新生儿窒息（英文）

新生儿窒息 Asphyxia of the Newborn Dr. Xiaoping Luo Professor and Chairman Department of Pediatrics Tongji Hospital Tongji 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 time spent in utero. The most trying ordeal a human being sustains is the ordeal of birth. Asphyxia Neonatorum: Causation and Treatment Professor of Obstetrics, Northwestern University Medical School Jos. B. De Lee Published in Medicine (Detroit) 3:643-660, 1897. Definition of Perinatal Asphyxia a a condition condition in in the the neonate neonate where where there there is is the the following combination:following combination: An An event event or or condition condition during during thethe perinatalperinatal period period that that is is likely likely to to severely severely reduce reduce oxygen oxygen delivery delivery and and lead lead to to acidosis; acidosis; ANDAND A A failure failure of of function function of of at at least least two two organs organs consistent consistent with with the effects of acute asphyxia.the effects of acute asphyxia. Hypoxemia, Hypercapnia, Mixed acidosis, Organic failure Risk Factors-Maternal FFSystemic Systemic disease:disease: diabetes, diabetes, heart heart or or renal renal diseases, anemia, infectious diseases diseases, anemia, infectious diseases FFObstetric Obstetric Conditions:Conditions: hypertensivehypertensive disease disease of of pregnancy or pre-pregnancy or pre-eclampsiaeclampsia, placental abruption, placental abruption FFSubstance abuse:Substance abuse: drug addiction, smoking drug addiction, smoking FFMaternal age:Maternal age: 35, or 35, or 16, multiple pregnancy Risk Factors-Fetal FFPremature, SGA, Premature, SGA, macrosomiamacrosomia FFCongenital Congenital malformation:malformation: nose nose and and l laryngo- pharynx malformation, lung hypoplasia, heart disease FAmniotic fluid or meconium aspiration FFIntrauterine infection: Intrauterine infection: Torch syndromeTorch syndrome Risk Factors-Intrapartum FFUmbilical cord: Umbilical cord: obstructionobstruction FFObstetric Obstetric procedures:procedures: forceps forceps delivery, delivery, breech extraction, vacuum extraction FFMedication:Medication: analgesic and oxytocic medicine Pathophysiology of Asphysia FFRespiratory Alteration:Respiratory Alteration: primary primary hyperpneahyperpnea, primary apnea, secondary apnea, primary apnea, secondary apnea FFHypoxic-Hypoxic-ischemicischemic Changes of Multi-organic system: Changes of Multi-organic system: “diving reflex”, inter-organ shunting, organ failure “diving reflex”, inter-organ shunting, organ failure FFBiochemical and metabolic Consequences:Biochemical and metabolic Consequences: acidosis, hyper- or hypoglycemia, acidosis, hyper- or hypoglycemia, hypocalcemiahypocalcemia, , hyperbilirubinemiahyperbilirubinemia, , hyperkalemiahyperkalemia, , hyponatremiahyponatremia Clinical Manifestation of Asphysia FFApgar Apgar Scoring SystemScoring System ApgarApgar Scoring System Scoring System Sign0 Points1 Point2 Points Activity (muscle tone) absentarms and legs flexed active movement Pulse (heart rate) absentbelow 100 bpm above 100 bpm Grimace (reflex irritability) no responsegrimacesneeze,cough, pulls away Appearance (skin color) blue-gray, pale all over normal, / -extremities normal over entire body Respiration absentslow, irregular good, crying A P G A R The Significance ofThe Significance of Apgar Apgar Score Score F Apgar 810, normal; 47, mild asphyxia; 03, severe asphyxia F Assigned at 1, 5, and 10 min, until score of 7 or more F 1 score indicate the severity and guide for resuscitation F 5 score and later is more predictive of prognosis F Premature infants intend to have lower scores Clinical Manifestation of Asphyxia FFMultiorganMultiorgan System Dysfunction System Dysfunction Renal compromise:Renal compromise: oliguria oliguria and elevated and elevated creatininecreatinine Hypoxic Hypoxic cardiomyopathycardiomyopathy (ECHO or ECG abnormality) (ECHO or ECG abnormality) Hypoxic Hypoxic ischemic encephalopathyischemic encephalopathy (HIE) (HIE) Pulmonary complications: respiratory distress (RDS), Pulmonary complications: respiratory distress (RDS), persistent pulmonary hypertension (PPHN) persistent pulmonary hypertension (PPHN) Disseminated Disseminated intravascularintravascular coagulation (DIC) coagulation (DIC) Hepatic failure, Hepatic failure, hyperbilirubinemiahyperbilirubinemia Necrotising enterocolitisNecrotising enterocolitis (NEC), (NEC), stress ulcer Fluid overload, Fluid overload, hyperkalemiahyperkalemia, hypoglycemia, and acidosis, hypoglycemia, and acidosis American Heart Association-American Academy of Pediatrics Approach to Resuscitation F Infant with an Apgar Score of 7 or more generally do not require resuscitation a brief period of oxygen blown over the face oxygen increases pulmonary blood flow avoid excessive suctioning of clear fluid F 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 ventilation American Heart Association-American Academy of Pediatrics Approach to Resuscitation F 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 F Infant with an Apgar Score of 0 no live born infant should be assigned a score of 0 resuscitation should proceed as for a score of 1 cardiac compression Resuscitation the ABCDE Protocol Air way Breathing Circulation Drugs Evaluation & Enviroment Advanced Life Support (ALS) The Neonatal Resuscitation Guidelines Pediatrics, 2000 Neonatal Resuscitation Medications MedicationConcentration to Administer PreparationDosage & Route Rate & Precautions Epinephrine 1:10,000 (0.1 mg/l)1 ml0.1-0.3 ml/kg IV or IT Give rapidly, may repeat every 5- 10 minutes. Volume Expanders whole blood, 5% albumin, saline, Ringers lactate Varies10 ml/kg IVGive over 5-10 minutes. Repeat as needed. Sodium Bicarbonate 0.5 meq/ml (4.2% solution) 20 ml or two 10 ml prefilled syringes 2 meq/kg (4 ml/kg) IV Give slowly,