高危新生儿产后访视管理

高危新生儿产后访视管理 徐韦 一.新生儿家庭访视 1.新生儿访视时间 第一次:出院后一周内。 第二次:出院一周后, 28天内。 2.新生儿访视服务: (1) 初访(出院后一周内):了解新生儿胎产时情况(出生情况，出生方式，有无窒息史，出生时的体重，有无接种卡介苗、乙肝疫苗，询问新生儿疾病筛查听力筛查和疾病筛查情况等)，喂养方式、大小便、睡眠情况;观察新生儿一般状况并进行相关检查(精神状态、哭声、体温、呼吸、心率、口腔、皮肤、脐部、生殖器、肛门等)，重点对先天缺陷、高危儿进行初步筛查;观察新生儿面色和皮肤颜色，有无黄疸，并鉴别其为生理性还是病理性，后者则需送医院治疗。注意脐带残端是否脱落，有无渗液，发现感染及时处理。秤小儿体重，观察生理性下降的程度，指导新生儿护理和母乳喂养方法。对高危新生儿，注意新生儿的各种生命指征和生理状态及喂养情况，并做好《高危儿访视记录》。如果发现新生儿未接种卡介苗和第1剂乙肝疫苗，提醒家长尽快补种。如果发现新生儿未接受新生儿疾病筛查，告知家长到具备筛查条件的医疗保健机构补筛。根据新生儿的具体情况，有针对性地对家长进行母乳喂养、护理和常见疾病预防指导。 (2)第二次访视(出院1周后, 28天内):主要观察脐部有无感染、脱落情况，黄疸是否消褪，生理性体重下降后的恢复情况;了解喂养及护理中出现的新问题，并帮助原因，给予及时指导。出生14天指导添加维生素AD制剂，指导母亲预防小儿佝偻病的方法;强调并指导母乳喂养。满月测体重，若增磅不足600克应分析原因，给予指导，并纳入体弱儿管理，预约每月一次的儿童保健门诊的检查。 重点:了解高危儿因素、先天缺陷、先天畸形、新生儿听力筛查、疾病筛查情况，通知满月体检，将异常情况进行登记并通知儿童保健人员。喂养指导 二.高危新生儿管理 概念 高危儿是指有高危因素的婴儿，其中大部分属于正常儿童范畴，但是高危儿存在发育障碍、脑损伤或相应疾病的潜在危险，应对高危儿进行专门保健管理和医学监测，以其能够早期发现异常，获得早期医学干预，达到预防疾病、促进生长发育或减少疾病危害、避免残障的目的。 高危新生儿管理范围: 主要是在围产期受到高危因素影响的存活高危儿，而高危因素按时期又分为胎儿期、分娩期、新生儿期、婴儿期。 , 早产儿 , 足月小样儿 , 新生儿期黄疸持续时间长(足月儿大于2周，早产儿大于4周)，黄疸重(大 于15毫克/分升) obstacles, correcting misunderstandings, advocate good cadre style. 2, adhere to the scientific decision-making and democratic decision-making decision-making law. Correctly handle to ensure that government decrees and based on the actual creative work, giving full play to subjective initiative, put an end to implement the conference meeting, to document the implementation of documents etc. Improve the scientific and democratic decision-making mechanism, improve and implement the decision to solicit the views of experts, the public hearing system. Improve the important decision of risk assessment mechanism and legal review mechanism. 3, to promote team unity. Uphold and improve the system of annual party book talk heart to heart, mind and Party members, Party members to exchange each other not less than 2 times. The implementation of sound team democratic life system, consolidate and enhance the party's mass line educational practice will promote the achievement of the topic of democratic life, criticism and self-criticism normalization, a long-term. Adhere to the party on the basis of the principle of unity, enhance internal communication, strengthen internal supervision, self Sleep maintenance team collective image and authority. (three) to ensure the execution is not strong or disguised to resist government decrees issues. Individual Bureau leadership team members lack of learning political theory system, not from the objective reality, not with the party's interests above all the principles to deal with personal problems. In the specific work safety supervision in the execution is not strong, in the implementation of the decision to deploy the discount, make choices, engage in work, the implementation of the agreement, uncomfortable is not performed, open or disguised to resist, the lack of subject consciousness of the party organization, the lack of resist in society all kinds of bad habits and unwholesome tendencies of courage Gas and courage. Such as the liability insurance of safe production work, individual leaders that have someone arrested, and no funding, not in the global chess perspective to the countryside to carry out daily inspection, found none of my business acceptance of the resumption of production in an armchair, with a pen, indifferent. Corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, to strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, To establish and perfect the muddle along and other issues. Bureau staff conduct work regulations, standardize the behavior of personnel. 2, strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. , 新生儿窒息(Apgar评分7分以下) , 新生儿ABO溶血病 , 新生儿低血糖、巨大儿。 , 脐部感染 , 新生儿缺血缺氧性脑病、颅内出血、败血症、肺炎、硬肿症。 , 胎儿、新生儿巨细胞病毒、弓形体、单纯疱疹病毒、肝炎病毒、衣原体、梅 毒等感染。 , 有抽搐、颅内感染史。 , 脑瘫。 , 先天缺陷、畸形(先天畸形包括:如先心、唇腭裂、多指、趾、耳道闭锁、 肛门闭锁、先天性巨结肠等)。 高危儿有三种状态 l.出生时已经出现病损高危儿 例如有明确的脑损伤病史的高危儿 (缺氧缺血性脑病、颅内出血、高胆红素脑病)或有疾病症相的婴儿 (先天性心脏病、，乙型病毒性肝炎、HIV感染) 。 ——需要早期医学于预，并医学随访。 2.疾病征象暂时未现出来的高危儿 例如早产儿和低出生体重儿、中、重度窒息儿，脑发育不良儿等。 ——需要进行医学监测，早期发现疾病，早期进行医学于预。 存在高危因素的健康高危儿 3. 通过医学监测没有发现病损。 ——按照正常儿童保健。 管理原则与内容 原则: 应该贯彻预防为主和防治结合的原则，早期发现异常，早期诊断、早期于预，开展早期综合性防治，保护高危儿健康成长。 管理内容: 高危儿一般保健、高危儿医学监测、高危儿定期健康检查、高危儿监测网的建立和管理。 (一) 一般保健措施 高危新生儿访视 高危新生儿自产院出院后，在生后28天内要进行3~4次家庭访视，如果高危新生儿有异常情况，应该增加访视次数。除常规新生儿访视内容 (包括保暖、喂养、生活护理、预防感染)外，对于高危儿应注意下列事项: 1?社区医疗保健人员在家访时应详细阅读新生儿的出院记录，了解新生儿出生前后的健康情况以及家访的重点问题，有的放矢地进行家庭访视。 指导家长进行高危儿家庭监测 。告知家长一旦发现新生儿有异常表现，应该及时去医院就诊。 2?建立高危儿随访记录和专案登记，进行高危儿管理。 3?建立转诊医疗制度。按照当地医疗保健的布局和实际情况，建立转诊制度，在新生儿家庭访视中一旦发现异常，要及早转诊，及早得到正确诊断和治疗，防止延误诊断和病情加重。 4. 早期发育检查以及早期教育指导 (如婴儿抚触、婴儿操，视、听训练等)。 (二).定期健康检查和预防接种 6个月以内婴儿每1个月1次，6~12个月婴儿每2个月I次，1~3岁幼儿每3个月1次。检查内容除生长发育测量和评价、全身各系统检查以及常见病的防治外，还obstacles, correcting misunderstandings, advocate good cadre style. 2, adhere to the scientific decision-making and democratic decision-making decision-making law. Correctly handle to ensure that government decrees and based on the actual creative work, giving full play to subjective initiative, put an end to implement the conference meeting, to document the implementation of documents etc. Improve the scientific and democratic decision-making mechanism, improve and implement the decision to solicit the views of experts, the public hearing system. Improve the important decision of risk assessment mechanism and legal review mechanism. 3, to promote team unity. Uphold and improve the system of annual party book talk heart to heart, mind and Party members, Party members to exchange each other not less than 2 times. The implementation of sound team democratic life system, consolidate and enhance the party's mass line educational practice will promote the achievement of the topic of democratic life, criticism and self-criticism normalization, a long-term. Adhere to the party on the basis of the principle of unity, enhance internal communication, strengthen internal supervision, self Sleep maintenance team collective image and authority. (three) to ensure the execution is not strong or disguised to resist government decrees issues. Individual Bureau leadership team members lack of learning political theory system, not from the objective reality, not with the party's interests above all the principles to deal with personal problems. In the specific work safety supervision in the execution is not strong, in the implementation of the decision to deploy the discount, make choices, engage in work, the implementation of the agreement, uncomfortable is not performed, open or disguised to resist, the lack of subject consciousness of the party organization, the lack of resist in society all kinds of bad habits and unwholesome tendencies of courage Gas and courage. Such as the liability insurance of safe production work, individual leaders that have someone arrested, and no funding, not in the global chess perspective to the countryside to carry out daily inspection, found none of my business acceptance of the resumption of production in an armchair, with a pen, indifferent. Corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, to strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, To establish and perfect the muddle along and other issues. Bureau staff conduct work regulations, standardize the behavior of personnel. 2, strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 应该进行科学养育、喂养和早期教育以及高危儿筛查(检查神经反射、运动发育和肌张力以及姿势反射)，早期发现异常，早期进行干预。 每3个月检查铁代谢 (铁蛋白和红细胞内原卟啉或锌卟啉)和血红蛋白1次。 每6个月进行1次智力检查 (DDST智力筛查或Gesell发育诊断)。 按计划免疫程序给高危儿进行预防接种，暂时尚未列入计划免疫程序的疫苗一般都应该接受 (例如肺炎双球菌疫苗、轮状病毒疫苗等)。 对于有脑损伤或神经发育障碍的高危儿要暂缓接种百白破三联疫苗、流行性脑膜炎疫苗和乙型脑炎疫苗，避免接种的不良反应，要待脑损伤或发育障碍康复后补种。 (三)婴儿抚触、婴儿操以及视听训练 婴儿抚触和婴儿操是适用于小婴儿的一种保健措施。通过全身的触摸和肢体运动，让大量温和的良好刺激通过皮肤感受器传到中枢神经系统，对脑功能的发育是良好的刺激。能提高婴儿的进食量，改善睡眠质量，有利于婴儿生长发育;并且加深母婴感情交流，使婴儿得 到心理安抚;通过肢体运动，还有利于肢体运动功能的发育。婴儿抚触对健康婴儿是一种保 健方法，对有脑发育异常的高危儿则属于早期干预的一种方法。 婴儿抚触和婴儿操上午和下午各做1次，每次时间不少于10分钟。 利用红球和响铃对小婴儿进行视觉、听觉训练，每天2次，对促进婴儿视、听感觉的发育也是很重要的保健方法。 (四)营养、喂养指导 母乳喂养: 指导母乳喂养的正确方法和辅助食物的添加方法，对母乳不足的母亲，指导其增加吸吮次数、乳母增加营养等增加乳汁分泌的办法，如果母乳仍不足时，应该及时添加配方乳，指导混合喂养的正确方法 (包括配方奶粉的选择、奶瓶消毒、喂养方法以及消化吸收能力的观察等。 2.、维生素和矿物质的补充 无论是母乳喂养、混合喂养或人工喂养幼儿，下列维生素和矿物质都应该适量补充，预防婴幼儿营养缺乏症。 维生素A和维生素D 从生后半个月开始给婴儿补充，每日维生素A600一10001U，维生素D400一6001U。通常使用单剂量的维生素AD胶囊补充。 (2)维生素B和维生素C的补充 建议乳母每天补充B族维生素和维生素C，因为B族维生素由于母乳中含量不足， 和维生素C是水溶性维生素，能够通过乳汁给婴儿补充。 (3)钙 母乳喂养儿每天补钙50一100mg补充母乳申钙量的不足。人工喂养儿如每天奶量达600mL以上，不需再补充钙了。 ( 4)碘 母乳中含碘不足，母乳喂养儿每日补充碘40一50μg，可采用每3天补充1次碘酸钾片剂 (每片含碘155μg)。也可以由乳母补充，每天补充碘酸钾l片，通过乳汁给婴儿补充碘。 (5)铁 obstacles, correcting misunderstandings, advocate good cadre style. 2, adhere to the scientific decision-making and democratic decision-making decision-making law. Correctly handle to ensure that government decrees and based on the actual creative work, giving full play to subjective initiative, put an end to implement the conference meeting, to document the implementation of documents etc. Improve the scientific and democratic decision-making mechanism, improve and implement the decision to solicit the views of experts, the public hearing system. Improve the important decision of risk assessment mechanism and legal review mechanism. 3, to promote team unity. Uphold and improve the system of annual party book talk heart to heart, mind and Party members, Party members to exchange each other not less than 2 times. The implementation of sound team democratic life system, consolidate and enhance the party's mass line educational practice will promote the achievement of the topic of democratic life, criticism and self-criticism normalization, a long-term. Adhere to the party on the basis of the principle of unity, enhance internal communication, strengthen internal supervision, self Sleep maintenance team collective image and authority. (three) to ensure the execution is not strong or disguised to resist government decrees issues. Individual Bureau leadership team members lack of learning political theory system, not from the objective reality, not with the party's interests above all the principles to deal with personal problems. In the specific work safety supervision in the execution is not strong, in the implementation of the decision to deploy the discount, make choices, engage in work, the implementation of the agreement, uncomfortable is not performed, open or disguised to resist, the lack of subject consciousness of the party organization, the lack of resist in society all kinds of bad habits and unwholesome tendencies of courage Gas and courage. Such as the liability insurance of safe production work, individual leaders that have someone arrested, and no funding, not in the global chess perspective to the countryside to carry out daily inspection, found none of my business acceptance of the resumption of production in an armchair, with a pen, indifferent. Corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, to strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, To establish and perfect the muddle along and other issues. Bureau staff conduct work regulations, standardize the behavior of personnel. 2, strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 由于母乳中铁含量不足，可采取补充铁剂的办法，预防婴儿铁缺乏。早产儿生后2一3个月、足月儿在生后4~5个月开始补充。可以采取小剂量间断补铁的方法进行 (每周1一2mg/kg)。因为在配方奶中已添加了铁剂，所以用配方奶喂养的婴儿就不需再补充铁剂了。 (五).健康教育 通过定期举办家长学校或高危几家长园地，利用讲课、电视、录像、图片、现场参观(如婴儿抚触、婴儿操、婴儿沫浴、婴幼儿早期教育和训练、脑损伤康复中心等，对家长进行婴幼儿健康教育，提高家长的保健意识和技能，健康教育是高危儿保健的重要内容。 高危儿监测 目的 通过医学监测手段，从高危儿人群中筛查出在发育上有异常可能性的小儿，从而进一步进行临床检查 (包括生长发育、神经反射、肌张力、姿势反射、智能发育测验以及影像学检查)，进行综合诊断，其中有发育障碍或脑损伤等异常者诊断为发育临界儿 ，早期进行医学干预，达到促进生长发育、恢复健康或减少伤残发生、提高儿童健康素质的目的。 高危儿监测是发育临界儿能否获得早期诊断和早期治疗的关键，是高危儿保健的核心内容。 高危儿监测的主要对象:是6个月以下的小婴儿，6个月以后的婴儿如有发育障碍或脑损伤，临床表现已较明显，诊断困难不大 (一)高危儿神经发育筛查 筛查是利用简单、有效的方法，从高危儿群体中筛查出有发育障碍或脑损伤可疑的小儿的方法。 高危儿监测 1.动态监测 灵活、纵向、动态、连续的监测方法，强调专业人士及家长的参与(需要家长定期如约携带高危儿随访，才能达到有效的监测作用。 2家庭监测 家庭是婴幼儿活动的主要场所(家长是婴幼儿的主要监护人。将运动发育落后或肌张力、姿势异常的婴儿即发育临界儿的早期表现以通俗的语言总结为“高危儿监测10条”(用口头和面资料告知家长，由家长在家中进行监测(其内容为: ?护理婴儿时手脚经常打挺、用力屈曲或伸直，好象“很有力”; ?满月后头总后仰，扶坐时竖不起头; ?3个月不能抬头;(4个月紧握拳，拇指紧贴手掌; ?5个月俯卧位时前臂不能支撑身体; ?6个月扶立时足尖、足跟不能落地: ?7个月不会发ba、ma音; ?8个月不能独坐; ?头和手频繁抖动; ?整日哭闹或过分安静。喂养困难。此项监测方法简单实用，家长容易掌握，适宜在家庭进行。为及早发现及诊断高危儿，提供了可靠的线索。 3门诊筛查 强调以家庭为中心。以儿童保健机构为依托(对新生儿及婴幼儿进行神经行为筛obstacles, correcting misunderstandings, advocate good cadre style. 2, adhere to the scientific decision-making and democratic decision-making decision-making law. Correctly handle to ensure that government decrees and based on the actual creative work, giving full play to subjective initiative, put an end to implement the conference meeting, to document the implementation of documents etc. Improve the scientific and democratic decision-making mechanism, improve and implement the decision to solicit the views of experts, the public hearing system. Improve the important decision of risk assessment mechanism and legal review mechanism. 3, to promote team unity. Uphold and improve the system of annual party book talk heart to heart, mind and Party members, Party members to exchange each other not less than 2 times. The implementation of sound team democratic life system, consolidate and enhance the party's mass line educational practice will promote the achievement of the topic of democratic life, criticism and self-criticism normalization, a long-term. Adhere to the party on the basis of the principle of unity, enhance internal communication, strengthen internal supervision, self Sleep maintenance team collective image and authority. (three) to ensure the execution is not strong or disguised to resist government decrees issues. Individual Bureau leadership team members lack of learning political theory system, not from the objective reality, not with the party's interests above all the principles to deal with personal problems. In the specific work safety supervision in the execution is not strong, in the implementation of the decision to deploy the discount, make choices, engage in work, the implementation of the agreement, uncomfortable is not performed, open or disguised to resist, the lack of subject consciousness of the party organization, the lack of resist in society all kinds of bad habits and unwholesome tendencies of courage Gas and courage. Such as the liability insurance of safe production work, individual leaders that have someone arrested, and no funding, not in the global chess perspective to the countryside to carry out daily inspection, found none of my business acceptance of the resumption of production in an armchair, with a pen, indifferent. Corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, to strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, To establish and perfect the muddle along and other issues. Bureau staff conduct work regulations, standardize the behavior of personnel. 2, strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 查。是发现高危儿行为异常与智力低下的重要手段。由社区、基层儿科或儿童保健人员以及各级医院儿科门诊医护人员完成。对家长在家庭中筛查出的可疑婴儿或儿科门诊、儿童保健健康门诊的小儿进行常规筛查，以早期发现神经发育异常的可疑儿童，转送到神经专科门诊或高危儿保健中心进行诊断。 筛查诊断方法 ?新生儿行为能力测定方法(NBNA):新生儿20项行为神经测查方法。NBNA评分<35分者归入高危儿管理。 ?鲍秀兰主编的《52项神经运动检查》或简易20项,通过检查意识反应、视听情况、原始反射、运动能力、肌张力检查、异常姿势检查等方面进行筛查。婴幼儿则使用CDCC、Gesell、贝莉发育量表及高危儿筛查5项(视听反应、拉起抬头、俯卧抬头、肌张力、异常姿势) ?新生儿听力筛查。 ?辅助检查: 头颅B超或CT、眼底检查、脑电图等。 (二)发育临界儿诊断或其他高危儿的临床诊断 对筛查出来的异常高危患儿进行相应的诊断和有效的医学干预或治疗。 一般由当地有诊断条件的医疗保健机构担当此项任务。 (三)高危儿早期干预康复要点 早期干预概念 早期干预是通过对高危儿进行各种感官刺激、提供丰富的环境教育以提高早产儿的智力能力的各类训练。 它用于发育(主要指神经、精神发育)偏离正常或可能偏离正常的婴幼儿。通过一些措施，使这些婴幼儿的各项发展有所提高，或赶上正常儿童的发育或增强生活自理能力。 早期干预可扭转婴幼儿偏离正常神经、精神发育的发展，充分发挥幼儿的潜能。 治疗的关键是早发现、早诊断、早干预、早治疗，起步越早、效果越好。 干预方法 ?参照《新生儿行为和0,3岁教育》制定早期干预措施，7d后病情平稳后开始，新生儿期进行感知觉刺激按摩、视、听、抬头及四肢活动训练，每次约半小时以上，每天至少2次;婴儿期进行感知、视听、语言、记忆和动作训练。 ?直接干预予新生儿视、听刺激, 注重按摩、被动体操、游泳等运动训练, 并按婴儿运动发育规律做抬头、翻身、坐位、爬行、站和走等主动运动训练。 ?对中重度脑损伤的患儿运用运动疗法,促进正常运动发育, 抑制异常运动和姿势, 循序渐进地促进小儿产生正确运动。 ?物理电治疗 ?认知功能训练 ?药物治疗(单唾液神经节苷酯、胞磷胆碱钠、丹参注射液、脑蛋白水解物、赖氨肌醇维B12口服液) 要根据患儿情况酌情选用治疗项目(10天为1疗程)。 出院后随访及干预 新生儿随访有助于早期发现体格发育或神经发育偏离正常的儿童，及时进行早期干预，减轻伤残程度。另外，随访也可以进行回顾性流行病学调查以及前瞻性临床随机对照探索神经发育伤残的发生率、危险因素和发病机制。 开始随访的时间应在出院后7,10天，评估新生儿疾病恢复情况。之后在1岁以内每月1次,1,2岁每3个月1次。内容包括体格发育测量、52项神经运动、贝obstacles, correcting misunderstandings, advocate good cadre style. 2, adhere to the scientific decision-making and democratic decision-making decision-making law. Correctly handle to ensure that government decrees and based on the actual creative work, giving full play to subjective initiative, put an end to implement the conference meeting, to document the implementation of documents etc. Improve the scientific and democratic decision-making mechanism, improve and implement the decision to solicit the views of experts, the public hearing system. Improve the important decision of risk assessment mechanism and legal review mechanism. 3, to promote team unity. Uphold and improve the system of annual party book talk heart to heart, mind and Party members, Party members to exchange each other not less than 2 times. The implementation of sound team democratic life system, consolidate and enhance the party's mass line educational practice will promote the achievement of the topic of democratic life, criticism and self-criticism normalization, a long-term. Adhere to the party on the basis of the principle of unity, enhance internal communication, strengthen internal supervision, self Sleep maintenance team collective image and authority. (three) to ensure the execution is not strong or disguised to resist government decrees issues. Individual Bureau leadership team members lack of learning political theory system, not from the objective reality, not with the party's interests above all the principles to deal with personal problems. In the specific work safety supervision in the execution is not strong, in the implementation of the decision to deploy the discount, make choices, engage in work, the implementation of the agreement, uncomfortable is not performed, open or disguised to resist, the lack of subject consciousness of the party organization, the lack of resist in society all kinds of bad habits and unwholesome tendencies of courage Gas and courage. Such as the liability insurance of safe production work, individual leaders that have someone arrested, and no funding, not in the global chess perspective to the countryside to carry out daily inspection, found none of my business acceptance of the resumption of production in an armchair, with a pen, indifferent. Corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, to strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, To establish and perfect the muddle along and other issues. Bureau staff conduct work regulations, standardize the behavior of personnel. 2, strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 利智力测试、粗大运动评估检查等。并有计划的对家长指导培训，介绍儿童发育的基本知识，对患儿继续施行家庭早期干预。对有异常发育的患儿，按照神经发育学治疗法继续治疗。 三.新生儿期低体重儿、早产儿及多胎儿管理 (一)早产儿的主要问题 早产儿追赶生长的营养支持 肠内营养(乳类选择)喂养方法及监测 出院后喂养及治疗目标 易发生发育障碍 早产儿脑损伤 早产儿脑室白质周围软化 颅内出血 易发生脑瘫、精神发育迟滞、听觉视觉障碍、轻微脑功 能障碍(包括 学习障碍、言语障碍、多动等) 早产儿视网膜病 造成低视力、盲。 (1) 喂养指导: 必须强调母奶喂养。母乳是最理想的选择 尤其对早产儿有益。 对吸吮力弱的小儿，可将母亲的奶汁挤在杯中，用滴管喂养。逐步增加喂奶次数，观察体重的增长。 添加母乳强化剂。纯母乳喂养的极超低出生体重儿摄入的营养不够其生长所需。国外推荐母乳喂养的早产儿使用含蛋白质、矿物质和维生素的母乳强化剂以确保满足预期的营养需求。添加时间:能耐受100ml /kg.d的母乳喂养后。强化母乳可使其热卡密度至80 kcal/dL。 早产儿配方奶:适用于出生体重<2000克的早产儿。早产儿配方奶保留了母乳的优点，补充母乳对早产儿营养需要的不足，提高热量，蛋白、糖、脂肪等营养素易于消化吸收。添加了更多的钙、磷、铁、钠，以满足其快速生长的需要。 强化维生素和微量元素。 对那些母乳量不足、或者不能用母乳喂养的情况，应该采用针对早产儿的出院后专用配方奶，或用婴儿配方奶粉加早产儿奶粉混合喂养。 推荐以下指导原则 , 出生体重<1800克的早产儿:热卡80kcal/100ml的早产配方奶或强化的母 乳。 , 体重>1800克的早产儿，且所有生长参数均达到相当胎龄的第25百分位者: 可转换为73kcal/100ml的过渡配方奶或强化的母乳。 , 当纠正月龄4,6个月达到相当月龄的第25百分位者:可转换为67kcal/100ml 的配方奶或纯母乳。 (2)保温指导 l)定期测体温，每小4,6小时测一次，作好记录(每日体温正常应波动在o36,37C之间)。 2)室温度保持在24,26?。以婴儿手足温和为适宜。 o3)体重大于 2000g的小儿，脐带脱落后每日可洗澡，室温最好在 28C左右，盆浴水温在38,40oC为宜，一切浴巾、衣服应预热后使用。 (3)护理指导 obstacles, correcting misunderstandings, advocate good cadre style. 2, adhere to the scientific decision-making and democratic decision-making decision-making law. Correctly handle to ensure that government decrees and based on the actual creative work, giving full play to subjective initiative, put an end to implement the conference meeting, to document the implementation of documents etc. Improve the scientific and democratic decision-making mechanism, improve and implement the decision to solicit the views of experts, the public hearing system. Improve the important decision of risk assessment mechanism and legal review mechanism. 3, to promote team unity. Uphold and improve the system of annual party book talk heart to heart, mind and Party members, Party members to exchange each other not less than 2 times. The implementation of sound team democratic life system, consolidate and enhance the party's mass line educational practice will promote the achievement of the topic of democratic life, criticism and self-criticism normalization, a long-term. Adhere to the party on the basis of the principle of unity, enhance internal communication, strengthen internal supervision, self Sleep maintenance team collective image and authority. (three) to ensure the execution is not strong or disguised to resist government decrees issues. Individual Bureau leadership team members lack of learning political theory system, not from the objective reality, not with the party's interests above all the principles to deal with personal problems. In the specific work safety supervision in the execution is not strong, in the implementation of the decision to deploy the discount, make choices, engage in work, the implementation of the agreement, uncomfortable is not performed, open or disguised to resist, the lack of subject consciousness of the party organization, the lack of resist in society all kinds of bad habits and unwholesome tendencies of courage Gas and courage. Such as the liability insurance of safe production work, individual leaders that have someone arrested, and no funding, not in the global chess perspective to the countryside to carry out daily inspection, found none of my business acceptance of the resumption of production in an armchair, with a pen, indifferent. Corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, to strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, To establish and perfect the muddle along and other issues. Bureau staff conduct work regulations, standardize the behavior of personnel. 2, strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 1)观察新生儿吃奶、精神、面色、呼吸、哭声、皮肤(注意黄疽、硬肿) 并嘱家长如发现异常及时告知负责访视的人员或到医院检及大小便性质和次数， 查。 2)每次换尿布或做其他护理时，动作要轻柔迅速，以防小儿受凉。 3)注意更换小儿的体位，定时翻身，侧卧。吃奶后应将小儿头部侧向一边，以免吐奶吸人呼吸道中。 4)注意观察脐部情况(按新生儿访视常规处理)。 5)新生儿满2周及28天时各测一次体重，但要注意保暖。对满月体重增长不足600g者应分析原因，进行指导，并转人体弱儿专案病历管理。 (4)新生儿视网膜病变筛查 筛查对象:孕周,32w、BW,1500g，孕周,35w、BW,1800g，生后曾接受氧 疗的早产儿。我国卫生部规定<2000克的早产儿都列为筛查对象。 筛查时机 :生后3,4w，矫正胎龄31,32w时。 (5)早产儿脑损伤的早期筛查、诊断和干预 早产儿脑白质软化于生后数天至数周内无特殊表现。当没有进行常规头颅B超或MRI筛查时 往往不能及时诊断, 于出生数月,2岁后可发现脑性瘫痪 常有双下肢痉挛性肌张力增高现象 并伴有发育迟缓 视、听觉影响等, 婴幼儿期后可出现认知障碍。 头颅B超及MRI。围产期及产后获得的脑室周围白质软化(PVL) ，一般于 ,6周后头颅B超即可发现脑室扩大。 MRI对于脑白质异常的发现比头颅生后3 B超敏感性高。出生23,30周的早产儿，在纠正胎龄33,36周时，应进行MRI评估PVL。MRI可发现脑室扩大、脑白质萎缩、囊腔形成等。婴儿管理中要注意观察，有运动、行为、认知等障碍者 应加强训练治疗。 四.新生儿期产伤、窒息儿的监测要点 有产伤、窒息史的新生儿应密切注视脑水肿、缺血缺氧性脑病的发生，具体注意如下: (l)观察新生儿有无嗜睡、烦躁、尖声叫、吸吮无力、拒奶、黄疽等表现。 (2)观察有无抽搐，特别应注意观察新生儿抽搐的特殊表现 1)眼球震颤，两眼凝视、斜视、发呆或不停地眨眼。 2)反复的吸吮动作或咀嚼或面部肌肉抽动，手指反复抓空或握拳。 3)呼吸暂停，呼吸不规律或阵发性青紫。 (3)对有产伤、窒息史的新生儿，应定期做视、听觉和神经反射的检查。如给铃声刺激检查听力，吸吮反射、拥抱反射、颈肢反射等。 (4)护理时应注意减少头部的活动，避免刺激。 五. 新生儿疾病特点 新生儿各脏器功能发育尚未成熟，机体免疫功能比较差，因此发病率高。患病后症状不够典型，不易发现。但如能仔细观察还是可以发现问题的。新生儿疾病总的看来有下列三方面的表现。 1、全身症状 新生儿的各种疾病，都可以出现全身症状，最突出的是“三不”:?不吃，即不肯吃奶，勉强吃下后容易呕吐。?不响，正常新生儿哭声响亮，病重时器声轻弱或不器，睡眠时间比正常新生儿长。?体重不增或下降。但有的新生儿得病扣不表现为“三不”，相反却表现为烦躁不安，多哭多闹，不肯入睡。感染性疾病在其他年龄阶段常表现为发热，可是新生儿感染时不一定都发热，体温可以正常，病情重时还可以体温不高，甚至全身冰冷。 obstacles, correcting misunderstandings, advocate good cadre style. 2, adhere to the scientific decision-making and democratic decision-making decision-making law. Correctly handle to ensure that government decrees and based on the actual creative work, giving full play to subjective initiative, put an end to implement the conference meeting, to document the implementation of documents etc. Improve the scientific and democratic decision-making mechanism, improve and implement the decision to solicit the views of experts, the public hearing system. Improve the important decision of risk assessment mechanism and legal review mechanism. 3, to promote team unity. Uphold and improve the system of annual party book talk heart to heart, mind and Party members, Party members to exchange each other not less than 2 times. The implementation of sound team democratic life system, consolidate and enhance the party's mass line educational practice will promote the achievement of the topic of democratic life, criticism and self-criticism normalization, a long-term. Adhere to the party on the basis of the principle of unity, enhance internal communication, strengthen internal supervision, self Sleep maintenance team collective image and authority. (three) to ensure the execution is not strong or disguised to resist government decrees issues. Individual Bureau leadership team members lack of learning political theory system, not from the objective reality, not with the party's interests above all the principles to deal with personal problems. In the specific work safety supervision in the execution is not strong, in the implementation of the decision to deploy the discount, make choices, engage in work, the implementation of the agreement, uncomfortable is not performed, open or disguised to resist, the lack of subject consciousness of the party organization, the lack of resist in society all kinds of bad habits and unwholesome tendencies of courage Gas and courage. Such as the liability insurance of safe production work, individual leaders that have someone arrested, and no funding, not in the global chess perspective to the countryside to carry out daily inspection, found none of my business acceptance of the resumption of production in an armchair, with a pen, indifferent. Corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, to strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, To establish and perfect the muddle along and other issues. Bureau staff conduct work regulations, standardize the behavior of personnel. 2, strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 2、各系统疾病的特殊表现 例如呼吸系统疾病时有鼻塞和咳嗽，新生儿鼻塞影响呼吸和吮乳因此吃奶时常哭闹不安。新生儿患肺炎时出现气促或口吐白沫。消化系统疾病时出现呕吐、腹泻、腹胀或便秘。中枢神经系统疾病时(如化脓性脑膜炎)出现眼睛定视和各部位肌肉的抽动等。 3、面色和皮肤颜色的改变 正常新生儿的皮肤娇嫩，呈浅红色，口唇呈深红色。患病时可能出现:1黄疸，虽然正常新生儿在生后3-10天可以出现生理性黄疸，但这种黄疸色不深，也不影响小儿食欲和精神状态，如果黄疸比较深，或突然加重，或超过生后10天仍持续不退，就可能是疾病的表现，需要就诊。2粘膜(如口唇)、唇周或指趾甲呈青灰色，常由于动脉血氧浓度低或由于休克血流缓慢引起，多见于败血症和硬肿症等严重疾病，常伴有神萎、食欲差等症状。单纯粘膜和皮肤青紫多为青紫型先天性心脏病。 3某些病毒感染性疾病时皮肤可出现麻疹样皮疹，分布在前胸、腹部、背部和面部。4 严重败血症或出血性疾病时四肢、胸颈部或其他部位皮肤可出现深红色出血点或紫红色瘀斑。5皮肤和粘膜苍白表示贫血，多由溶血或出血性疾病引起。此外皮肤和皮下组织水肿或硬肿也是疾病的表现。 各种先天性畸形和遗传性疾病虽然出生时已经存在，但不是都在新生儿期发病，例如先天性心脏病种类很多，但在新生儿期发病的主要是大血管错位、左心发育不良、肺静脉回流异常等复杂的畸形。消化道畸形在新生儿期发病的较多，如食道梗阻、幽门肥大、小肠发育不食品店、无肛等，这些疾病都有各系统的特殊症状，不难被家长发现。 总之新生儿疾病种类爽，症状不典型，但如平日父母多注意小儿的吃、睡、哭声、大小便、呼吸等生活情况，喂奶、换尿布和洗澡换衣服时注意有无特殊征象，不难早期发现疾病。 七. 早期发现先天性心脏病 先天性心脏病的重要特征是心脏杂音，心脏杂音是心脏或大血管病变时所产生的异常声音。不正常的血流在心脏听诊区、胸、背等处听到混合在正常心音间的这些异常血流的音响。但听到杂音不一定都是心脏病，半数以上的健康小儿体检时能听到比较局限、柔和不粗的杂音，这种杂音被称为功能性杂音。先天性心脏病听到的杂音响亮、粗糙、广泛。 除心脏杂音外，紫绀是先天性心脏病的重要表现。有些严重的先天性心脏病出生后就表现为紫绀;有些先天性心脏病早期没有紫绀，晚期出现紫绀;还有些先天性心脏病一直不出现紫绀。这是由心脏左右两半之间有无分流、以及分流的方向所决定的。紫绀与先天性心脏病的关系有以下三种: (1)动脉导管未闭、室间隔缺损、房间隔缺损:在疾病早期由于是动脉的血分流到静脉，属于左向右分流型，因此无紫绀;但到了晚期，心脏左侧的压力超过了右侧，就出现了紫绀。 (2)法乐氏四联症、大动脉转位、肺动脉瓣闭锁:由于部分或全部静脉血直接分流入动脉，属于右向左分流型，因此出生后就有紫绀。 (3)肺动脉狭窄、主动脉狭窄、主动脉缩窄:尽管存在心脏畸形，但左右两侧之间无异常通道，属于无分流型，因此，终身不出现紫绀。 因此，要早期发现先天性心脏病，重要的是给小儿定期进行健康检查，发现异常体征或症状，早期明确诊断及治疗。 obstacles, correcting misunderstandings, advocate good cadre style. 2, adhere to the scientific decision-making and democratic decision-making decision-making law. Correctly handle to ensure that government decrees and based on the actual creative work, giving full play to subjective initiative, put an end to implement the conference meeting, to document the implementation of documents etc. Improve the scientific and democratic decision-making mechanism, improve and implement the decision to solicit the views of experts, the public hearing system. Improve the important decision of risk assessment mechanism and legal review mechanism. 3, to promote team unity. Uphold and improve the system of annual party book talk heart to heart, mind and Party members, Party members to exchange each other not less than 2 times. The implementation of sound team democratic life system, consolidate and enhance the party's mass line educational practice will promote the achievement of the topic of democratic life, criticism and self-criticism normalization, a long-term. Adhere to the party on the basis of the principle of unity, enhance internal communication, strengthen internal supervision, self Sleep maintenance team collective image and authority. (three) to ensure the execution is not strong or disguised to resist government decrees issues. Individual Bureau leadership team members lack of learning political theory system, not from the objective reality, not with the party's interests above all the principles to deal with personal problems. In the specific work safety supervision in the execution is not strong, in the implementation of the decision to deploy the discount, make choices, engage in work, the implementation of the agreement, uncomfortable is not performed, open or disguised to resist, the lack of subject consciousness of the party organization, the lack of resist in society all kinds of bad habits and unwholesome tendencies of courage Gas and courage. Such as the liability insurance of safe production work, individual leaders that have someone arrested, and no funding, not in the global chess perspective to the countryside to carry out daily inspection, found none of my business acceptance of the resumption of production in an armchair, with a pen, indifferent. Corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, to strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, To establish and perfect the muddle along and other issues. Bureau staff conduct work regulations, standardize the behavior of personnel. 2, strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No.