1 / 38

Neonatology: Asphyxia of The Newborns at birth

Neonatology: Asphyxia of The Newborns at birth. Lecture Points. Clinical definition and Epidemiology: incidence/mortality Etiology and Pathophysiology Apgar’s score significance of clinical use reevaluation of the score Resuscitation Complication and prognosis.

heath
Télécharger la présentation

Neonatology: Asphyxia of The Newborns at birth

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Neonatology: Asphyxia of The Newborns at birth

  2. Lecture Points • Clinical definition and Epidemiology: incidence/mortality • Etiology and Pathophysiology • Apgar’s score significance of clinical use reevaluation of the score • Resuscitation • Complication and prognosis

  3. Clinical Definition/Epidemiology • Clinical definition Failure to initiate respiration no / irregular breathing with hypoxemia and acidosis • Incidence : 6-10%, in live birth • Mortality: leading death in neonates account for 1/3 in neonates death

  4. Etiology Maternal： • Systematic diseases hypertension/hypoxia • Obstetric/pregnant complication • Addiction • Age at pregnancy/multiple pregnancy

  5. Etiology Intrapartum • Abnormal umbilical cord • Abnormal fetal position • Procedure: Forceps • Medication：narcotic，Sedatives

  6. Etiology Fetus • Premature, SGA, LGA, Macrosomia • Various abnormality • Intrauterine aspiration • Nerves injury

  7. Pathophysiology Hypoxic/ Ischemia  Failure to initiatebreath  O2, CO2 Exchange Obstacle  Hypoxemia/acidosis  Organ/system injury

  8. repiration change HR  stop HR Primary apnea Secondary apnea ________  System/organ Ischemia/hypoxic Biochemical/metabolism Hypoxemia, acidosis Catecholamine Glucagon Free fatty acids ANP PCO2  Acidosis Hyperglycemia Hypoglycemia Hypocalcemia Hyponatremia Blood redistribution: compensation decompensation Organ/system damage Pathophysiology

  9. Apgar Scoring System

  10. Apgar Scoring System • Apgar Score • Methods: at 1 and 5 min. post birth till >7 min. or 20 min. after birth

  11. Clinical Manifestation • Fetal distress： • Fetal motion or no • Fetal HR or • Meconium-stained amniotic fluid • Apgar Score • <3 at 1 or 5 min. : severe • 4-7 at 1 or 5 min. :slight

  12. Reevaluation of Apgar Score Does Apgar Score reflect: • Accuracy of Predict the death • The severity of perinatal hypoxic • The process and severity of intrauterine fetal hypoxic Facts: • The subjectivity of the scoring and experience based • Low scoring always for prematures American Academy of Pediatrtics, American College of Obstetricians and Gynecologists. Pediatrics 1996,98:141-2

  13. Reevaluation of Apgar Score Inconsistent of the Apgar score with brain damage • If lower score at 5 min. , >4 at 10 min. • Brain Damage only 1% in children at 7 years old • In brain damaged children 75% were normal for Apgar score. American Academy of Pediatrtics, American College of Obstetricians and Gynecologists. Pediatrics 1996,98:141-2

  14. Reevaluation of Apgar Score The relevance to the outcome of asphyxia with survival and system/organ function • Umbilical arteryPH＜7.00 • BE: -20mEq/L Papile LA. The Apgar score in the 21st century. N Engl J Med 2001;344:519-20

  15. NRP 5th edition 2006 • 2006: 5th edition; • Suction when • Meconium present • Resuscitation with • oxygen or room air • Epinaphrine for • bradycardia or cardiac • arrest

  16. NRP 5th edition 2006

  17. Neonatal Resuscitation 5th edition Birth • Routine care • Provide warmth • Clear airway • Dry • Assess color • Term gestation ？ • Clear amniotic fluid？ • Breathing or crying？ • Good muscle tone？ yes No

  18. Neonatal Resuscitation 5th edition No • Provide warmth • Position， Clear airwayEIT (if necessary) • Dry，stimulate • Reposition • Evaluate respiration， • HR and color Breathing Observational care 30s HR>100 and pink Cyanosis Apnea Or HR<100 Pink • Give supplemental • oxygen Persistent cyanosis

  19. Neonatal Resuscitation 5th edition • Positive pressure ventilation EIT • Administer chest compressions EIT Apnea Or HR<100 Persistent cyanosis Effective ventilation Post resuscitation care Positive pressure EIT ventilation HR>100 and pink 30s HR<60 HR>60 HR<60 30s Administer epinephrine EIT

  20. Oxygen Concentration for PPV 2006 Guideline • Supplementary oxygen is recommended whenever positive-pressure ventilation is indicated for resuscitation. • There is insufficient evidence to specify the concentration of oxygen to be used at the initiation of resuscitation. • 100% - standard approach • < 100% - acceptable alternative • 21% - acceptable alternative

  21. Meconium-stained fluid

  22. Suction when Meconium present Meconiumpresent? Yes No Baby vigorous ? No Yes • Respiration effort • HR>100 bpm • Good muscle tone Suction mouth and trachea • Continuo with remainder of initial steps • Clear mouth and nose secretion • Dry, stimulate and repositon

  23. Suctioning Meconium

  24. Epinephrine for Bradycardia 2006 Guideline • Intravenous administration of epinephrine 0.01 – 0.03 mg/kg/dose is the preferred route (Class IIa). • While access is being obtained, administration of a higher dose (up to 0.1 mg/kg) through the endotracheal tube may be considered.

  25. Neonatal Resuscitation 5th edition SpO2 Monitoring: • Once per 30Sec. • To 95% for new a born baby: 10 min. • Premature: • Use Blend and Oxygen air • Adjust the oxygen air to SpO2 near 90% International Liaison Committee on Resuscitation.Part 13: Neonatal resuscitation guidelines.Circulation 2005:112(24, Suppl):IV188-IV195

  26. Resuscitation technology Suction：beginning from Oral then Nasal

  27. Resuscitation technology • Tactile stimulation：Tap the plantar

  28. Resuscitation technology • Tactile stimulation：Rubber the Back

  29. Resuscitation technology • O2supply viaPPV bag

  30. Resuscitation technology Chest compress:

  31. Resuscitation technology Endotracheal intubation： • Method：by nasal or by oral • Indication： • Meconium aspiration • Normal SaO2 onlymaintained by PPV • Serious hypoxemia • Persistent irregular breathing

  32. Resuscitation technology Endotracheal intubation by oral：

  33. Resuscitation technology Endotracheal intubation: Vocal and Tracheal

  34. Resuscitation technology Monitoring post resuscitation • Temp, Respiration, HR • BP, Urine volume • Skin color • CNS signs • Acid base, Balance of electrolytes, Infection

  35. Prognosis • Indications of poor outcome or CNS damage • Umbilical artery showed severe acidosis • (PH <7.00) • Apgar score 0-3 persists over 5 min. • Manifesting signs of acute CNS damage • (convulsion) • MODS>3 American Academy of Pediatrtics, American College of Obstetricians and Gynecologists. Pediatrics 1996,98:141-2

  36. Prevention of Asphyxia • Antenatal care • To avoid premature delivering and obstetric procedure (forceps) • Monitoring high risk prehnent • Pre and post born preparations and adequate care

  37. Summary • The importance of early detection and recognition of the fetal distress • Pathophysiological Changes of the asphyxia • Use and reevaluation of the Apgar’s score • Main procedure of the delivery resuscitation (New guideline and ABCs sequence) • Prognosis

  38. Thanks and questions?

More Related