儿科学新生儿出生时窒息(英文)

Neonatology: Asphyxia of The Newborns at birth,Lecture Points,Clinical definition and Epidemiology: incidence/mortality Etiology and Pathophysiology Apgars score significance of clinical use reevaluation of the score Resuscitation Complication and prognosis,Clinical Definition/Epidemiology,Clinical definition Failure to initiate respiration no / irregular breathing with hypoxemia and acidosis Incidence : 6-10 in live birth Mortality: leading death in neonates account for 1/3 in neonates death,Etiology,Maternal： Systematic diseases hypertension/hypoxia Obstetric/pregnant complication Addiction Age at pregnancy/multiple pregnancy,Etiology,Intrapartum Abnormal umbilical cord Abnormal fetal position Procedure: Forceps Medication：narcotic，Sedatives,Etiology,Fetus Premature, SGA, LGA, Macrosomia Various abnormality Intrauterine aspiration Nerves injury,Pathophysiology,Hypoxic/ Ischemia ,Organ/system injury,Hypoxemia/acidosis ,O2, CO2 Exchange Obstacle ,Failure to initiate breath ,Pathophysiology,Apgar Scoring System,Apgar Scoring System,Apgar Score Methods: at 1 and 5 min. post birth till 7 min. or 20 min. after birth,Clinical Manifestation,Fetal distress： Fetal motion or no Fetal HR or Meconium-stained amniotic fluid,Apgar Score 3 at 1 or 5 min. : severe 4-7 at 1 or 5 min. : slight,Reevaluation of Apgar Score,Does Apgar Score reflect: Accuracy of Predict the death The severity of perinatal hypoxic The process and severity of intrauterine fetal hypoxic Facts: The subjectivity of the scoring and experience based Low scoring always for prematures,American Academy of Pediatrtics, American College of Obstetricians and Gynecologists. Pediatrics 1996,98:141-2,Inconsistent of the Apgar score with brain damage If lower score at 5 min. , 4 at 10 min. Brain Damage only 1% in children at 7 years old In brain damaged children 75% were normal for Apgar score.,Reevaluation of Apgar Score,American Academy of Pediatrtics, American College of Obstetricians and Gynecologists. Pediatrics 1996,98:141-2,The relevance to the outcome of asphyxia with survival and system/organ function Umbilical artery PH7.00 BE: -20mEq/L,Papile LA. The Apgar score in the 21st century. N Engl J Med 2001;344:519-20,Reevaluation of Apgar Score,NRP 5th edition 2010,NRP 2010流程图,提供保温，清理气道prn 拭干全身，给予刺激,否,HR100, 呼吸暂停或喘息样呼吸？,呼吸困难或持续紫绀,30秒,PPV SpO2监测,否,否,是,清理气道 SpO2监测 考虑CPAP,60秒,是否足月？ 有呼吸或哭声？ 肌张力好？,常规医护 保持体温 清理气道（prn) 拭干,是，母婴同室,出生,新生儿复苏2010版流程分解,新生儿复苏2010版流程分解,否,Oxygen Concentration for PPV,Guideline Supplementary oxygen is recommended whenever positive-pressure ventilation is indicated for resuscitation. There is insufficient evidence to specify the concentration of oxygen to be used at the initiation of resuscitation. 100% - standard approach 100% - acceptable alternative 21% - acceptable alternative,Meconium-stained fluid,Suction when Meconium present,Meconium present?,Baby vigorous ?,Suction mouth and trachea,Continuo with remainder of initial steps Clear mouth and nose secretion Dry, stimulate and repositon,Respiration effort HR100 bpm Good muscle tone,No,Yes,Yes,No,Suctioning Meconium,Epinephrine for Bradycardia,Guideline Intravenous administration of epinephrine 0.01 0.03 mg/kg/dose is the preferred route (Class IIa). While access is being obtained, administration of a higher dose (up to 0.1 mg/kg) through the endotracheal tube may be considered.,Neonatal Resuscitation 5th edition,SpO2 Monitoring: Once per 30Sec. To 95% for new a born baby: 10 min. Premature: Use Blend and Oxygen air Adjust the oxygen air to SpO2 near 90%,International Liaison Committee on Resuscitation.Part 13: Neonatal resuscitation guidelines. Circulation 2005:112(24, Suppl):IV188-IV195,Resuscitation technology,Suction：beginning from Oral then Nasal,Resuscitation technology,Tactile stimulation：Tap the plantar,Resuscitation technology,Tactile stimulation：Rubber the Back,Resuscitation technology,O2 supply via PPV bag,Resuscitation technology,Chest compress:,Resuscitation technology,Endotracheal intubation： Method：by nasal or by oral Indication： Meconium aspiration Normal SaO2 only maintained by PPV Serious hypoxemia Persistent irregular breathing,Resuscitation technology,Endotracheal intubation by oral：,Resuscitation technology,Endotracheal intubation: Vocal and Tracheal,Resuscitation technology,Monitoring post resuscitation Temp, Respiration, HR BP, Urine volume Skin color CNS signs Acid base, Balance of electrolytes, Infection,American Academy of Pediatrtics, American College of Obstetricians and Gynecologists. Pediatrics 1996,98:141-2,Indications of poor outcome or CNS damage Umbilical artery showed severe acidosis (PH 3,Prognosis,Prevention of Asphyxia,Antenatal care To avoid premature delivering and obstetric procedure (forceps) Monitoring high risk prehnent Pre and post born preparations and adequate care,Summary,The importance of early detection and recognition of the fetal distress Pathophysiological Changes of the asphyxia Use and re