neonatal scleredema
Introduction
Introduction to neonatal scleredema Neonatal sclerosing disease (neonatalscleredema), also known as neonatal sebaceosis, is mostly caused by cold, so it is also called cold injury syndrome, but it can also be caused by other factors such as infection in summer, so it is called infection. Scleredema or scleredema in summer. This disease is one of the serious diseases of newborns. It is more common in premature infants or babies with congestive asphyxia and congenital malformation in the first 1-2 weeks after birth. It occurs mostly in the cold season. It can be seen in the summer caused by infectious factors, and the sick children appear. The whole body is cold, the skin and subcutaneous fat are hard and edematous, and the feeling of "cold pork" is touched. In severe cases, it can cause pulmonary hemorrhage, DIC, acute renal failure or secondary infection and death. The incidence of this disease is second only to pneumonia, and its mortality rate is still as high as 20-50% in recent years. However, with the improvement of medical technology and medical conditions, the cure rate of this disease has increased year by year. It has been reported that premature infants with a sclerosis of less than 1.5 kg can be cured and discharged by integrated Chinese and Western medicine. basic knowledge The proportion of illness: 0.005% Susceptible population: newborn Mode of infection: non-infectious Complications: acute renal failure, hypoglycemia, metabolic acidosis
Cause
Causes of neonatal scleredema
The neonatal body surface area is relatively large, the skin is thin and tender, the blood vessels are rich, and it is easy to dissipate heat. The complex color fat is a unique tissue in the newborn, and its metabolism is the main source of energy when the newborn is in urgent need of heat production in a cold environment, and is hungry. The energy source is white fat. If the ambient temperature in children is too low, the heat is too much, the brown fat is easily depleted, the body temperature will drop, and the body temperature will not rise when the newborn is seriously infected. In these cases, the subcutaneous fat is easy to coagulate. It hardens, and at the same time, the surrounding capillaries expand at low temperature, the permeability increases, and edema is easy to occur, resulting in hard swelling.
Surrounding resistance (20%):
At low body temperature, peripheral circulation resistance decreases, blood stasis, tissue hypoxia, central blood circulation decreases, heart rate slows, urine volume decreases, and blood circulation increases during rewarming. If urine volume does not increase, heart failure may occur. Even pulmonary edema and pulmonary hemorrhage occur.
Red blood cells (15%):
At low body temperature, hematocrit and blood viscosity increase, thrombocytopenia, heparin-like substances are also reduced, and various causes can cause coagulopathy, induce diffuse intravascular coagulation (DIC), and DIC is more likely to occur due to shock during severe infection.
Breathing (20%):
Breathing slows down at low body temperature, sometimes apnea, prone to respiratory acidosis, and due to insufficient nutrient intake, resulting in metabolic acidosis, so severe fatty swollen acidosis is also heavier.
Sugar metabolism (10%):
At low body temperature, glucose metabolism is imperfect, and hyperglycemia may occur at the beginning of the disease, but hypoglycemia occurs after the increase in sugar consumption.
Prevention
Neonatal scleredema prevention
1. Do a good job in perinatal health care, strengthen prenatal care, and reduce the incidence of premature babies.
2, cold seasons and areas should be equipped with warm equipment for the delivery room.
3. Once the newborn is delivered, wrap it in a warm towel and move it to a warm bed.
4. Do a good temperature monitoring for high-risk children.
5, active early treatment of neonatal infectious diseases, does not cause scleredema.
Complication
Neonatal scleredema complications Complications acute renal failure hypoglycemia metabolic acidosis
Large area of hard swelling, accompanied by multiple organ failure, such as circulatory failure, acute renal failure, pulmonary hemorrhage, DIC, etc., can also cause hyperbilirubinemia and promote bilirubin encephalopathy; metabolic disorders such as hypoglycemia, Low blood calcium and metabolic acidosis.
Symptom
Symptoms of neonatal scleredema Common symptoms Purpura limbs cold face pale sclerotherapy scleredema hypothermia hypopnea edema edema no urinary heart failure
The disease mainly occurs in the cold season of winter and spring and low birth age group, especially in premature infants. The clinical manifestations include three major characteristics, namely, the body temperature is not rising, the skin is swollen and the systemic function is damaged.
1, body temperature does not rise: body temperature is too low is the main performance, body or limbs cool, body temperature is often below 35 degrees Celsius, severe cases can be below 30 degrees, low body temperature, good heat production and heat failure two different The situation helps to judge the condition, and the fever is good. The temperature is > anus temperature, and the temperature difference is positive (between 0 and 0.9 degrees). Most of the disease is short, the area of hard swelling is small, it is light, and the heat is generated. Depleted, phlegm temperature <anal temperature, phlegm temperature minus anal temperature difference is negative, mostly long course, hard swollen area, accompanied by multiple organ failure, is heavy.
2, skin swelling: including sebum hardening and edema in two cases, the skin becomes hard, the skin can not be lifted under the subcutaneous tissue, severe limb stiffness, can not move, touch like a hard rubber, the skin is dark red or pale yellow, Can be associated with edema, finger pressure is concave, hard swelling is often symmetrical, 3, organ function damage: light, low organ function, manifested as not eating, not crying, low response, slow heart rate or ECG and blood biochemical abnormalities; In severe cases of multiple organ failure, shock, heart failure, DIC, renal failure and pulmonary hemorrhage can occur.
(1) Circulatory failure: children with severe hypothermia, especially when the body temperature <30 ° C or hard swelling, often accompanied by obvious microcirculatory disorders, such as pale, blemishes, cold limbs, skin pattern, capillary filling Time prolonged, heart rate is fast and slow, heart sound is low and blunt and arrhythmia, severe heart failure, myocardial damage and cardiogenic shock.
(2) Acute renal failure: When the disease is aggravated, it is accompanied by oliguria or even acute renal function damage without urine. In severe cases, renal failure occurs.
(3) Pulmonary hemorrhage: It is the extreme performance of severe cases. 1 Dyspnea and sudden increase of purpura. Symptoms are not relieved after oxygenation; 2 The wet rales in the lungs increase rapidly; 3 Foamy blood flows from the nose or mouth or tracheal intubation Hemorrhagic fluid; 4 blood gas shows PaO2 decline, PaCO2 increases, pulmonary hemorrhage is the most critical clinical symptoms and major causes of death, if not timely, can die in a short time.
(4) DIC: spontaneous bleeding of common skin and mucous membranes, or injection of pinhole oozing, may be accompanied by shock and hemolysis.
4, other can cause hyperbilirubinemia and promote bilirubin encephalopathy: metabolic disorders such as hypoglycemia, hypocalcemia and metabolic acidosis.
This disease occurs in 7 to 10 days after birth, body temperature does not rise, below 35 ° C, severely below 30 ° C, body temperature (anal temperature) may be lower than body surface temperature ( temperature), skin and subcutaneous tissue Hard swelling, the skin is light red or dark red, severely poor circulation may be pale gray or blue-purple, hard swelling first appeared in the lower limbs, buttocks, cheeks and lower abdomen, then to the upper limbs and the whole body, sometimes only hard and not swollen, then The color of the skin is pale, like rubber, and the range is limited. It only affects the thigh and buttocks. This condition often occurs in sclered diseases caused by infectious diseases. Severe sclerosis can occur in shock, pulmonary hemorrhage and DIC.
DIC, the estimated percentage of the body area of lung hemorrhage: 20% of the head and neck, 18% of the upper limbs, 14% of the chest and abdomen, 14% of the back and lumbosacral region, 8% of the buttocks, and 26% of the lower limbs.
Examine
Examination of neonatal scleredema
1. Blood routine: There is no significant change in the total number of peripheral white blood cells. The total number of white blood cells and neutrophils may increase or decrease in different degrees when combined with infection. If the neutrophils are significantly increased or decreased, the prognosis is poor.
2. DIC screening test: The following six tests should be made for patients with critical cirrhosis who are diagnosed with DIC:
(1) Platelet count: It is often progressive, and the platelet count of about 2/3 children is <100×109/L (100000/mm3).
(2) Prothrombin time: Prothrombin time is prolonged in severe cases, 20s in the 4th day after birth, and 15s in the 5th day and above.
(3) Partial thromboplastin time in white clay is >45s.
(4) Plasma thrombin time: the normal value of neonates was 19-44 s (16. s older), which was more diagnostic than the control group of the same age > 3 s.
(5) Fibrinogen <1.17g/L (117mg/dl), <1.16g/L (160mg/dl) has reference value.
(6) 3P test (plasma protamine paracoagulation test): 65% of normal newborns have a 65% fibrinolytic activity, and may have fibrin degradation products (FDP), so the 3P test can be positive, and still positive after 24 hours. Not normal, but the DIC late 3P test can be turned negative.
3, blood gas analysis: due to lack of oxygen and acidosis, blood pH decreased, PaO2 decreased, PaCO2 increased.
4, blood sugar is often reduced, may have creatinine, non-protein nitrogen increased.
5, ultra-micro red blood cell electrophoresis time measurement: due to increased blood viscosity, red blood cell electrophoresis time is prolonged.
6, ECG changes: some cases may have ECG changes, manifested as QT prolongation, hypotension, T wave low or ST segment decreased.
Diagnosis
Diagnosis and diagnosis of neonatal scleredema
diagnosis
1, the diagnosis of scleredema disease classification: There is no unified opinion at present, but also according to the scope of hard swelling, general condition, body temperature, and whether there is no shock, pulmonary hemorrhage is divided into light, medium and severe.
2, the diagnosis of skin hard swelling range: according to the size of the skin hard swelling, light, medium, heavy three degrees, mild: hard swelling range less than 30%; moderate: hard swelling range of 30% to 50%; severe: hard swelling The range is greater than 50%.
3, hard swollen subcutaneous fat toughness diagnosis degree I degree: subcutaneous fat is slightly hard, skin color is slightly red; II degree: edema is more obvious, subcutaneous fat elasticity is basically disappeared, skin color is slightly dark red; III degree: edema is obvious, The elasticity of the subcutaneous fat disappeared, and the rubbery appearance was hard and the complexion was dark red.
4. Diagnostic criteria for critical scleredema: According to the Trial Program for Critical Case Scoring Method prepared by the Office of Children's First Aid Project of the Ministry of Health of the Ministry of Health, the following two indicators are specified.
(1) The temperature of the anus is below 30 °C, and the degree of hard swelling is more than 2 degrees, regardless of the size.
(2) The rectal temperature is below 33 °C, the hard swelling is above 2 degrees, and the range is over 60%.
Anyone who meets one of the above two conditions can be diagnosed as critically ill.
Differential diagnosis
The disease sometimes has edema, should be differentiated from neonatal edema, and should also be differentiated from neonatal subcutaneous gangrene, neonatal subcutaneous fat necrosis.
