儿童保健.ppt

新生儿窒息 Asphyxia of the Newborn,Dr. Xiaoping Luo Professor and Chairman Department of Pediatrics Tongji Hospital Tongji 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 time spent in utero. The most trying ordeal a human being sustains is the ordeal of birth.,Asphyxia Neonatorum: Causation and Treatment,Professor of Obstetrics, Northwestern University Medical School,Jos. B. De Lee,Published in Medicine (Detroit) 3:643-660, 1897.,Definition of Perinatal Asphyxia,a condition in the neonate where there is the following combination: An event or condition during the perinatal period that is likely to severely reduce oxygen delivery and lead to acidosis; AND A failure of function of at least two organs consistent with the effects of acute asphyxia.,Hypoxemia, Hypercapnia, Mixed acidosis, Organic failure,Risk Factors-Maternal,Systemic disease: diabetes, heart or renal diseases, anemia, infectious diseases Obstetric Conditions: hypertensive disease of pregnancy or pre-eclampsia, placental abruption Substance abuse: drug addiction, smoking Maternal age: 35, or 16, multiple pregnancy,Risk Factors-Fetal,Premature, SGA, macrosomia Congenital malformation: nose and laryngo- pharynx malformation, lung hypoplasia, heart disease Amniotic fluid or meconium aspiration Intrauterine infection: Torch syndrome,Risk Factors-Intrapartum,Umbilical cord: obstruction Obstetric procedures: forceps delivery, breech extraction, vacuum extraction Medication: analgesic and oxytocic medicine,Pathophysiology of Asphysia,Respiratory Alteration: primary hyperpnea, primary apnea, secondary apnea Hypoxic-ischemic Changes of Multi-organic system: “diving reflex”, inter-organ shunting, organ failure Biochemical and metabolic Consequences: acidosis, hyper- or hypoglycemia, hypocalcemia, hyperbilirubinemia, hyperkalemia, hyponatremia,Clinical Manifestation of Asphysia,Apgar Scoring System,Apgar Scoring System,A,P,G,A,R,The Significance of Apgar Score,Apgar 810, normal; 47, mild asphyxia; 03, severe asphyxia Assigned at 1, 5, and 10 min, until score of 7 or more 1 score indicate the severity and guide for resuscitation 5 score and later is more predictive of prognosis Premature infants intend to have lower scores,Clinical Manifestation of Asphyxia,Multiorgan System Dysfunction Renal compromise: oliguria and elevated creatinine 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 Necrotising enterocolitis (NEC), stress ulcer Fluid overload, hyperkalemia, hypoglycemia, and acidosis,American Heart Association-American Academy of Pediatrics Approach 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 clear 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,American Heart Association-American Academy of Pediatrics Approach to Resuscitation,Infant 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 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 cardiac compression,Resuscitation the ABCDE Protocol,Air way Breathing Circulation Drugs Evaluation & Enviroment,Advanced Life Support (ALS),The Neonatal Resuscitation Guidelines,Pediatrics, 2000,Neonatal Resuscitation Medications,Post-resuscitation Issues and More,Continuing Care of the Newly Born Infant supportive or ongoing care monitoring appropriate diagnostic evalu