors can cause NCIS? Which complication is caused by NCIS? State the clinic S/S and degrees of NCIS.,Thank You,Mini case discussion,Clinical case presentation,Patient1:10.09.06 Sex: male GA:32+2W BW:1240g Vaginal delivery Apgar:8-10-10 Umbilical pH:7.22,PR

16、OM of 2days intrapartum ampicillin because of PROM(胎膜早破） and maternal elevation of CRP Admitted to NICU duo to prematurity General condition is unstable,Frequent apnea 2 hrs after birth, aminophyllin and CPAP（持續(xù)呼吸末正壓通氣） was given for 3 days and apnea disappeared. Because of VLBW, umbilical venous ca

17、theterization was performed on D1 and the catheter was removed on D7. PICC（經(jīng)外周中心靜脈置管術(shù)） was inserted on D7.,The general condition was stable after D3 except poor enteral feeding. On postnatal D13, he was getting worse : tachypnea, tachycardia, pale, grunting , abdominal distention, cyanosis, low BP and hypothemia. -antibiotics , IVIG, CPAP was given.