《儿科学》HIE.pptVIP

Basic Concepts *is a kind of brain injuries in fetus and neonates due to hypoxia and decline of cerebral blood flow during perinatal period. *has characteristic pathophysiological process and nerve pathological changes. *has a series of clinical encephalo-pathy performances. *can leave nervous system sequelae. 1. Etiology 2. Pathogenesis※3. Clinical manifestations and degrees 4. Diagnosis 5. Differential diagnosis※6.Treatment 7. Prognosis 8. Prevention Etiology Key: Anoxia  Anoxia link:  mother  placenta umbilical cord fetus and neonates Anoxia time:  before birth 20% during birth 35%  before and during birth 35% after birth 10% Pathogenesis 1 Changes of brain blood dynamics 2 Changes of brain energy metabolism 3 Nervous pathological changes 1.1 Incomplete anoxia:1stThe whole body blood recontribution→ The blood flow to heart, brain, adrenal glands↑　 to the kidney, lung, skin, stomach and intestines↓2nd Persistent anoxia→ system blood pressure ↓ → The blood flow to brain ↓ →The brain blood recontribution ( to guarantee the function of the important part:The thalamus, brain stem, hippocampi, cerebellum).3rd Persistent lacking of the blood flow→ nervous cell injury. 1.2 Acute complete anoxia: Thalamus, brain stem and cerebellum are the vulnerable areas, however, the cerebral hemisphere are normal. 1.3 Dysfunction of the cerebraovascular regulation: Caused by hypoxia and acidosis;  lead to cerebral blood flow unstable: BP↑→hemorrage around ventricular BP↓→brain blood flow↓ Early period: 7 ～ 10 days  edema, hemorrhageLater period: after 10 days necrosis, liquefaction,bubble, atrophy Sequelae period: neuron number reduces neuron dysfunction formation of the myelin sheath reduces periventricular leukomalacia(PVL) Clinical manifestations and degre