1、新生儿窒息Asphyxia of the NewbornDr. Xiaoping LuoProfessor and ChairmanDepartment of PediatricsTongji HospitalTongji Medical CollegeThe 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
2、 spent in utero. The most trying ordeal a human being sustains is the ordeal of birth. Asphyxia Neonatorum: Causation and TreatmentProfessor of Obstetrics, Northwestern University Medical SchoolJos. B. De Lee Published in Medicine (Detroit) 3:643-660, 1897.Definition of Perinatal Asphyxiaa condition
3、 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, M
4、ixed acidosis, Organic failureRisk Factors-MaternalFSystemic disease: diabetes, heart or renal diseases, anemia, infectious diseases FObstetric Conditions: hypertensive disease of pregnancy or pre-eclampsia, placental abruptionFSubstance abuse: drug addiction, smokingFMaternal age: 35, or 16, multip
5、le pregnancyRisk Factors-FetalFPremature, SGA, macrosomiaFCongenital malformation: nose and laryngo- pharynx malformation, lung hypoplasia, heart diseaseFAmniotic fluid or meconium aspirationFIntrauterine infection: Torch syndromeRisk Factors-IntrapartumFUmbilical cord: obstructionFObstetric procedu
6、res: forceps delivery, breech extraction, vacuum extraction FMedication: analgesic and oxytocic medicinePathophysiology of AsphysiaFRespiratory Alteration:primary hyperpnea, primary apnea, secondary apnea FHypoxic-ischemic Changes of Multi-organic system:“diving reflex”, inter-organ shunting, organ
7、failure FBiochemical and metabolic Consequences:acidosis, hyper- or hypoglycemia, hypocalcemia, hyperbilirubinemia, hyperkalemia, hyponatremiaClinical Manifestation of AsphysiaFApgar Scoring SystemApgar Scoring SystemSign 0 Points 1 Point 2 PointsActivity (muscle tone)absent arms and legs flexedacti
8、ve movementPulse (heart rate)absent below 100 bpmabove 100 bpmGrimace (reflex irritability)no response grimace sneeze,cough,pulls awayAppearance (skin color)blue-gray, pale all overnormal, /-extremitiesnormal over entire bodyRespiration absent slow, irregulargood, cryingAPGARThe Significance of Apgar ScoreF Apgar 810, normal; 47, mild asphyxia; 03, severe asphyxia F Assigned at 1, 5, and 10 min, until score of 7 or moreF 1 score indicate the severity and guide for resuscitationF 5 score and later is more predictive of prognosisF Premature infants intend to have lower scores
