新生儿窒息 asphyxia of the newborns at 课件

Neonatology AsphyxiaofTheNewbornsatbirth LecturePoints ClinicaldefinitionandEpidemiology incidence mortalityEtiologyandPathophysiologyApgar sscoresignificanceofclinicalusereevaluationofthescoreResuscitationComplicationandprognosis ClinicalDefinition Epidemiology ClinicaldefinitionFailuretoinitiaterespirationno irregularbreathingwithhypoxemiaandacidosisIncidence 6 10 inlivebirthMortality leadingdeathinneonatesaccountfor1 3inneonatesdeath Etiology Maternal Systematicdiseaseshypertension hypoxiaObstetric pregnantcomplicationAddictionAgeatpregnancy multiplepregnancy Etiology IntrapartumAbnormalumbilicalcordAbnormalfetalpositionProcedure ForcepsMedication narcotic Sedatives Etiology FetusPremature SGA LGA MacrosomiaVariousabnormalityIntrauterineaspirationNervesinjury Pathophysiology Hypoxic Ischemia Organ systeminjury Hypoxemia acidosis O2 CO2ExchangeObstacle Failuretoinitiatebreath Pathophysiology ApgarScoringSystem ApgarScoringSystem ApgarScoreMethods at1and5min postbirthtill 7min or20min afterbirth ClinicalManifestation Fetaldistress Fetalmotion ornoFetalHR or Meconium stainedamnioticfluid ApgarScore 3at1or5min severe4 7at1or5min slight ReevaluationofApgarScore DoesApgarScorereflect AccuracyofPredictthedeathTheseverityofperinatalhypoxicTheprocessandseverityofintrauterinefetalhypoxicFacts ThesubjectivityofthescoringandexperiencebasedLowscoringalwaysforprematures AmericanAcademyofPediatrtics AmericanCollegeofObstetriciansandGynecologists Pediatrics1996 98 141 2 InconsistentoftheApgarscorewithbraindamageIflowerscoreat5min 4at10min BrainDamageonly1 inchildrenat7yearsoldInbraindamagedchildren75 werenormalforApgarscore ReevaluationofApgarScore AmericanAcademyofPediatrtics AmericanCollegeofObstetriciansandGynecologists Pediatrics1996 98 141 2 Therelevancetotheoutcomeofasphyxiawithsurvivalandsystem organfunctionUmbilicalarteryPH 7 00BE 20mEq L PapileLA TheApgarscoreinthe21stcentury NEnglJMed2001 344 519 20 ReevaluationofApgarScore NRP5thedition2006 2006 5thedition SuctionwhenMeconiumpresentResuscitationwithoxygenorroomairEpinaphrineforbradycardiaorcardiacarrest NRP5thedition2006 NeonatalResuscitation5thedition Birth Termgestation Clearamnioticfluid Breathingorcrying Goodmuscletone yes No RoutinecareProvidewarmthClearairwayDryAssesscolor NeonatalResuscitation5thedition ProvidewarmthPosition ClearairwayEIT ifnecessary Dry stimulateReposition No Evaluaterespiration HRandcolor ApneaOrHR 100 Givesupplementaloxygen Observationalcare Breathing HR 100andpink Cyanosis 30s Persistentcyanosis Pink NeonatalResuscitation5thedition PositivepressureventilationEITAdministerchestcompressionsEIT HR 60 AdministerepinephrineEIT HR 60 30s PositivepressureEITventilation 30s Effectiveventilation HR 100andpink Postresuscitationcare Persistentcyanosis HR 60 ApneaOrHR 100 OxygenConcentrationforPPV 2006GuidelineSupplementaryoxygenisrecommendedwheneverpositive pressureventilationisindicatedforresuscitation Thereisinsufficientevidencetospecifytheconcentrationofoxygentobeusedattheinitiationofresuscitation 100 standardapproach 100 acceptablealternative21 acceptablealternative Meconium stainedfluid SuctionwhenMeconiumpresent Meconiumpresent Babyvigorous Suctionmouthandtrachea ContinuowithremainderofinitialstepsClearmouthandnosesecretionDry stimulateandrepositon RespirationeffortHR 100bpmGoodmuscletone No Yes Yes No SuctioningMeconium EpinephrineforBradycardia 2006GuidelineIntravenousadministrationofepinephrine0 01 0 03mg kg doseisthepreferredroute ClassIIa Whileaccessisbeingobtained administrationofahigherdose upto0 1mg kg throughtheendotrachealtubemaybeconsidered NeonatalResuscitation5thedition SpO2Monitoring Onceper30Sec To95 fornewabornbaby 10min Premature UseBlendandOxygenairAdjusttheoxygenairtoSpO2near90 InternationalLiaisonCommitteeonResuscitation Part13 Neonatalresuscitationguidelines Circulation2005 112 24 Suppl IV188 IV195 Resuscitationtechnology Suction beginningfromOralthenNasal Resuscitationtechnology Tactilestimulation Taptheplantar Resuscitationtechnology Tactilestimulation RubbertheBack Resuscitationtechnology O2supplyviaPPVbag Resuscitationtechnology Chestcompress Resuscitationtechnology Endotrachealintubation Method bynasalorbyoralIndication MeconiumaspirationNormalSaO2onlymaintainedbyPPVSerioushypoxemiaPersistentirregularbreathing Resuscitationtechnology Endotrachealintubationbyoral Resuscitationtechnology Endotrachealintubation VocalandTracheal Resuscitationtechnology MonitoringpostresuscitationTemp Respiration HRBP UrinevolumeSkincolorCNSsignsAcidbase Balanceofelectrolytes Infection AmericanAcademyofPediatrtics AmericanCollegeofObstetriciansandGynecologists Pediatrics1996 98 141 2 IndicationsofpooroutcomeorCNSdamageUmbilicalarteryshowedsevereacidosis PH3 Prognosis PreventionofAsphyxia AntenatalcareToavoidprematuredeliveringandobstetricprocedure forceps MonitoringhighriskprehnentPreandpostbornpreparation