新生儿窒息AsphyxiaofNewborn.ppt

AsphyxiaofNewborn,新生儿窒息,DefinitionofPerinatalAsphyxia,Aneventorconditionduringtheperinatalperiodthatislikelytoseverelyimpairedgasexchangeandleadstothreebiochemicalcomponents:ANDAfailureoffunctionofatleasttwoorgans.,Hypoxemia,Hypercapnia,metabolicacidosis,Etiology,Allfactorsleadingtoaninterruptionofoxygensupplyorbloodflowtothefetusduringperinatalperiod(prenatal,intrapartumandpostnatal)RiskFactors-MaternalSystemicdisease:diabetes,heartorrenaldiseases,anemia,infectiousdiseasesObstetricConditions:hypertensionofpregnancyorpre-eclampsia,placentalabruptionSubstanceabuse:drugaddiction,smokingAgeorother:35y,or160bpmlatestage:decreasedmovement,fetalheartrate71scoreindicatetheseverityofasphyxiaandguideforresuscitationscoreat5andlaterismorepredictivetoprognosisPrematureinfantsintendtohavelowerscores0lowApgarscoresmayleadedby:asphyxia,drugs,trauma,hypovolemia,infectionoranomalies,MultiorganSystemDysfunction,Renalcompromise:oliguriaandelevatedcreatinineAcutetubularnecrosisHypoxiccardiomyopathy(ECHOorECGabnormality)Hypoxicischemicencephalopathy(HIE)Pulmonarycomplications:respiratorydistress(RDS),persistentpulmonaryhypertension(PPHN)Disseminatedintravascularcoagulation(DIC)Hepaticfailure,hyperbilirubinemiaNecrotizingenterocolitis(NEC),feedintoleranceFluidoverload,hyperkalemia,hypoglycemia,andacidosis,Bloodgas(pH、PaO2、PaCO2）Serumsugar,electrolyte（Calcium、Natrium）Serum:BUN,Cr,DIC-coagulationprofile,ALTHeadimage(Ultrasonic,CT,MRI)ChestX-rayECG,Examination,Theassessmentofasphyxiashouldcombine:AhistoryofmaternalandintrapartumriskfactorsApgarscoreat1,5(0to3forlongerthan5minutes)ScalppH(7),orumbilicalarterialbloodgasClinicalmanifestation:neurologicalstatusforHIEgrading;featuresoforganinjureExamination(assessmentoforgandysfunction),Diagnosis,Treatment,Aim:firstcorrectingtheoriginalhypoxiasecondalleviatingtissueischemiamaintainingorrestoringcerebralperfusionManagementoforgandysfunctionsManagements:Acontinoussupplyofbothoxygenandglucose;Normalizingbloodpressure,volumeexpansion,pressoragents,sodiumbicarbonateCarefulfluidandelectrolytemonitoring,Resuscitation,Principles:Attendanceofneonatalstaffduringallhigh-riskdeliveriesNeedofresuscitationdependsonthesignsofrespiration,heartrate,colorProcesses:evaluationdecisionmanagementreassess(newcircle)Method:ABCDEprotocol,GuidelinestoResuscitation,InfantwithanApgarScoreof7ormoregenerallydonotrequireresuscitationabriefperiodofoxygenblownoverthefaceoxygenincreasespulmonarybloodflowavoidexcessivesuctioningofamnioticfluidInfantwithanApgarScoreof4to6stimulationadministrationofoxygenbyfacemask,orbagemptythestomachwhenusingbagormaskventilation,InfantwithanApgarScoreof1to3resuscitationcommencedwithoutdelayusuallyrequireintubationandchestexpansionfurtherstepsdependontheresponsetoventilationInfantwithanApgarScoreof0noliveborninfantshouldbeassignedascoreof0resuscitationshouldproceedasforascoreof1immediatelycardiaccompression,ResuscitationtheABCDEProtocol,AirwayBreathingCirculationDrugsEvaluation&Environment,AdvancedLifeSupport(ALS),TheNeonatalResuscitationGuidelines,Pediatrics,2000,NeonatalResuscitationMedications,Post-resuscitationIssuesandMore,ContinuingCareoftheNewlyBornInfantsupportiveorongoingcaremonitoringappropriatediagnosticevaluationDocumentationofResuscitationContinuingCareoftheFamilyEthics:NoinitiationofResuscitationDiscontinuationofResuscitation,Tosave,ornottosave,?,Preventheatloss:Neutralthermalenviroment，maintainbodytemperaturein37Oxygensupply：PaO26080mmHgforterminfant,5060mmHgforpreterminfant，normallevelofPaCO2Correctingacidosis:ventilation,infusionofNaHCO3Normalizingthesystemicperfusion:extensionofvolume,Dopamine520/(kg.min)Supportivecare:monitoringelectrolyte,fluidinfusion6080ml/kg.dordependonurineV.,Othermanagement,Prognosis,NosinglefactormaypredictmortalityorCNSabnormalitywithabsolutecertainty.Apgarscore:0-3,morbidity5%at1and53%at200-3,cerebralpalsy1%at5,9%at15,57%at20TimetosustainedspontaneousrespirationCordbloodgas:pH7.05mayindicateabadresultswithincreasingincidenceofdeathandseizuresGestation