兒科課件-新生兒窒息

1、新生兒窒息Asphyxia of the NewbornDr. Xiaoping LuoProfessor and ChairmanDepartment of PediatricsTongji HospitalTongji Medical College 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 tim

2、e spent 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.Definition of Perinatal Asphyxia a conditio

3、n in the neonate where there is the following combination:An event or condition during the perinatal period that is likely to severely reduce oxygen delivery and lead to acidosis; AND A failure of function of at least two organs consistent with the effects of acute asphyxia.Hypoxemia, Hypercapnia, M

4、ixed acidosis, Organic failureRisk Factors-MaternalSystemic disease: diabetes, heart or renal diseases, anemia, infectious diseases Obstetric Conditions: hypertensive disease of pregnancy or pre-eclampsia, placental abruptionSubstance abuse: drug addiction, smokingMaternal age: 35, or 16, multiple p

5、regnancyRisk Factors-FetalPremature, SGA, macrosomiaCongenital malformation: nose and laryngo- pharynx malformation, lung hypoplasia, heart diseaseAmniotic fluid or meconium aspirationIntrauterine infection: Torch syndromeRisk Factors-IntrapartumUmbilical cord: obstructionObstetric procedures: force

6、ps delivery, breech extraction, vacuum extraction Medication: analgesic and oxytocic medicinePathophysiology of AsphysiaRespiratory Alteration: primary hyperpnea, primary apnea, secondary apnea Hypoxic-ischemic Changes of Multi-organic system: “diving reflex”, inter-organ shunting, organ failure Bio

7、chemical and metabolic Consequences: acidosis, hyper- or hypoglycemia, hypocalcemia, hyperbilirubinemia, hyperkalemia, hyponatremiaClinical Manifestation of AsphysiaApgar Scoring System Apgar Scoring SystemSign0 Points1 Point2 PointsActivity (muscle tone)absentarms and legs flexedactive movementPuls

8、e (heart rate)absentbelow 100 bpmabove 100 bpmGrimace (reflex irritability)no responsegrimacesneeze,cough, pulls awayAppearance (skin color)blue-gray, pale all overnormal, /-extremitiesnormal over entire bodyRespirationabsentslow, irregulargood, cryingAPGARThe Significance of Apgar Score Apgar 810,

9、normal; 47, mild asphyxia; 03, severe asphyxia Assigned at 1, 5, and 10 min, until score of 7 or more 1 score indicate the severity and guide for resuscitation 5 score and later is more predictive of prognosis Premature infants intend to have lower scores Clinical Manifestation of AsphyxiaMultiorgan

10、 System Dysfunction Renal compromise: oliguria and elevated creatinineHypoxic cardiomyopathy (ECHO or ECG abnormality)Hypoxic ischemic encephalopathy (HIE)Pulmonary complications: respiratory distress (RDS), persistent pulmonary hypertension (PPHN)Disseminated intravascular coagulation (DIC)Hepatic

11、failure, hyperbilirubinemiaNecrotising enterocolitis (NEC), stress ulcer Fluid overload, hyperkalemia, hypoglycemia, and acidosisAmerican Heart Association-American Academy of Pediatrics Approach to Resuscitation Infant with an Apgar Score of 7 or more generally do not require resuscitation a brief

12、period of oxygen blown over the face oxygen increases pulmonary blood flow avoid excessive suctioning of clear fluid 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 ventilationAmerican Heart Association-American

13、Academy of Pediatrics Approach to Resuscitation 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 ventilation Infant with an Apgar Score of 0 no live born infant sh

14、ould be assigned a score of 0 resuscitation should proceed as for a score of 1 cardiac compressionResuscitation the ABCDE Protocol Air way Breathing Circulation Drugs Evaluation & EnviromentAdvanced LifeSupport (ALS)The Neonatal ResuscitationGuidelinesPediatrics, 2000Neonatal Resuscitation Medicatio

15、nsMedicationConcentration 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 n

16、eeded.Sodium Bicarbonate0.5 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 ml100 mg/kg (1 ml/kg) IVGive over 3-5 minutes, may repeat every 15 min. Do not mix with sodium bicarbonate in line. Post-resuscitation Issues and More Continui