华中科技大学：《儿科学》课程PPT教学课件（讲稿）（英文版）新生儿窒息

新生儿窒息 Asphyxia of the Newborn Dr Xiaoping luo Professor and Chairman Department of pediatrics Tongji Hospital Tongji Medical College 爭屮斜技大字同濟鲁學 AZHONG UNIVERSITY OF SCIENCE AND TECHNOLOGY

新生儿窒息 Asphyxia of the Newborn Dr. Xiaoping Luo Professor and Chairman Department of Pediatrics Tongji Hospital Tongji Medical College

Asphyxia Neonatorum: Causation and treatment Professor of obstetrics, Northwestern University Medical School Jos. B De Lee Published in Medicine(Detroit) 3: 643-660, 1897 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

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

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 g Obstetric Conditions: hypertensive disease of pregnancy or pre-eclampsia, placental abruption Substance abuse: drug addiction, smoking P Maternal age: >35, or<16, multiple pregnancy

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 G Premature. SGA. macrosomia 9 Congenital malformation: nose and laryngo pharynx malformation, lung hypoplasia, heart disease Amniotic fluid or meconium aspiration 9 Intrauterine infection: Torch syndrome

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-ntrapartum e Umbilical cord: obstruction Obstetric procedures: forceps delivery breech extraction. vacuum extraction Medication: analgesic and oxytocic medicine

Risk Factors-Intrapartum  Umbilical cord: obstruction  Obstetric procedures: forceps delivery, breech extraction, vacuum extraction  Medication: analgesic and oxytocic medicine

Pathophysiology of Asphysia g Respiratory alteration: primary hyperpnea, primary apnea, secondary apnea Hypoxic-ischemic Changes of Multi-organic system diving reflex", inter-organ shunting, organ failure Biochemical and meta bolic Consequences acidosis, hyper-or hypoglycemia, hypocalcemia, hyperbilirubinemia, hyperkalemia, hyponatremia

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 Current Researches in Anesthesia and Analgesia-July-August, 1953 A Proposal for a New Method of Evaluation of the Newborn Infant.* Virginia apgar.D, New York, N.Y. Department of Anesthesiology, Columbia Univeraity, College of Physicians and Surgeons and the Anesthesia Service, The Presbyterian hospital \ ESUSCI TATION OF INFANTS at birth has been the bie cles there imaginative ideas, such enthusiasms, and dislikes, and such unscientific observations and study about one clinical picture, There are outstanding exceptions to these state ments, but the poor quality and lack of precise data of the majority of papers concerned with infant resuscitation are interesting

Clinical Manifestation of Asphysia  Apgar Scoring System

Apgar Scoring System Sign 0 Points 1 Point 2 Points Activity absent arms and active APG muscle tone legs flexed movement Pulse absent below 100 above 100 (heart rate) bpm bpm Grimace no response grimace sneeze, cough, (reflex irritability) pulls away A Appearance blue-gray, normal normal over (skin color) pale all over/-extremities entire body R Respiration absent slow good, crying irregular

Apgar Scoring System Sign 0 Points 1 Point 2 Points Activity (muscle tone) absent arms and legs flexed active movement Pulse (heart rate) absent below 100 bpm above 100 bpm Grimace (reflex irritability) no response grimace sneeze,cough, pulls away Appearance (skin color) blue-gray, pale all over normal, /-extremities normal over entire body Respiration absent slow, irregular good, crying A P G A R

The significance of Apgar Score G Apgar 8-10, normal; 4-7, mild asphyxia; 0-3, severe asphyxia Ce Assigned at 1, 5, and 10 min, until score of 7 or more G 1 score indicate the severity and guide for resuscitation g 5 score and later is more predictive of prognosis g Premature infants intend to have lower scores

The Significance of Apgar Score  Apgar 8~10, normal; 4~7, mild asphyxia; 0~3, 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