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文檔簡介
Neonatology:
AsphyxiaofTheNewborns
atbirthLecturePointsClinicaldefinitionandEpidemiology:incidence/mortalityEtiologyandPathophysiologyApgar’sscoresignificanceofclinicalusereevaluationofthescoreResuscitationComplicationandprognosisClinicalDefinition/EpidemiologyClinicaldefinitionFailuretoinitiaterespirationno/irregularbreathingwithhypoxemiaandacidosisIncidence:6-10‰inlivebirthMortality:leadingdeathinneonatesaccountfor1/3inneonatesdeathEtiologyMaternal:Systematicdiseaseshypertension/hypoxiaObstetric/pregnantcomplicationAddictionAgeatpregnancy/multiplepregnancyEtiologyIntrapartumAbnormalumbilicalcordAbnormalfetalpositionProcedure:ForcepsMedication:narcotic,SedativesEtiologyFetusPremature,SGA,LGA,MacrosomiaVariousabnormalityIntrauterineaspirationNervesinjuryPathophysiologyHypoxic/Ischemia
Organ/systeminjuryHypoxemia/acidosis
O2,CO2ExchangeObstacle
Failuretoinitiate
breath
Pathophysiology
repirationchangeHR
HRstopPrimaryapneaSecondaryapneaSystem/organIschemia/hypoxicBiochemical/metabolism________
Hypoxemia,acidosisOrgan/systemdamageBloodredistribution:compensationdecompensationCatecholamine
Glucagon
Freefattyacids
ANP
PCO2AcidosisHyperglycemiaHypoglycemiaHypocalcemiaHyponatremiaApgarScoringSystemSCORE012HeartrateAbsent<100/min>100/minRespirationsAbsentSlow,irregularGood,cryingMuscletoneLimpSomemotionActivemotionReflexirritabilityNoresponseGrimaceCough,sneeze,cryColorBlue,paleBodypink,bluelimbsCompletelypinkApgarScoringSystemApgarScoreMethods:at1and5min.postbirth till>7min.or20min.afterbirthClinicalManifestationFetaldistress:Fetalmotion
ornoFetalHRorMeconium-stainedamnioticfluidApgarScore<3at1or5min.:severe4-7at1or5min.:
slightReevaluationofApgarScoreDoesApgarScorereflect:AccuracyofPredictthedeathTheseverityofperinatalhypoxicTheprocessandseverityofintrauterinefetalhypoxicFacts:ThesubjectivityofthescoringandexperiencebasedLowscoringalwaysforprematuresAmericanAcademyofPediatrtics,AmericanCollegeofObstetriciansandGynecologists.Pediatrics1996,98:141-2
InconsistentoftheApgarscorewithbraindamageIflowerscoreat5min.,>4at10min.BrainDamageonly1%inchildrenat7yearsoldInbraindamagedchildren75%werenormalforApgarscore.ReevaluationofApgarScoreAmericanAcademyofPediatrtics,AmericanCollegeofObstetriciansandGynecologists.Pediatrics1996,98:141-2
Therelevancetotheoutcomeofasphyxiawithsurvivalandsystem/organfunctionUmbilicalartery
PH<7.00BE:-20mEq/LPapileLA.TheApgarscoreinthe21stcentury.NEnglJMed2001;344:519-20ReevaluationofApgarScoreNRP5thedition2010NRP2010流程圖提供保溫,清理氣道prn拭干全身,給予刺激否HR<100,呼吸暫?;虼雍粑??呼吸困難或持續(xù)紫紺30秒PPVSpO2監(jiān)測否否是清理氣道SpO2監(jiān)測考慮CPAP60秒是否足月?有呼吸或哭聲?肌張力好?常規(guī)醫(yī)護保持體溫清理氣道(prn)拭干是,母嬰同室出生新生兒復蘇2010版流程分解HR<100?糾正通氣步驟HR<60?否是考慮氣管插管胸外按壓,與PPV配合HR<60?糾正通氣步驟如胸廓抬舉不好考慮插管給予腎上腺素否是考慮低血容量氣胸復蘇后護理新生兒復蘇2010版流程分解否OxygenConcentrationforPPVGuidelineSupplementaryoxygenisrecommendedwheneverpositive-pressureventilationisindicatedforresuscitation.Thereisinsufficientevidencetospecifytheconcentrationofoxygentobeusedattheinitiationofresuscitation.100%-standardapproach<100%-acceptablealternative21%-acceptablealternativeMeconium-stainedfluidSuctionwhenMeconiumpresentMeconium
present?Babyvigorous?SuctionmouthandtracheaContinuowithremainderofinitialstepsClearmouthandnosesecretionDry,stimulateandrepositonRespirationeffortHR>100bpmGoodmuscletoneNoYesYesNoSuctioningMeconiumEpinephrineforBradycardiaGuidelineIntravenousadministrationofepinephrine0.01–0.03mg/kg/doseisthepreferredroute(ClassIIa).Whileaccessisbeingobtained,administrationofahigherdose(upto0.1mg/kg)throughtheendotrachealtubemaybeconsidered.NeonatalResuscitation5theditionSpO2Monitoring:Onceper30Sec.To95%fornewabornbaby:10min.Premature:UseBlendandOxygenairAdjusttheoxygenairtoSpO2near90%InternationalLiaisonCommitteeonResuscitation.Part13:Neonatalresuscitationguidelines.
Circulation2005:112(24,Suppl):IV188-IV195ResuscitationtechnologySuction:beginningfromOralthenNasalResuscitationtechnologyTactilestimulation:TaptheplantarResuscitationtechnologyTactilestimulation:RubbertheBackResuscitationtechnologyO2
supplyvia
PPVbagResuscitationtechnologyChestcompress:ResuscitationtechnologyEndotrachealintubation:Method:bynasalorbyoralIndication:MeconiumaspirationNormalSaO2only
maintainedbyPPVSerioushypoxemiaPersistentirregularbreathingResuscitationtechnologyEndotrachealintubationbyoral:ResuscitationtechnologyEndotrachealintubation:VocalandTrachealResuscitationtechnologyMonitoringpostresuscitationTemp,Respiration,HRBP,UrinevolumeSkincolorCNSsignsAcidbase,Balanceofelectrolytes,InfectionAmericanAcademyofPediatrtics,AmericanCollegeofObstetriciansandGynecologists.Pediatrics1996,98:141-2
IndicationsofpooroutcomeorCNSdam
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