新生儿窒息(英文）.ppt

新生儿窒息Asphyxia of the Newborn 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. 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 The Significance of Apgar Score 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, hyperbi