常見的高危嬰兒

1、Common High Risk Infants常見的高危嬰兒 Marcy Mallouf RN, IBCLC, RLCLucile Packard Childrens Hospital/Stanford University/M. Mallouf, 2010 Identifying the Common High Risk Infant辨認常見的高危嬰兒Caesarian Sectioned Infants剖腹產(chǎn)兒Late Pre-Term Infants (34 37 weeks gestation晚期早產(chǎn)兒（產(chǎn)齡在34-37周）Low Birth Weight (less than 2.

2、7 kg or 6 lbs)低體重兒（出生體重低于2.7公斤）Multiples多胎Infants Born by Caesarian Section剖腹產(chǎn)兒Minor / transient respiratory distress輕度或過渡性呼吸困難Anesthesias effect on infant and mom麻醉對嬰兒和母親的影響Mom not able to breastfeed without assistance母親哺乳需要幫助Delayed lactogenesis III (milk coming in)延緩泌乳期Tongue movement anomalies i

3、n infant嬰兒舌頭運動異常Lactation Support after Caesarian Delivery剖腹產(chǎn)后的哺乳指導與幫助Initiate breastfeeding early breastfeeding 早期啟動母乳喂養(yǎng)Involve family members鼓勵家族成員參與 sit by bedside during skin to skin 鼓勵母嬰肌膚接觸 assist mom in positioning 協(xié)助母親找到最舒適的姿式Maintain pain control 止痛Late Pre-Term and Low Birth Weight Infants

4、晚期早產(chǎn)兒與低體重兒The “great pretenders”是最容易被忽視的群體The Late Pre-Term Infant晚期早產(chǎn)兒 “Looks” like a term infant看起來像足月嬰兒Considered “not really” premature 認為他們不是真正的早產(chǎn)兒 Considered “almost full term”認為他們接近足月May look like they are breastfeeding well 看起來哺乳沒有問題 Make up 70% of all pre-term births 占所有早產(chǎn)兒的70%Late Pre-Term

5、 Infants“An expert panel has suggested that the phrase “Late Pre-Term Infant” conveys the sense that infants that are born between 34 through 36 weeks of gestation are immature and vulnerable and need close monitoring, evaluation, and follow-up.”專家建議：晚期早產(chǎn)兒是指胎齡介于34-36+6周的早產(chǎn)兒，這些早產(chǎn)兒是不成熟兒，高危兒，需要嚴密觀察，評估與

6、隨訪。Raju TNK, Pediatrics 2008 “Late-Preterm Birth: Challenges and OpportunitiesInfants born at 37 weeks gestation胎齡37周的嬰兒比胎齡大于38周的have higher morbidity rates嬰兒患病率高compared to infants born at 38 weeksThe Risks for the Late Pre-Term Infant 晚期早產(chǎn)兒的風險因素Respiratory distress呼吸困難Hypoglycemia低血糖Hypothermia低體溫

7、Lower Suck Pressure 弱吸吮力Sleepiness嗜睡Hyperbilirubinemia高膽紅素血癥Higher risk for readmission再入院率高Susceptibility to Sepsis易于感染Higher Incidence of SIDS高突發(fā)性嬰兒死亡綜合癥發(fā)生率Dehydration脫水Poor Weight Gain體重增長緩慢Susceptibility to SepsisOther Issues of the Late Pre-Term Infant晚期早產(chǎn)兒的其他問題GI tract: immature which may lead

8、 to difficulty in coordinating sucking and swallowing消化道：不成熟的消化道可導致吸吮困難吞咽困難Brain weight only 60% that of term infants大腦的重量僅為足月嬰兒的60%Readmission mainly due to jaundice, sepsis, feeding difficulties and FTT (failure to thrive)再入院的原因：黃疸，感染，喂養(yǎng)困難，嬰兒生長緩慢Have a higher metabolic rate and limited energy stor

9、es較高的代謝率及有限的能量貯存Breastfeeding Risks for the Late Pre-Term Infant and Mother晚期早產(chǎn)嬰兒與母親的哺乳風險I. Delayed Lactogenesis III: 泌乳期延遲 a. Immature development of breasts- less amount of glandular tissue (secretory cells) 乳腺腺泡組織發(fā)育不成熟 b. Less Colostrum removal- decreased suck pressures decreased number of breast

10、feedings sleepiness at breast decreased coordination of suckle 初乳排空不夠，吸吮力弱,哺乳次數(shù)少，哺乳時睡覺，吸吮不協(xié)調(diào)。Breastfeeding Risks for the Late Pre-Term Infant and Mother晚期早產(chǎn)兒與母親的哺乳風險因素 2. Higher Morbidity Readmission to Hospital 高發(fā)病率 - 再入院 a. Stress 思想負擔 b. Maternal/Infant Separation 母親與嬰兒分開 c. Higher use of Bottles/Pacifiers 人工喂養(yǎng)增加 d. Decreased number of Breastfeedings 母乳喂養(yǎng)次數(shù)減少FOUR GOLDEN RULES黃金定律1. Always feed the Baby 堅持母乳喂養(yǎng)2. Always keep something happening at the breast 堅持在乳房上做工作3. Always protect milk supply 維持乳汁產(chǎn)量Always normalize