新生兒學英語課件NeoResDistres培訓課件

1、Lecture Points Neonatal pulmonary functionClinical ManifestationThe main causes Main types of the diseaseCase discussion and presentationSummary and conclusionLecture Points Neonatal pulmonPulmonary function of the newborns in particular Relative small capacity of the lungs： limited reserved volume

2、poor compensation, likely to be distressedRespiratory on abdomen and diaphragmatic movement Distension: likely to be respiratory distressedpulmonary surfactant (PS) relative in small amount in preterms and easily to be deficiencyDiseased lungs trends poor compliance and even ARDSPulmonary function o

3、f the newbNeonatal Respiratory DistressGeneral picturecommonly occurs during neonatal period caused by various pathogeneses breath or 、irregular, apneaWith or without retraction at breathing, suprasternal and intercostalusually with cyanosis more or less Neonatal Respiratory DistressGCausation of ne

4、onatal respiratory distress Upper respiratory tract： choana, macrotongue, micrognathiaLarynx/throat and trachea：inteneratepulmonary disease： inflammation、abnormality or hypogenesisothers：congenital heart disease metabolic problems, CNS causedCausation of neonatal respiraPathophysiology in neonatal r

5、espiratory distress hypoxic and /or hypoventilation hypoxemia, PCO2 respiration center peripheral biochemical sensors breath or 、irregular, apneaPathophysiology in neonatal r Neonatal Respiratory DistressHyaline Membrane Disease （HMD、RDS) Neonatal infectious PneumoniaMeconium Aspiration Syndrome (MA

6、S) for differentiation Neonatal Respiratory DistressHyaline Membrane Disease（HMD/RDS）Clinical manifestation pretermsnormal at birth, respiratory distressed in several hours after birthprogressively developing and deterioration self cured process during the sickness Hyaline Membrane Disease（HMD/RClin

7、ical manifestation After birth commonly seen, intrauterine infectious pneumonia relatively less seen Occurring in neonates with different GAs and agesGeneral appearance of infection Various in severity of respiratory distressBlood-gas：PaO2 、PaCO2 Neonatal infectious PneumoniaClinical manifestation N

8、eonata Meconium Aspiration Syndrome (MAS)Clinical manifestationTerms and post-terms commonly seenHistory of intrauterine distressamniotic fluid stained by meconiumLower Apgars scoreDistress occurs soon after birthTachypnea and withdrawal at breathing Blood-gas：PaO2 , PaCO2 and acidosis Meconium Aspi

9、ration SyndromeCXR:HMDCXR:HMDCXR: pneumonia CXR: pneumonia CXR:MASCXR:MASCXR: MAS CXR: MAS Clinical management for neonatal respiratory distressMonitoringGeneral appearance：T; response, skin color, feeding tolerance respiration（frequency, pattern and apnea）Other systems: HR, liver, abdomen Blood-gas

10、, Pa O2 、SaO2Clinical management for neonatClinical management for neonatal respiratory distressOxygen therapyNasal tubeMask and tent Pressed facial maskAttention! fio2 O2 concentration ROP,CLD/BPDClinical management for neonatClinical management for neonatal respiratory distressMechanical ventilati

11、onTarget：early intervention and early withdrawIndication： persistent cyanosis under oxygen therapy Remarkable SaO2 PaO2 and /or PaCO2 indicated by ABG Clinical management for neonatClinical management for neonatal respiratory distressMechanical ventilationVentilation modes and parametersContinuous p

12、ositive airway pressure (CPAP)： 4 - 8 cmH2O; Assistant/control (A/C) ： PIP 15-25 cmH2O；RR 25-35； I/E：1：1.5-2.5；PEEP： 4 - 12 cmH2OPressure support ventilation ( PSV )：6-10 cmH2OHigh frequency oxillation ventilation: HFOVClinical management for neonatClinical management for neonatal respiratory distre

13、ssMedicationantibiotics penicillin: 10-40 萬u/kg/d ampicillin: 50-75mg /kg/d cephalosporin: 25-50mg /kg/dPS: 80-120 mg /kg, 1 to 2 dose Clinical management for neonatClinical management for neonatal respiratory distressKeep the baby warmIncubator Radiator Stable room temperetureClinical management for neonatClinical management for neonatal respiratory distress