新生兒窒息ppt課件

1、新生兒窒息新生兒窒息Asphyxia of the NewbornDr. 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 birth. . It is said that the most important period of the life of a human being is th

2、e time spent in utero. The most trying ordeal a human being sustains is the ordeal of birth. Asphyxia Neonatorum: Causation and TreatmentProfessor of Obstetrics, Northwestern University Medical SchoolJos. B. De LeePublished in Medicine (Detroit) 3:643-660, 1897.Definition of Perinatal AsphyxiaHypoxe

3、mia, Hypercapnia, Mixed acidosis, Organic failureRisk Factors-MaternalRisk Factors-FetalRisk Factors-IntrapartumPathophysiology of AsphysiaF hyperbilirubinemia, hyperkalemia, hyponatremiaClinical Manifestation of AsphysiaSign0 Points1 Point2 PointsActivity (muscle tone)absentarms and legs flexedacti

4、ve movementPulse (heart rate)absentbelow 100 bpmabove 100 bpmGrimace (reflex irritability)no responsegrimacesneeze,cough, pulls awayAppearance (skin color)blue-gray, pale all overnormal, /-extremitiesnormal over entire bodyRespirationabsentslow, irregulargood, cryingAPGARF Apgar 810, normal; F 47, m

5、ild asphyxia; F 03, severe asphyxia F Assigned at 1, 5, and 10 min, until score of 7 or moreF 1 score indicate the severity and guide for resuscitationF 5 score and later is more predictive of prognosisF Premature infants intend to have lower scores Clinical Manifestation of AsphyxiaF Disseminated i

6、ntravascular coagulation (DIC)F Hepatic failure, hyperbilirubinemiaF Necrotising enterocolitis (NEC), stress ulcer F Fluid overload, hyperkalemia, hypoglycemia, and acidosisAmerican Heart Association-American Academy of Pediatrics Approach to ResuscitationF Infant with an Apgar Score of 7 or moreF g

7、enerally do not require resuscitationF a brief period of oxygen blown over the faceF oxygen increases pulmonary blood flowF avoid excessive suctioning of clear fluidF Infant with an Apgar Score of 4 to 6F stimulationF administration of oxygen by face mask, or bagF empty the stomach when using bag or

8、 mask ventilationAmerican Heart Association-American Academy of Pediatrics Approach to ResuscitationF Infant with an Apgar Score of 1 to 3F usually require intubation and expansion of the lungF bag and mask ventilation usually is adequate to sustainF further steps depend on the response to ventilati

9、onF Infant with an Apgar Score of 0F no live born infant should be assigned a score of 0F resuscitation should proceed as for a score of 1F cardiac compressionResuscitation the ABCDE Protocol Air way Breathing Circulation Drugs Evaluation & EnviromentAdvanced LifeSupport (ALS)The Neonatal Resusc

10、itationGuidelinesPediatrics, 2000Neonatal Resuscitation MedicationsMedicationConcentration to AdministerPreparationDosage & RouteRate & Precautions Epinephrine1:10,000 (0.1 mg/l)1 ml0.1-0.3 ml/kg IV or ITGive rapidly, may repeat every 5-10 minutes. Volume Expanderswhole blood, 5% albumin, sa

11、line, Ringers lactateVaries10 ml/kg IVGive over 5-10 minutes. Repeat as needed.Sodium Bicarbonate0.5 meq/ml (4.2% solution)20 ml or two 10 ml prefilled syringes2 meq/kg (4 ml/kg) IVGive slowly, over at least 2 minutes, may repeat every 10 minutes. Ventilate infant. Narcan (Naloxone)0.4 mg/ml1 ml0.1

12、mg/kg (0.25ml/kg) IV, IM, SQ, ITGive rapidly.Calcium Gluconate100 mg/ml (10% solution, 0.465 mEq/ml)10 ml100 mg/kg (1 ml/kg) IVGive over 3-5 minutes, may repeat every 15 min. Do not mix with sodium bicarbonate in line. Post-resuscitation Issues and MoreF Continuing Care of the Newly Born Infant F supportive or ongoing careF monitoringF appropriate diagnostic evaluation F Documentation of Resuscitation F Continuing Care of the Famil