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1、新生儿窒息Asphyxia of the Newborn,Dr. Xiaoping LuoProfessor and ChairmanDepartment of PediatricsTongji HospitalTongji Medical College,新生儿窒息Asphyxia of the NewbornD,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 l
2、ife 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.,The high
3、est mortality t,Definition of Perinatal Asphyxia,a condition in the neonate where 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 A failure of function of at least two organs consistent w
4、ith the effects of acute asphyxia.,Hypoxemia, Hypercapnia, Mixed acidosis, Organic failure,Definition of Perinatal Asphyx,Risk Factors-Maternal,Systemic disease: diabetes, heart or renal diseases, anemia, infectious diseases Obstetric Conditions: hypertensive disease of pregnancy or pre-eclampsia, p
5、lacental abruptionSubstance abuse: drug addiction, smokingMaternal age: 35, or 16, multiple pregnancy,Risk Factors-MaternalSystemic,Risk Factors-Fetal,Premature, SGA, macrosomiaCongenital malformation: nose and laryngo- pharynx malformation, lung hypoplasia, heart diseaseAmniotic fluid or meconium a
6、spirationIntrauterine infection: Torch syndrome,Risk Factors-FetalPremature, S,Risk Factors-Intrapartum,Umbilical cord: obstructionObstetric procedures: forceps delivery, breech extraction, vacuum extraction Medication: analgesic and oxytocic medicine,Risk Factors-IntrapartumUmbili,Pathophysiology o
7、f Asphysia,Respiratory Alteration: primary hyperpnea, primary apnea, secondary apnea Hypoxic-ischemic Changes of Multi-organic system: “diving reflex”, inter-organ shunting, organ failure Biochemical and metabolic Consequences: acidosis, hyper- or hypoglycemia, hypocalcemia, hyperbilirubinemia, hype
8、rkalemia, hyponatremia,Pathophysiology of AsphysiaRes,Clinical Manifestation of Asphysia,Apgar Scoring System,Clinical Manifestation of Asph,Apgar Scoring System,A,P,G,A,R,Apgar Scoring SystemSign0 Poi,The Significance of Apgar Score,Apgar 810, normal; 47, mild asphyxia; 03, severe asphyxia Assigned
9、 at 1, 5, and 10 min, until score of 7 or more 1 score indicate the severity and guide for resuscitation 5 score and later is more predictive of prognosis Premature infants intend to have lower scores,The Significance of Apgar Scor,Clinical Manifestation of Asphyxia,Multiorgan System Dysfunction Ren
10、al compromise: oliguria and elevated creatinineHypoxic cardiomyopathy (ECHO or ECG abnormality)Hypoxic ischemic encephalopathy (HIE)Pulmonary complications: respiratory distress (RDS), persistent pulmonary hypertension (PPHN)Disseminated intravascular coagulation (DIC)Hepatic failure, hyperbilirubin
11、emiaNecrotising enterocolitis (NEC), stress ulcer Fluid overload, hyperkalemia, hypoglycemia, and acidosis,Clinical Manifestation of Asph,American Heart Association-American Academy of Pediatrics Approach to Resuscitation,Infant with an Apgar Score of 7 or more generally do not require resuscitation
12、 a brief period of oxygen blown over the face oxygen increases pulmonary 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,American Heart Association
13、-Ame,American 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 adequate to sustain further steps depend on the response to ventilation Infant with a
14、n 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,American Heart Association-Ame,Resuscitation the ABCDE Protocol,Air way Breathing Circulation Drugs Evaluation & Enviroment,Resuscitation the ABCDE Prot,Advance
15、d LifeSupport (ALS),The Neonatal ResuscitationGuidelines,Pediatrics, 2000,Advanced LifeSupport (ALS)Th,Neonatal Resuscitation Medications,Neonatal Resuscitation Medicat,Post-resuscitation Issues and More,Continuing Care of the Newly Born Infant supportive or ongoing care monitoring appropriate diagnostic evaluation Documentation of Resuscitation Continuing Care of the Family Ethics: Noninitiation of Resuscitation Discontinuation of Resuscitation,To save, or not to save,?,Post-resuscitation Issues and,Advanced life support, Your support!,Thank you!,Advanced life support, Thank,
