最新国新生儿复苏指南.pptVIP

RESUSCITATION OF THE NEWBORN NEONATAL RESUSCITATION EACH YEAR IN THE U.S., 3.5 MILLON BABIES ARE BORN IN A SYSTEM OF ABOUT 5000 HOSPITALS 10%, OR 350,000 WILL REQUIRE RESUSCITATION 35,000 WILL WEIGHT 1500 GM, AND 80% WILL REQUIRE RESUSCITATION OF THE 5000 HOSPITALS, 90% DO NOT HAVE NEONATOLOGISTS OR NEONATAL INTENSIVE CARE UNITS OF U.S. MEDICAL SCHOOLS, 25% TEACH BASIC CARDIOPULMONARY RESUSCITATION AND 12% TEACH ADVANCED CARDIOPULMONARY LIFE SUPPORT APGAR SCORE DIFFERENTIAL DIAGNOSIS OF “LOW APGAR” SCORE Common Causes of Partial Asphyxia of the Fetus Excessive oxytocin Maternal hypotension Placental abnormalities BASIC GOALS FOR NEONATAL RESUSCITATION To assist the infant in establishing adequate oxygenation, ventilation, pulmonary perfusion, and cardiac output. To minimize body heat loss. To maintain adequate peripheral cireculation To provide an adequate supply of glucose. To correct acid-base and electrolyte disturbances. RISK FACTORS OR CONTRIBUTING FACTORS MATERNAL FACTORS Maternal Disease (renal, pulmonary, diabetes, etc. Maternal Drugs (Mg++, narcotics) History of Perinatal Disease or Death Inadequate Prenatal Care Surgery During Pregnancy PROM ( 24 Hours) Abruption, Placenta Previa Pre-Eclampsia, Eclampsia, Hypertension INTRAPARTUM FACTORS Cephalopelvic Disproportion Sedatives/Analgesics Prolonged Labor Precipitous Labor Difficult Delivery Maternal Hypotension Cord Compression or Prolapse C-section Abnormal Presentations (Breech, etc. Forceps other than Low Elective FETAL FACTORS Multiple Births Polyhydramnios Oligohydramnios Immature L/S Ratio Premature/Postmature Large or Small for Gestational Age Meconium Stained Amniotic Fluid Abnormal Heart Rate or Rhythm Fetal Acidosis RESUSCITATION EQUIPMENT Overhead Radiant Warmer Light Source Oxygen Stethoscope Suction (Machine, Catheters, Bulb, DeLee) Bag and Masks Laryngoscope (0 and 1 Straight Blades) Endotracheal Tubes (2.5, 3.0, 3.5 mm) Umbilical Vessel Catheterization Tray (with 3.5 and 5.0 Fr. Catheters