新生儿窒息(英文)课件.ppt

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1、新生儿窒息Asphyxia of the NewbornDr.Xiaoping LuoProfessor and ChairmanDepartment of PediatricsTongji HospitalTongji Medical College1 The highest mortality that befalls the human race in one day occurs on the day of birth.It is said that the most important period of the life of a human being is the time s

2、pent in utero.The most trying ordeal a human being sustains is the ordeal of birth.Asphyxia Neonatorum:Causation and TreatmentProfessor of Obstetrics,Northwestern University Medical SchoolJos.B.De LeePublished in Medicine(Detroit)3:643-660,1897.2Definition of Perinatal Asphyxia a a condition conditi

3、on in in the the neonate neonate where where there there is the following combination:is the following combination:An An event event or or condition condition during during the the perinatal perinatal period period that that is is likely likely to to severely severely reduce reduce oxygen oxygen del

4、ivery delivery and lead to acidosis;and lead to acidosis;ANDAND A A failure failure of of function function of of at at least least two two organs organs consistent with the effects of acute asphyxia.consistent with the effects of acute asphyxia.Hypoxemia,Hypercapnia,Mixed acidosis,Organic failure3R

5、isk Factors-MaternalFSystemic Systemic disease:disease:diabetes,diabetes,heart heart or or renal renal diseases,anemia,infectious diseases diseases,anemia,infectious diseases FObstetric Obstetric Conditions:Conditions:hypertensive hypertensive disease disease of of pregnancy pregnancy or or pre-ecla

6、mpsia,pre-eclampsia,placental placental abruptionabruptionFSubstance abuse:Substance abuse:drug addiction,smoking drug addiction,smokingFMaternal Maternal age:age:35,35,or or 16,16,multiple multiple pregnancypregnancy4Risk Factors-FetalFPremature,SGA,macrosomiaFCongenital malformation:nose and laryn

7、go-pharynx malformation,lung hypoplasia,heart diseaseFAmniotic fluid or meconium aspirationFIntrauterine infection:Torch syndrome5Risk Factors-IntrapartumFUmbilical cord:obstructionFObstetric procedures:forceps delivery,breech extraction,vacuum extraction FMedication:analgesic and oxytocic medicine6

8、Pathophysiology of AsphysiaFRespiratory Alteration:Respiratory Alteration:primary primary hyperpnea,hyperpnea,primary primary apnea,apnea,secondary secondary apneaapnea FHypoxic-ischemic Hypoxic-ischemic Changes Changes of of Multi-organic Multi-organic system:system:“diving diving reflexreflex”,int

9、er-organ inter-organ shunting,shunting,organ organ failure failure FBiochemical and metabolic Consequences:Biochemical and metabolic Consequences:acidosis,acidosis,hyper-hyper-or or hypoglycemia,hypoglycemia,hypocalcemia,hypocalcemia,hyperbilirubinemia,hyperbilirubinemia,hyperkalemia,hyperkalemia,hy

10、ponatremiahyponatremia7Clinical Manifestation of AsphysiaFApgar Scoring System 8Apgar Scoring SystemSign0 Points1 Point2 PointsActivity(muscle tone)absentarms and legs flexedactive movementPulse(heart rate)absentbelow 100 bpmabove 100 bpmGrimace(reflex irritability)no responsegrimacesneeze,cough,pul

11、ls awayAppearance(skin color)blue-gray,pale all overnormal,/-extremitiesnormal over entire bodyRespirationabsentslow,irregulargood,cryingAPGAR9The Significance of Apgar ScoreF Apgar 810,normal;47,mild asphyxia;03,severe asphyxia F Assigned at 1,5,and 10 min,until score of 7 or moreF 1 score indicate

12、 the severity and guide for resuscitationF 5 score and later is more predictive of prognosisF Premature infants intend to have lower scores 10Clinical Manifestation of AsphyxiaFMultiorgan System Dysfunction Multiorgan System Dysfunction Renal compromise:oliguria and elevated creatinineRenal compromi

13、se:oliguria and elevated creatinineHypoxic Hypoxic cardiomyopathy cardiomyopathy(ECHO(ECHO or or ECG ECG abnormality)abnormality)Hypoxic ischemic encephalopathy(HIE)Hypoxic ischemic encephalopathy(HIE)Pulmonary Pulmonary complications:complications:respiratory respiratory distress distress(RDS),(RDS

14、),persistent persistent pulmonary pulmonary hypertension hypertension(PPHN)(PPHN)Disseminated intravascular coagulation(DIC)Disseminated intravascular coagulation(DIC)Hepatic failure,hyperbilirubinemiaHepatic failure,hyperbilirubinemiaNecrotising enterocolitis(NEC),Necrotising enterocolitis(NEC),str

15、ess ulcer Fluid Fluid overload,overload,hyperkalemia,hyperkalemia,hypoglycemia,hypoglycemia,and and acidosisacidosis11American Heart Association-American Academy of Pediatrics Approach to ResuscitationF Infant with an Apgar Score of 7 or more generally do not require resuscitation a brief period of

16、oxygen blown over the face oxygen increases pulmonary blood flow avoid excessive suctioning of clear fluidF Infant with an Apgar Score of 4 to 6 stimulation administration of oxygen by face mask,or bag empty the stomach when using bag or mask ventilation12American Heart Association-American Academy

17、of Pediatrics Approach to ResuscitationF Infant with an Apgar Score of 1 to 3 usually require intubation and expansion of the lung bag and mask ventilation usually is adequate to sustain further steps depend on the response to ventilationF Infant with an Apgar Score of 0 no live born infant should b

18、e assigned a score of 0 resuscitation should proceed as for a score of 1 cardiac compression13Resuscitation the ABCDE Protocol Air way Breathing Circulation Drugs Evaluation&Enviroment14Advanced LifeSupport(ALS)The Neonatal ResuscitationGuidelinesPediatrics,200015Neonatal Resuscitation MedicationsMe

19、dicationConcentration to AdministerPreparationDosage&RouteRate&Precautions Epinephrine1:10,000(0.1 mg/l)1 ml0.1-0.3 ml/kg IV or ITGive rapidly,may repeat every 5-10 minutes.Volume Expanderswhole blood,5%albumin,saline,Ringers lactateVaries10 ml/kg IVGive over 5-10 minutes.Repeat as needed.Sodium Bic

20、arbonate0.5 meq/ml(4.2%solution)20 ml or two 10 ml prefilled syringes2 meq/kg(4 ml/kg)IVGive slowly,over at least 2 minutes,may repeat every 10 minutes.Ventilate infant.Narcan(Naloxone)0.4 mg/ml1 ml0.1 mg/kg(0.25ml/kg)IV,IM,SQ,ITGive rapidly.Calcium Gluconate100 mg/ml(10%solution,0.465 mEq/ml)10 ml1

21、00 mg/kg(1 ml/kg)IVGive over 3-5 minutes,may repeat every 15 min.Do not mix with sodium bicarbonate in line.16Post-resuscitation Issues and MoreF Continuing Care of the Newly Born Infant supportive or ongoing care monitoring appropriate diagnostic evaluation F Documentation of Resuscitation F Continuing Care of the Family F Ethics:Noninitiation of Resuscitation Discontinuation of Resuscitation To save,or not to save?17 Advanced life support,Your support!Thank you!182023/1/419.