,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Dept.of Pediatrics,Tongji Hospital,HUST,Asphyxia of Newborn,新生儿窒息,Asphyxia of Newborn新生儿窒息,1,Definition of Perinatal Asphyxia,An event or condition during the perinatal period that is likely to severely impaired gas exchange and leads to three biochemical components:,AND,A failure of function of at least two organs.,Hypoxemia,Hypercapnia,metabolic acidosis,Definition of Perinatal Asphyx,2,Etiology,All factors leading to an interruption of oxygen supply,or blood flow to the fetus during perinatal period,(prenatal,intrapartum and postnatal),Risk Factors-Maternal,Systemic disease:,diabetes,heart or renal diseases,anemia,infectious diseases,Obstetric Conditions:,hypertension of pregnancy or pre-eclampsia,placental abruption,Substance abuse:,drug addiction,smoking,Age or other:,35y,or 160 bpm,late stage:,decreased movement,fetal heart rate 7,1 score indicate the severity of asphyxia and guide,for resuscitation,score 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 anomalies,The Significance of Apgar Scor,9,Multiorgan System Dysfunction,Renal compromise:oliguria and elevated creatinine,Acute tubular necrosis,Hypoxic cardiomyopathy(ECHO or ECG abnormality),Hypoxic ischemic encephalopathy(HIE),Pulmonary complications:respiratory distress(RDS),persistent pulmonary hypertension(PPHN),Disseminated intravascular coagulation(DIC),Hepatic failure,hyperbilirubinemia,Necrotizing enterocolitis(NEC),feed intolerance,Fluid overload,hyperkalemia,hypoglycemia,and acidosis,Multiorgan System DysfunctionR,10,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,ECG,Examination,Blood gas (pH、PaO2、PaCO2）,11,The,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(assessment of organ dysfunction),Diagnosis,The assessment of asphyxia sho,12,Treatment,Aim:,first correcting the original hypoxia,second alleviating tissue ischemia,maintaining or restoring cerebral perfusion,Management of organ dysfunctions,Managements:,A continous supply of both oxygen and glucose;,Normalizing blood pressure,volume expansion,pressor agents,sodium bicarbonate,Careful fluid and electrolyte monitoring,TreatmentAim:,13,Resuscitation,Principles:,Attendance of neonatal staff during,all,high-risk deliveries,Need of resuscitation depends on the signs of,respiration,heart rate,color,Processes:evaluation decision,management reassess(new circle),Method:ABCDE protocol,Resuscitation,14,Guidelines to Resuscitation,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 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 ventilation,Guidelines to Resuscitation In,15,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,resuscitation should proceed as for a score of 1,immediately cardiac compression,Infant with an Apgar Score of,16,Resuscitation the ABCDE Protocol,A,ir way,B,reathing,C,irculation,D,rugs,E,valuation&,Environment,Resuscitation the ABCDE Prot,17,Advanced LifeSupport(ALS),The Neonatal,Resuscitation,Guidelines,Pediatrics,2000,Advanced LifeSupport(ALS)Th,18,Neonatal Resuscitation Medications,Medication,Concentration to Administer,Preparation,Dosage&Route,Rate&Precautions,Epinephrine,1:10,000(0.1 mg/l),1 ml,0.1-0.3 ml/kg IV or IT,Give rapidly,may repeat every 5-10 minutes.,Volume Expanders,whole blood,5%albumin,saline,Ringers lactate,Varies,10 ml/kg IV,Give over 5-10 minutes.Repeat as needed.,Sodium Bicarbonate,0.5 me/ml(4.2%solution),20 ml or two 10 ml profiled syringes,2 me/kg,(4 ml/kg)IV,Give slowly,over at least 2 minutes,may repeat every 10 minutes.Ventilate infant.,Arcane(Saloon),0.4 mg/ml,1 ml,0.1 mg/kg(0.25ml/kg)IV,IM,SQ,IT,Give rapidly.,Calcium Glaciate,100 mg/ml(10%solution,0.465 me/ml),10 ml,100 mg/kg,(1 ml/kg)IV,Give over 3-5 minutes,may repeat every 15 min.Do not mix with sodium bicarbonate in line.,Neonatal Resuscitation Medicat,19,Post-resuscitation Issues and More,Continuing Care of the Newly Born Infant,supportive or ongoing care,monitoring,appropriate diagnostic evaluation,Documentation of Resuscitation,Continuing Care of the Family,Ethics:,No initiation of Resuscitation,Discontinuation of Resuscitation,To save,or,not to sa