1、 Neonatology:Asphyxia of The Newborns at birthLecture PointslClinical definition and Epidemiology:incidence/mortalitylEtiology and Pathophysiology lApgars score significance of clinical use reevaluation of the scorelResuscitation lComplication and prognosisClinical Definition/EpidemiologylClinical d
2、efinition Failure to initiate respiration no/irregular breathing with hypoxemia and acidosis lIncidence:6-10%,in live birthlMortality:leading death in neonates account for 1/3 in neonates deathEtiologyMaternal：Systematic diseases hypertension/hypoxia Obstetric/pregnant complication Addiction Age at
3、pregnancy/multiple pregnancyEtiologyIntrapartum Abnormal umbilical cord Abnormal fetal position Procedure:Forceps Medication：narcotic，SedativesEtiologyFetus Premature,SGA,LGA,Macrosomia Various abnormality Intrauterine aspiration Nerves injury Pathophysiology Hypoxic/Ischemia Organ/system injuryHypo
4、xemia/acidosis O2,CO2 Exchange Obstacle Failure to initiate breath Pathophysiology repiration changeHR HR stopPrimary apneaSecondary apneaSystem/organ Ischemia/hypoxicBiochemical/metabolism_ Hypoxemia,acidosisOrgan/system damageBlood redistribution:compensation decompensationCatecholamine Glucagon F
5、ree fatty acids ANP PCO2 AcidosisHyperglycemia HypoglycemiaHypocalcemiaHyponatremiaApgar Scoring SystemSCORE012Heart rateAbsent 100/minRespirationsAbsentSlow,irregularGood,cryingMuscle tone LimpSome motionActive motionReflex irritabilityNo responseGrimaceCough,sneeze,cryColorBlue,paleBody pink,blue
6、limbsCompletely pinkApgar Scoring System Apgar Score Methods:at 1 and 5 min.post birth till 7 min.or 20 min.after birthClinical Manifestation Fetal distress：Fetal motion or no Fetal HR or Meconium-stained amniotic fluid Apgar Score 4 at 10 min.Brain Damage only 1%in children at 7 years oldIn brain d
7、amaged children 75%were normal for Apgar score.Reevaluation of Apgar ScoreAmerican 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/LP
8、apile LA.The Apgar score in the 21st century.N Engl J Med 2001;344:519-20Reevaluation of Apgar ScoreNRP 5th edition 20062006:5th edition;Suction when Meconium present Resuscitation with oxygen or room air Epinaphrine for bradycardia or cardiac arrestNRP 5th edition 2006Neonatal Resuscitation 5th edi
9、tion Birth Term gestation？Clear amniotic fluid？Breathing or crying？Good muscle tone？yesNoRoutine carel Provide warmthl Clear airwayl Dryl Assess colorNeonatal Resuscitation 5th edition Provide warmth Position，Clear airway EIT (if necessary)l Dry，stimulatel RepositionNol Evaluate respiration，l HR and
10、 colorApnea Or HR100 and pinkCyanosis30s Persistent cyanosis PinkNeonatal Resuscitation 5th edition Positive pressure ventilation EIT Administer chest compressions EITHR60Administer epinephrine EIT HR100 and pinkPost resuscitationcarePersistent cyanosis HR60Apnea Or HR100Oxygen Concentration for PPV
11、2006 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 bpmGood muscle toneNoYesYesNoSuction
12、ing MeconiumEpinephrine for Bradycardia2006 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
13、 5th editionSpO2 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 tec
14、hnologySuction：beginning from Oral then Nasal Resuscitation technology Tactile stimulation：Tap the plantarResuscitation technology Tactile stimulation：Rubber the BackResuscitation technology O2 supply via PPV bag Resuscitation technologyChest compress:Resuscitation technologyEndotracheal intubation：
15、Method：by nasal or by oral Indication：Meconium aspiration Normal SaO2 only maintained by PPV Serious hypoxemia Persistent irregular breathingResuscitation technologyEndotracheal intubation by oral：Resuscitation technologyEndotracheal intubation:Vocal and TrachealResuscitation technologyMonitoring po
16、st resuscitation Temp,Respiration,HR BP,Urine volume Skin color CNS signs Acid base,Balance of electrolytes,InfectionAmerican Academy of Pediatrtics,American College of Obstetricians and Gynecologists.Pediatrics 1996,98:141-2Indications of poor outcome or CNS damage Umbilical artery showed severe ac
17、idosis(PH 3PrognosisPrevention of AsphyxiaAntenatal careTo avoid premature delivering and obstetric procedure(forceps)Monitoring high risk prehnentPre and post born preparations and adequate careSummary The importance of early detection and recognition of the fetal distress Pathophysiological Changes of the asphyxia Use and reevaluation of the Apgars score Main procedure of the delivery resuscitation (New guideline and ABCs sequence)Prognosis Thanks and questions?
