1、新生儿窒息新生儿窒息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 the ti
2、me 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 AsphyxiaHypoxemia,Hypercapn
3、ia,Mixed acidosis,Organic failureRisk Factors-MaternalRisk Factors-Fetalaryngo-pharynx malformation,lung hypoplasia,heart diseaseF Amniotic fluid or meconium aspirationRisk Factors-Intrapartumbreech extraction,vacuum extraction analgesic and oxytocic medicinePathophysiology of AsphysiaClinical Manif
4、estation of AsphysiaSign0 Points1 Point2 PointsActivity(muscle tone)absentarms and legs flexedactive movementPulse(heart rate)absentbelow 100 bpmabove 100 bpmGrimace(reflex irritability)no responsegrimacesneeze,cough,pulls awayAppearance(skin color)blue-gray,pale all overnormal,/-extremitiesnormal o
5、ver entire bodyRespirationabsentslow,irregulargood,cryingAPGARF Apgar 810,normal;47,mild asphyxia;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
6、intend to have lower scores Clinical Manifestation of Asphyxiastress ulcerAmerican Heart Association-American Academy of Pediatrics Approach to ResuscitationF Infant with an Apgar Score of 7 or more generally do not require resuscitation a brief period of oxygen blown over the face oxygen increases
7、pulmonary blood flow avoid excessive suctioning of clear fluidF 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 ventilationAmerican Heart Association-American Academy of Pediatrics Approach to ResuscitationF Infan
8、t with an Apgar Score of 1 to 3 usually require intubation and expansion of the lung bag and mask ventilation usually is adequate to sustain further steps depend on the response to ventilationF Infant with an Apgar Score of 0 no live born infant should be assigned a score of 0 resuscitation should p
9、roceed as for a score of 1 cardiac compressionResuscitation the ABCDE Protocol Air way Breathing Circulation Drugs Evaluation&EnviromentAdvanced LifeSupport(ALS)The Neonatal ResuscitationGuidelinesPediatrics,2000Neonatal Resuscitation MedicationsMedicationConcentration to AdministerPreparationDosage
10、&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,saline,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 p
11、refilled 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 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
12、every 15 min.Do not mix with sodium bicarbonate in line.Post-resuscitation Issues and MoreF Continuing Care of the Newly Born Infant supportive or ongoing care monitoring appropriate diagnostic evaluation F Documentation of Resuscitation F Continuing Care of the Family F Ethics:Noninitiation of Resuscitation Discontinuation of Resuscitation To save,or not to save?Advanced life support,Advanced life support,Your support!Your support!Thank you!Thank you!
