1、Dept. of Pediatrics,Tongji Hospital, HUSTDefinition of Perinatal Definition of Perinatal AsphyxiaAsphyxiaHypoxemia, Hypercapnia, metabolic acidosisDept. of Pediatrics,Tongji Hospital, HUSTEtiologyEtiologyRisk Factors-MaternalDept. of Pediatrics,Tongji Hospital, HUST Risk Factors-Fetalaryngo- pharynx
2、 malformation, lung hypoplasia, heart diseaseFAmniotic fluid or meconium aspirationDept. of Pediatrics,Tongji Hospital, HUST Risk Factors-Intrapartumbreech extraction, vacuum extraction analgesic and oxytocic medicineDept. of Pediatrics,Tongji Hospital, HUSTPathophysiologyPathophysiologyDept. of Ped
3、iatrics,Tongji Hospital, HUSTClinical ManifestationClinical ManifestationDept. of Pediatrics,Tongji Hospital, HUSTSign0 Points1 Point2 PointsActivity (muscle tone)absentarms and legs flexedactive movementPulse (heart rate)absentbelow 100 bumabove 100 bumGrimace (reflex irritability)no responsegrimac
4、esneeze,cough, pulls awayAppearance (skin color)blue-gray, pale all overnormal, /-extremitiesnormal over entire bodyRespirationabsentslow, irregulargood, cryingAPGARDept. of Pediatrics,Tongji Hospital, HUST Apgar 810, normal; 47, mild asphyxia; 03, severe asphyxia Assigned at 1, 5, and 10 min, until
5、 score up to 7 1 score indicate the severity of asphyxia and guide for resuscitationscore at 5 and later is more predictive to prognosis Premature infants intend to have lower scores 0 low Apgar scores may leaded by: asphyxia, drugs, trauma, hypovolemia, infection or anomaliesDept. of Pediatrics,Ton
6、gji Hospital, HUSTfeed intoleranceDept. of Pediatrics,Tongji Hospital, HUST Blood gas ( pH、PaO2、PaCO2 ） Serum sugar, electrolyte（Calcium 、Natrium） Serum: BUN, Cr, DIC-coagulation profile, ALT Head image (Ultrasonic, CT, MRI) Chest X-ray ECGExaminationExaminationDept. of Pediatrics,Tongji Hospital, H
7、USTThe assessment of asphyxia should combine: A history of maternal and intrapartum risk factors Apgar score at 1, 5 (0 to 3 for longer than 5 minutes) Scalp pH (7), or umbilical arterial blood gas Clinical manifestation: neurological status for HIE grading; features of organ injure Examination (ass
8、essment of organ dysfunction)DiagnosisDiagnosisDept. of Pediatrics,Tongji Hospital, HUSTTreatmentTreatmentAim: first correcting the original hypoxia second alleviating tissue ischemia maintaining or restoring cerebral perfusionManagement of organ dysfunctionsManagements: A continous supply of both o
9、xygen and glucose; Normalizing blood pressure, volume expansion, pressor agents, sodium bicarbonate Careful fluid and electrolyte monitoring Dept. of Pediatrics,Tongji Hospital, HUSTResuscitationResuscitationPrinciples: Attendance of neonatal staff during all high-risk deliveries Need of resuscitati
10、on depends on the signs of respiration, heart rate, color Processes : evaluation decision management reassess (new circle) Method: ABCDE protocolDept. of Pediatrics,Tongji Hospital, HUSTGuidelines to ResuscitationGuidelines to Resuscitation Infant with an Apgar Score of 7 or more generally do not re
11、quire resuscitation a brief period of oxygen blown over the face oxygen increases pulmonary blood flow avoid excessive suctioning of amniotic 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 ventilationDept.
12、 of Pediatrics,Tongji Hospital, HUST Infant with an Apgar Score of 1 to 3 resuscitation commenced without delay usually require intubation and chest expansion further steps depend on the response to ventilation Infant with an Apgar Score of 0 no live born infant should be assigned a score of 0 resus
13、citation should proceed as for a score of 1 immediately cardiac compression Dept. of Pediatrics,Tongji Hospital, HUSTResuscitation the ABCDE Resuscitation the ABCDE ProtocolProtocol Air way Breathing Circulation Drugs Evaluation & EnvironmentDept. of Pediatrics,Tongji Hospital, HUSTAdvanced Advanced
14、 LifeLifeSupport (ALS)Support (ALS)The Neonatal ResuscitationGuidelinesPediatrics, 2000Dept. of Pediatrics,Tongji Hospital, HUSTNeonatal Resuscitation Neonatal Resuscitation MedicationsMedicationsMedicationConcentration to AdministerPreparationDosage & RouteRate & Precautions Epinephrine1:10,000 (0.
15、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, saline, Ringers lactateVaries10 ml/kg IVGive over 5-10 minutes. Repeat as needed.Sodium Bicarbonate0.5 me/ml (4.2% solution)20 ml or two 10 ml profiled syringes2 me/kg (4 ml/kg) IVG
16、ive slowly, over at least 2 minutes, may repeat every 10 minutes. Ventilate infant. Arcane (Saloon)0.4 mg/ml1 ml0.1 mg/kg (0.25ml/kg) IV, IM, SQ, ITGive rapidly.Calcium Glaciate100 mg/ml (10% solution, 0.465 me/ml)10 ml100 mg/kg (1 ml/kg) IVGive over 3-5 minutes, may repeat every 15 min. Do not mix
17、with sodium bicarbonate in line. Dept. of Pediatrics,Tongji Hospital, HUSTPost-resuscitation Issues and MorePost-resuscitation Issues and More Continuing Care of the Newly Born Infant supportive or ongoing care monitoring appropriate diagnostic evaluation Documentation of Resuscitation Continuing Ca
18、re of the Family Ethics: No initiation of Resuscitation Discontinuation of Resuscitation To save, or not to save?Dept. of Pediatrics,Tongji Hospital, HUST Prevent heat loss: Neutral thermal enviroment， maintain body temperature in 37 Oxygen supply：PaO2 6080mmHg for term infant, 5060mmHg for preterm
19、infant，normal level of PaCO2 Correcting acidosis: ventilation, infusion of NaHCO3 Normalizing the systemic perfusion: extension of volume, Dopamine 5 20/(kg.min) Supportive care: monitoring electrolyte, fluid infusion 6080ml/kg.d or depend on urine V.Other managementDept. of Pediatrics,Tongji Hospit
20、al, HUSTPrognosisPrognosisNo single factor may predict mortality or CNS abnormality with absolute certainty. Apgar score: 0-3, morbidity 5% at 1 and 53% at 20 0-3, cerebral palsy 1% at 5, 9% at 15, 57% at 20 Time to sustained spontaneous respiration Cord blood gas: pH7.05 may indicate a bad results
21、with increasing incidence of death and seizures Gestation age Dept. of Pediatrics,Tongji Hospital, HUSTYou should be able to :Definition of neonatal asphyxiaAppreciate the importance of neonatal asphyxiaList the dangers (risk factors) of hypoxia. List which infants are likely to need resuscitation at birthResuscitate an infant Dept. of Pediatrics,Tongji Hospital, HUST
