新生兒學-新生兒窒息(英文)

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