新生兒窒息英文

1、新生兒窒息Asphyxia of the Newborn,,Dr. 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

2、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:

3、 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 condition in the neonate where

4、 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

5、 A failure of function of at least two organs consistent with the effects of acute asphyxia.,,Hypoxemia, Hypercapnia, Mixed acidosis, Organic failure,Risk Factors-Maternal,Systemic disease: diabetes, heart or renal dis

6、eases, anemia, infectious diseases Obstetric Conditions: hypertensive disease of pregnancy or pre-eclampsia, placental abruptionSubstance abuse: drug addiction, smokingMaternal age: >35, or <16, multiple pregnan

7、cy,,Risk Factors-Fetal,Premature, SGA, macrosomiaCongenital malformation: nose and laryngo- pharynx malformation, lung hypoplasia, heart diseaseAmniotic fluid or meconium aspirationIntrauterine infection: Torch syndr

8、ome,,Risk Factors-Intrapartum,Umbilical cord: obstructionObstetric procedures: forceps delivery, breech extraction, vacuum extraction Medication: analgesic and oxytocic medicine,,Pathophysiology of Asphysia,Respiratory

9、 Alteration: primary hyperpnea, primary apnea, secondary apnea Hypoxic-ischemic Changes of Multi-organic system: “diving reflex”, inter-organ shunting, organ failure Biochemical and metabolic Cons

10、equences: acidosis, hyper- or hypoglycemia, hypocalcemia, hyperbilirubinemia, hyperkalemia, hyponatremia,,Clinical Manifestation of Asphysia,Apgar Scoring System,,,Apgar Scoring System,,A,P,G,A,R,The

11、Significance of Apgar Score,,Apgar 8~10, normal; 4~7, mild asphyxia; 0~3, severe asphyxia Assigned at 1, 5, and 10 min, until score of 7 or more 1’ score indicate the severity

12、and guide for resuscitation 5’ score and later is more predictive of prognosis Premature infants intend to have lower scores,Clinical Manifestation of Asphyxia,Multiorgan System Dysfunction Renal compromise: oliguria

13、and elevated creatinineHypoxic cardiomyopathy (ECHO or ECG abnormality)Hypoxic ischemic encephalopathy (HIE)Pulmonary complications: respiratory distress (RDS), persistent pulmonary hype

14、rtension (PPHN)Disseminated intravascular coagulation (DIC)Hepatic failure, hyperbilirubinemiaNecrotising enterocolitis (NEC), stress ulcer Fluid overload, hyperkalemia, hypoglycemia, and acidosis,,American Heart Ass

15、ociation-American Academy of Pediatrics Approach to Resuscitation,,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 pulm

16、onary 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 ventilation,Am

17、erican Heart Association-American 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 adequa

18、te to sustain further steps depend on the response to ventilation 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 co

19、mpression,Resuscitation – the ABCDE Protocol,,Air way Breathing Circulation Drugs Evaluation & Enviroment,Advanced LifeSupport (ALS),The Neonatal ResuscitationGuidelines,Pediatrics, 2000,,Neonatal Resusci

20、tation Medications,,Post-resuscitation Issues and More,,Continuing Care of the Newly Born Infant supportive or ongoing care monitoring appropriate diagnostic evaluation Docum

21、entation of Resuscitation Continuing Care of the Family Ethics: Noninitiation of Resuscitation Discontinuation of Resuscitation,To save, or not to save,???,,Advanced life