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Neonatal scleredema (sclerema neonatorum) means new infants from various causes of the skin and subcutaneous fat stiffen, edema associated with the low temperature clinical syndrome. Were simply known as neonatal cold injury caused by the cold SARS more severe multiple organ dysfunction.
Clinical manifestations
The disease mainly occurred in the winter cold season, and low age group of newborns, especially premature infants. Clinical manifestations include the three main, and that is not temperature or skin edema and multi-system dysfunction.
(1) the temperature did not rise : hypothermia is the main body or acromegaly cooler. normal body temperature of 35 degrees Celsius, 30 degrees below can be serious. Good thermal breakdown of hypothermia caused by the heat produced two different situations with the help diagnose an illness. Good heat production were axillary temperature "rectal temperature, and axillary temperature was reduced to rectal temperature (0-0.9 degrees), most of short duration. sclerema small size, is light. Production caused by the heat, axillary temperature "rectal temperature and rectal temperature negative axillary temperature reduction, mostly for long-duration, hard swollen area, associated with multiple organ failure, is heavy.
(2) hardening of skin and skin edema : edema, including two cases. Stiffen the skin, subcutaneous tissue can not be brought close to the skin. Serious limbs were stiff, not activities inconsistent as hard rubber kind. Cang Chengangongshai or yellow skin, with edema, massage parlors were depressed. Sclerema often symmetry involved were part of the leg, buttocks, cheek, upper limbs, back, abdominal, thoracic, and eyelids, palms and foot. back because of the penis and scrotum and other places with little or lack of subcutaneous fat, there are no hard.
(3) : Light organ damage, organ function. Performance to eat, cry, the reaction was low, slow heart rate or abnormal electrocardiogram and blood biochemistry; Severe multiple organ failure. may shock, heart failure, disseminated intravascular coagulation, renal failure and pulmonary bleeding.
1. Circulatory failure in children with severe hypothermia, body temperature is the "hard swelling or increased at 30 กใ C, Obviously microcirculation diarrhea, paleness, cyanosis, cold extremities, patterns like the skin, capillary filling time. After slow heart beat fast, blunt and low arrhythmogenic heart sounds. There severe heart failure, cardiogenic shock and cardiac damage.
2. Acute renal failure associated with the disease when they increased plasma, urine or other non-acute renal injury, severe renal failure.
3. Severe cases of pulmonary hemorrhage was very difficult to breathe and cyanotic appropri-period performance of a sudden increase, not ease the symptoms of oxygen; 2 rapid increase in pulmonary rales wetlands; 3. bubble blood from the mouth and nose bleeding emission or absorption liquid tracheal intubation; Blood gas fell 4 PaO2, PaCO2 increase. Pulmonary hemorrhage is the most severe clinical manifestations of this disease and the main cause of death, if not in a short period of time where he died.
4. DIC common skin and mucous spontaneous hemorrhage, or bleeding more than a pinhole injection, with shock and hemolytic performance.
(D) can be induced hyperbilirubinemia and helped other bilirubin encephalopathy; metabolic disorders such as low blood sugar, low blood calcium and other metabolic acidosis.
Treatment
Treatment should include the correct temperature, a reasonable supply of calories. Early prevention and correct and remove the causes of organ failure.
(1) temperature :
1. Rewarming methods :
Appropri mild-to-moderate patients, temperature, "a good 30 กใ C heat production (axillary-rectal temperature is positive). immediately placed in moderate temperature and reduce heat loss, increased body temperature. Children can be placed preheated to 30 กใ C warming boxes and boxes in the 30-34 กใ C temperature range. restore normal body temperature in the 6-12 hour period. Rural, flat plane to be adapted and used Reshuidai heat kang, or wrapped tight heating Heating Blanket rewarming methods.
2 patients with severe, the temperature "or 30 กใ C heat failure (axillary-negative rectal temperature). 1-2 กใ C higher than the temperature were the first to start warming boxes rewarming. Box 0.5-1 กใ C temperature increase per hour ( "34 กใ C) in 12-24 hours to restore normal body temperature. Taiwan may adopt, as appropriate, or far-infrared radiation temperature water bath temperature.
2. Rewarming the guardianship, including : blood pressure, heart rate, respiration, body temperature regularly detected, axillary temperature. Abdominal skin temperature and ambient temperature (room temperature warmer temperatures box). Rectal temperature for the body to balance indicators; Axillary-rectal temperature of thermal indicators; Skin-temperature indicator for heat. Accurate records calorie intake or imported, fluid and urine.
(2) heat and liquid supply :
Calorie liquid supplement and ensure the success and maintain normal body temperature. 210KJ/kg calories daily (50KJ/kg) and quickly rose to 418-502KJ/kg (100-120KCcl/kg). Or premature infants with heat failure patients can be appropriately increased at low temperature due to lower glucose tolerance and metabolic inhibition. to strictly control the entry of glucose are advised to remain at 6-8mg/min to prevent excessive blood sugar. But low blood sugar can increase the importation of sugar. Rewarm tolerance resume 8-10mg/kg/min due to increased importation of sugar. If need be inadequate heat, add the intravenous fat emulsion. 1ml/Kcal may give daily amount of liquid, accompanied by severe plasma, urine or no significant heart and kidney function, and fluid infusion rate should be strictly limited.
This article was posted on 2007-02-27
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