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保定月嫂分享新生儿常态与病态区别

添加时间：2017/8/31 16:33:13 浏览次数：

新生儿出生时可出现某些有别于成人的特殊表现，可能是病态，然并非表示真正有病。保定月嫂提示由于新生儿各系统、器官，特别是中枢神经系统尚未发育成熟，故一旦患病，症状不明显，或仅有不吃、不哭、不闹、嗜睡，也无发热，常误认为小宝宝很乖，新生儿的病情进展及变化快，可在短期内迅速恶化死亡。故新生儿正常与异常的识别很重要。
The birth of a new baby may be something different from that of an adult, and it may be pathological, but not really. Baoding month sister-in-law prompt because neonatal each system, organs, especially in the central nervous system is not yet mature, so once sicken, no obvious symptoms, or only don't eat, don't cry, don't make, lethargy, no fever, often mistaken for a baby is very lovely, the newborn's disease progression and change fast, death may deteriorate rapidly in a short time. It is important to recognize the normal and abnormal newborn babies.

一、似“病态”而非病
One, like "pathological" not disease

一些情况是新生儿的某些特殊表现，是儿科的特色，盲目处理会造成真正的病态。
Some conditions are special features of newborns, which are characteristic of paediatrics, and blind treatment can cause real morbidity.

1、“板牙”、“螳螂子”：
1. "die" and "praying mantis" :

不少新生儿口腔上腭正中线附近有一颗或数颗粟粒大小的白色颗粒，为上皮细胞堆积、角化而成，称“硬腭小结”或“包氏小结（珠）”，俗你“板牙”，其非病态，不影响吃奶及以后的出牙，一般经2—3周或几月自行消退、脱落。同样，在牙龈跟部见有米粒大小的颗粒，称“马牙”。也可在齿龈粘膜下产生，为粘液腺肿胀潴留所致。新生儿出现的咬奶头、拒奶、哭闹时应查明其它原因，不要认为是板牙、马牙所致，而采取“挑”、“割”、“擦”处理，易贻误病情，且会新生儿及口腔粘膜娇嫩，损伤后引起出血或细菌感染而发生口腔炎，甚致发展成严重的败血症。
Many newborns on oral palatal midline near the size of one or several millet white particles, for epithelial cell accumulation, diversification, says "the hard palate subtotal" or "pao summary (pearl)," vulgar "die", you not sick, do not affect milk and so on the teeth, usually after 2 to 3 weeks or months to fade and fall off. Similarly, in the gingival heel, there are granule sized particles, called "horse teeth". Can also be produced under the gum submucosa, for mucinous gland swelling retention. Newborn babies bite nipples, rejected, should find out other reason when crying, don't thought to be caused by die, horse teeth, and take the "pick up", "cut", "rubbing" processing, easy to delay the disease, and neonatal and oral mucosa and tender, and damage caused by bleeding or bacterial infections, and stomatitis, to develop severe sepsis.

新生儿口腔两侧峡部各有一块隆起的软组织，是峡粘膜下的脂肪垫，有利于吸吮动作，俗称“螳螂子”，不要误认为病理性肿胀而影响吸乳。采用“挑”、“割”、“擦”处理，同样会引起败血症，且为农村新生儿败血症首要原因之一。
Newborn oral on both sides of the isthmus, each have a bulge of soft tissue, is the fat pad of submucosal, is advantageous to the sucking action, commonly known as "mantis son," don't mistaken for pathological swelling and influence sucked. The use of "pick", "cut" and "wipe" can also cause septicaemia and one of the leading causes of neonatal sepsis in rural areas.

2、乳房肿大、分泌乳液：
2. Breast enlargement and secretory emulsion:

部分女婴或男婴在生后2—3天可出现乳房肿胀，并有少量黄色乳液分泌。这为生前受母体激素(生乳素)影响所致。一般生后10天最明显，2—3周后渐消退，乃生理现象，不必惊慌，不要作处理。按摩、挤压会损伤皮肤引起感染。一旦肿胀的乳房出现红、肿，说明有感染，应给适量抗生素或切开引流。
Some baby girls or baby boys can have swollen breast and a small amount of yellow latex during 2-3 days after birth. This is due to the influence of maternal hormone (raw milk). The 10 days after birth most obviously, 2-3 weeks after receding, is physiological phenomenon, need not panic, do not do processing. Massages and compresses can injure the skin and cause infection. Once swollen breast appears red and swollen, indicating infection, appropriate antibiotics or incised drainage should be given.

3、女婴阴道出血和分泌粘液：
3. Vaginal bleeding and secretion of the baby girl:

有少数女婴生后3—5天有少量血样分泌物或白色粘液从阴道排出。其为阴道分泌物，由母体激素（雌激素）传授引起，称“假月经”、“白带”。一般1—2天后会自行消失，不必处理，也为物殊生理现象。一般出血量少，仅沾染尿布，也无其它部位出血，可适当考虑应用淡清洗液清洗外阴。
There are a small number of baby girls who have a small amount of blood secretions or white mucus from the vagina 3 to 5 days after birth. It is vaginal discharge, caused by maternal hormone (estrogen), called "false menstruation", "white belt". General 1-2 days will disappear by itself, not to deal with, also for the physical phenomenon. Generally the amount of blood is small, only the diapers, no other parts of the hemorrhage, may consider the application of mild cleaning fluid to clean the vulva.

4、尿红或排尿时啼哭：
4. Cry when urinating or urinating:

新生儿生后48小时内应有小便排出，有的生后2—5天在排尿时啼哭，且尿布染成红色一片。这是由于尿少，尿酸盐潴留在肾内形成尿酸梗塞引起，随吮乳量及吮水量增加，尿量增多，尿酸盐全部溶解尿中而消失，婴儿也就能安静入睡。
The newborn should have urine and urine within 48 hours after birth, and some of them will cry during urination two or five days later, and the diaper is dyed red. This is due to less urine, uric acid salt retention form uric acid in the renal infarction caused, with the increase of suck and suck water, urine volume increased, uric acid salt dissolve urine, the baby can quiet sleep.

5、“色素斑”、“粟粒疹”：
5. "pigment spot" and "miliary rash" :

色素斑多于新生儿的臀部、尾骶部和背部。大小不一，边缘不规则。压之不退色的灰兰色“色素斑”又称“胎记”。是皮肤深层堆积了色素细胞所致。随年龄增长，色泽转淡，约5—6岁才可能消失，无需治疗。
The pigmentation is more than the hip, posterior sacral and back of the newborn. The size is different, the edge is irregular. The color of the grey blue pigment stain is also called "birthmark". It is caused by the accumulation of pigment cells deep in the skin. With age, the color fades, and about 5 to 6 years old can disappear without treatment.

粟粒疹是新生儿出生后几天在前额、面颊、鼻尖等处，出现的较多呈黄白色的小颗粒。一般生后数周可自行消失，不要挑、割，以防感染。
The miliary rash is a few days after the birth of the newborn in the forehead, cheek, nasal tip, the occurrence of more yellow and white particles. Normally after a few weeks can disappear, do not pick, cut, in case of infection.

6、生理性体重下降：
6. Physiological weight loss:

生后一周内，由于出生后的排尿、排胎粪，通过皮肤、肺排出水分及进食水少等多方面因素，体重可略有下降，正常情况下不超过9%。生后7—10天左右，随奶量增加及对外界环境的适应。体重可恢复致出生时体重。如下降超过10%以上或恢复较慢，考虑为非生理性，应寻找原因。
Within a week after birth, due to the urine and excrement of excrement, the body weight can be reduced slightly in terms of skin, lungs, water and water intake. Normally, it is not more than 9 percent. 7 to 10 days after birth, with the increase of milk and adaptation to the environment. Weight can be restored to birth weight. If the decline exceeds more than 10% or the recovery is slow, consider the reason for non-biological reason.

7、胎位畸形：
7. Fetal malformation:

胎儿在宫内，受子宫范围限制，躯干、四肢不能舒展，只能背弓屈膝，且多数为倒立。故初生时，新生儿的手脚屈曲，小腿有些向内弯曲，呈“WM”，这为正常现象。随生长发育会自然恢复，无需捆绑，但注意与“抑脚—足外翻”、“脚下垂—足内翻”相鉴别。若刺激活动后即恢复正常，称新生儿胎位性假性畸形足，一般3—4月后渐恢复，无后遗症，若不能恢复应外科处理。
In utero, the fetus is restricted by the scope of the uterus, and the trunk and limbs cannot be stretched. Therefore, in the first period of life, the infant's hands and feet flexion, and the lower legs are curved to the inside, showing "WM", which is normal. The growth and development will naturally recover, without the need to be bound, but the attention should be identified with the "foot - foot pronation" and "underfoot - foot pronation". If the stimulation activity is returned to normal, it is said that the neonatal fetal sex pseudo malformation foot, generally 3 - April after the gradual recovery, without sequelae, if cannot restore should surgical treatment.

8、溢乳（回奶）：
8. Spilled milk (back milk) :

由于新生儿的胃与成人不同，位置呈横位（成人为相对直立），容量小，胃底部发育不全，入口处贲门发育不完善，关闭不全，而出口幽门口发育相对成熟，因此胃为“敞开口的瓶子”，在吸乳过程中，空气易咽入胃腔，如喂奶过多、过快、吸入空气，或喂后换尿布或摇动过多、或牛奶过热、过冷均会产生溢乳。溢乳时一般无不适感，也不影响生长发育。但若溶易溢乳，在喂后应取右侧卧位，或将床头抬高。若不见好转，且溢乳时有痛苦，且量多有奶块、体重下降，应查找原因。
Due to the newborn's stomach, unlike adults, location is horizontal (adult is relatively upright), small capacity, at the bottom of the stomach hypoplasia, the entrance to immature cardiac, closing is not complete, and exports helicobacter port development is relatively mature, so the stomach to "open the mouth of the bottle", in the process of sucking, easy to swallow air into the gastric cavity, such as feeding too much, too fast, inhalation of air, or feed after changing diapers or shaking too much, or extreme heat, cold milk spilled milk is produced. Excessive milk generally has no discomfort and does not affect growth and development. However, if the solution is easy to overflow, the right side of the bed should be taken after feeding, or the head of the bed should be raised. If there is no improvement, and the overflow is painful, and quantity of milk block, weight loss, should look for the cause.

二、是“病态”也可非病态
Two, is "sick" also can not morbid

1、黄疸：
1. Jaundice:

黄疸是胆红素在血液及组织中积聚而引起的一种症状，在新生儿期有许多因素引起，可为生理性，也可病理性。生理性黄疸是由于胎儿离开母体，外界供氧增多无需较多红细胞摄氧、携氧，而使红细胞破坏增多，从而使胆红素产生增多，加上新生儿的肝脏清除功能（摄取、转化、排泄）低下等综合因素使胆红素在血液中积聚而产生。其特点：一般生后2—3天产生，4—5天达高峰，一般不超过2周。并有一定的胆红素测定值佐证。病理性黄疸的原因较多，应综合分析，确定原因。
Jaundice is a symptom caused by the accumulation of bilirubin in blood and tissues, which can be caused by many factors during the neonatal period, which can be rational and pathological. Physiological jaundice is due to leave the mother, fetus increased oxygen to the outside world does not need more red blood cell oxygen uptake, carry oxygen, and make the red blood cell damage increased, to produce more protein bilirubin, plus the newborn's clear liver function (intake, transformation and low discharge) and other comprehensive factors make bilirubin in the blood accumulation and produce. Its characteristics: generally 2 to 3 days after the birth, 4-5 days peak, generally not more than 2 weeks. There is some determination of bilirubin. There are many reasons for pathological jaundice and should be analyzed comprehensively to determine the cause.

2、浮肿：
2. Edema:

新生儿肾脏发育不成熟，肾功能差、排泄过剩的水钠能力低下，3—5天易出现水肿，常发生于手脚、小腿、眼窝处，一般2—3天后随肾功能完善而消失。如伴有体温不升、不吃、不哭、皮肤发凉并在硬肿，或呈明显可凹性应查找原因。
Immature neonatal kidney development, poor renal function, low sodium excretion of excess water capacity, easy to appear edema, 3 to 5 days often happens on the hands, legs, eyes, generally 2 to 3 days later disappear with improve renal function. If the body temperature does not rise, do not eat, do not cry, the skin is cool and in the case of hard swelling, or the appearance of the obvious concave sex should look for the cause.

3、呕吐：
3. Vomiting:

为常见症状，生理者为溢乳。若吐奶前有痛苦、烦躁、量多且冲力大，即为病态，多见于喂养不当、肠胃功能紊乱、羊水吸入，或消化道畸形等，任何系统的疾病均可引起消化道的症状。
For common symptoms, the physiological is spilled milk. If there is pain, be agitated, before spit milk quantity is much and great momentum, is the pathological, see more at improper feeding, gastrointestinal dysfunction, amniotic fluid intake, or digestive tract malformation, any system diseases can cause the symptoms of digestive tract.

4、头部肿块：
4. Head mass:

由于生产时产道受压，刚出生的2—3天内常有头颅变形：①产瘤：一般恢复良好；②头颅血肿：常位于头顶一侧，有波动、吸收慢，切忌穿刺，一般2—3周或数月吸收，需注意合并颅内出血。
Due to the compression of the birth canal during the production, the first two to three days of birth often have a head deformation: a tumor: generally recovered well; Head hematoma: often located on the side of the head, with fluctuation, slow absorption, and avoid puncture, generally 2 to 3 weeks or months, the intracranial hemorrhage should be paid attention to.

5、脐疝：
5. Umbilical hernia:

由于婴儿腹壁脐环发育不良，部分可自行愈合，若3岁仍未愈合者可考虑外科手术治疗。
Due to the poor growth of the baby's abdominal wall, partial healing can be done, and surgical treatment can be considered if the age of 3 is still not healed.

6、口疮：
6. Oral ulcer:

由于口腔粘膜受霉菌感染所致，可影响吸奶，应予处理，但需与吸奶后的“奶花”相别。
Because the oral mucosa is affected by mold infection, it can affect Suckling and should be treated, but should not be associated with the "milk flower" after Suckling.

7、斜颈：
7. Oblique neck:

部分由于睡姿不好造成假性斜颈，改变体位后可自行纠正。病态性者，多见于产伤或其它因素引起的胸锁乳突肌血肿所致，需及时处理。
Partly because the sleeping position does not result in the false slant, the position can be corrected by itself. Pathological sex, most see the sternocleidomastoid hematoma caused by birth injury or other factors, need to be dealt with in time.

8、哭闹不安：
8. Crying and disturbing:

哭闹是新生儿的一种特殊语言，是寻求帮助的一种方式，正常儿一天哭闹几次，有利于体格发育，可增加肺活量，为锻炼的好机会，特别对于胸廓的发育大有益处，并非病态。生理性哭闹多数哭声洪亮有力，边哭边四肢动，多见于饥饿、口渴、尿布湿、解大、小便、遇冷、热等，解除因素后会自行停止。若哭闹两眼发呆、尖叫、哭声低或无力，或在触及身体某处部位发生，则多见于病态，应找出原因。
Crying is a kind of special language, the newborn is a way to seek help, normal son crying several times a day, is beneficial to physical development, can increase the lung capacity, good opportunities for exercise, especially for the development of thoracic great benefit, not sick. Most of the crying sounds are powerful, crying and limb movement, often seen in hunger, thirst, diaper wet, defecate, urination, cold, heat, etc., after lifting the factor, will stop itself. If the two eyes are staring, screaming, crying low or weak, or if they are touching one part of the body, they are more pathological and should be found.

三、一旦出现肯定是病态
Three, once appear must be morbid

1、发热或体温不升：
1. Fever or hypothermia:

新生儿体温调节功能不成熟，易受外界因素影响，过高、过低、喂水不足，疾病时均可引起发热或体温不升。发热是人们最敏感的，也最易引起注意和重视。发热是感染的一种表现，其高低与疾病轻重并非成正比，但体温过高或超高（>40.5度)会影响多种生理功能。而体温不升同样有意义，有时比发热更加可怕。某些家长对发热比较紧张，退热心切，给予不合理或过量的退热可产生各种并发症。在夏季，生后3—4天的新生儿，因喂水不足而产生脱水热，体温可达39—40度，皮肤红，而一般情况尚可，应增加饮水，适当降温。严重者可出现捂热综合症。
Newborn body temperature regulation function is immature, easy to be affected by external factors, too high, too low, feed water insufficient, can cause fever or body temperature not rise when disease. Heat is the most sensitive and the most noticeable and important. Fever is a manifestation of infection, which is not proportional to the severity of the disease, but the hyperthermia or ultra high (> 40.5 degree) can affect a variety of physiological functions. Body temperature is also meaningful, sometimes more terrifying than fever. Some parents are nervous about fever, deferential, giving unreasonable or excessive fever can produce various complications. In the summer, the newborn of 3 to 4 days after the birth, because the water is insufficient to produce dehydration heat, the body temperature can reach 39-40 degrees, the skin is red, and general situation still can, should increase drinking water, appropriate cooling. Severe people can be covered with heat syndrome.

2、呼吸异常：
2. Abnormal breathing:

新生儿的呼吸可出现快慢不均、深浅不一，但皮肤颜色及心率正常为生理现象；若呼吸费力，不规则、暂停、青紫、心率减慢，鼻翼煽动、三凹征，四肢肌张力低下等应及时诊治。
Neonatal breathing can be uneven and varied, but skin color and heart rate are normal physiological phenomena. If breathing exertion, irregular, pause, violet, heart rate decelerate, nasal wing incitement, triple concave, limb muscle tension low should diagnose and cure in time.

3、呻呤：
3.

为疾病危重之征，为新生儿求救信号，持续呻呤提示病情严重，应立即处置。
For the sign of the disease, for the newborn distress signal, persistent groin indicates that the condition is serious and should be dealt with immediately.

4、苍白：
4. Pale:

常为缺血缺氧所致，但营养不良也是原因之一。
Malnutrition is often caused by ischemia, but malnutrition is also a cause.

5、不吃、不哭：
5, do not eat, do not cry:

为疾病早期表象，虽无特异性，但提示患儿有病，多数为感染所致。应明确原因。
For the early appearance of the disease, although there is no specificity, but it is suggested that the children are sick, most of them are caused by infection. The reason should be clear.

6、口吐泡沫：
6. Foam at the mouth:

为肺部炎症的主要症状，肺部炎症，气道内分泌物增加，成人以咳嗽为主，而新生儿咳嗽反射不完善，以呼吸增快，气流加速代偿，呼气时气流经气管，将气道内分泌物吹成许多小泡从口中吐出而产生。
As the main symptom of lung inflammation, lung inflammation, airway secretions increase, adult is given priority to with a cough, and neonatal cough reflex is not perfect, to breathe faster, airflow speed compensation, puffing out through the trachea, airway secretions within blowing into many small bubble arising out of his mouth.

7、青紫：
7. Cyan:

分局部与全身，局部者多由于出生时爱压，或寒冷、外周血管收缩所致。适当处会消失。若青紫持续，常提示缺血，如右向左分流先心、严重感染或中枢性疾病。
The division and the whole body, the local population mostly due to love pressure at birth, or cold, peripheral blood tube constriction. The proper place will disappear. If violet persists, it is often suggested that ischemia, such as right-left shunt, severe infection or central disease.

8、惊厥：
8. Convulsion:

属新生儿急重症，其表现多种，有别于小儿，很少有全身抽搐，常表现为两眼凝视、震颤、眨眼，有的可出现面肌抽动，口部反复咀嚼或吸吮。有的为呼吸不规则、暂停伴皮肤青紫，少数一侧肢体或全身抽动或四肢呈强直。引起抽搐原因很多，包括：感染、代谢、内分泌、遗传，涉及各个系统。一旦出现尽快明确并处理。
Belong to neonatal expectations, and its performance of kinds, different from the children, there are few whole body twitching, often characterized by two eye gaze, tremor, blink of an eye, some can appear facial spasm, mouth chewing and sucking again and again. Some of them are irregular breathing, a suspension of the skin, a few of the limbs or whole body twitch or the limbs are straight. There are many causes of convulsions, including infection, metabolism, endocrine, and genetics, involving various systems. Once it appears as soon as it is clear and processed.

总之，正常与异常新生儿的识别有重要临床意义，但并非易事，应善于察言观色，这样可减少误诊及不必要的惊慌，为培育优秀下一代打好基础。
In short, normal and abnormal neonatal recognition has important clinical significance, but it is not easy, should be good at sense motive, that can reduce the misdiagnosis and unnecessary panic, provided a basis for cultivating good the next generation.

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