如何快速的将Word文字转换为Pdf格式的文件.ppt

Hemophilia in the Newborn Lab studies: CBC (to assess H/H, plt count) PT aPTT Factor VIII level Imaging studies: Head CT Body CT as directed by clinical suspicion MRI for further assessment Angiography nucleotide bleeding scan Hemophilia in the Newborn Medication: Recombinant FVIII or FIX infusion to correct activity to 100% of normal For CNS, GI airway hemorrhage 50U/kg FVIII, then cont. infusion of 2-3U/kg/hr to maintain FVIII100 U/dL for 24hr, then for 5-7d to keep FVIII50 80U/kg FIX, then 20-30U/kg q12-24hr to maintain FIX20U/dL for 5-7d then 30 for 5d Hemophilia in the Newborn Most commonly presents with prolonged oozing from heel puncture or bleeding from circumcision. Prolongation of PTT B/c FVIII reaches normal adult range by 20 weeks’ gestation, Dx is usu. not difficult to assign @ birth. FIX develops more slowly and normal term infants may have FIX activities as low as 15%. Therefore only severe FIX deficiency Dx @ birth. Hemophilia in the Newborn Affected babies must receive factor infusions prior to surgery or invasive procedures. Immunizations may be given IM vitamin K may be delivered using careful technique to avoid muscle trauma. Direct pressure for min of 10 min. in attempt to decrease hemorrhage. IM administration of drugs (Abx) should be avoided. Hemophilia in the Newborn:Current Issues Intracranial Hemorrhage has been reported in 1-4% of hemophiliac NBNs. May be the first indication of Dx Surveys show that even in the face of documented ICH, few neonatalogists consider the Dx and/or order appropriate tests Majority of hematologists disagree w/ administration of Clotting Factor Concentrates to Dx NBN to offset birth trauma Hemophilia in the Newborn:Current Issues Major concern is safe delivery w/ minimal trauma to minimize hemorrhage risks No guidelines for mode of delivery (NVSD vs CS) Avoid vacuum and forceps deliveries Survey states only 47% OB routinely save cord blood for future clotting assays in NBN of known carrier Thank y