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 more1 score indicate the severity and guide for resuscitation5 score and later is more predictive of prognosisPremature 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 moregenerally do not require resuscitationa brief period of oxygen blown over the faceoxygen increases pulmonary blood flowavoid excessive suctioning of clear fluidInfant with an Apgar Score of 4 to 6stimulationadministration of oxygen by face mask, or bagempty 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 3usually require intubation and expansion of the lungbag and mask ventilation usually is adequate to sustainfurther steps depend on the response to ventilationInfant with an Apgar Score of 0no live born infant should be assigned a score of 0resuscitation should proceed as for a score of 1cardiac compression,Resuscitation the ABCDE Protocol,Air wayBreathingCirculationDrugsEvaluation & 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 caremonitoringappropriate diagnostic evaluation Documentation of Resuscitation Continuing Care of the Family Ethics: Noninitiation of Resuscitation Discontinuation of Resuscitation,To save, or not to save,?,Advanced life support, Your support!,Thank you!,