胎粪污染新生儿的临床管理 Care of the Meconium-Stained Infant.pptx

Care of the Meconium-Stained Infant Objectives Meconium-Stained Fluid Delivery room management Meconium Aspiration Syndrome Treatment strategies after birth When is it NOT meconium? Meconium-Stained Fluid:Background Greek word, “mekoni” – opium Aristotle: association between meconium-stained fluid and neonatal “sleepy state” (neurologic depression) Sterile, black-green, intestinal “debris” Mostly term post-term neonates ( 37 weeks) Very rare before 32 weeks gestation Frequency: 8-25% of all deliveries Meconium-Stained Fluid:Pathophysiology Associated with fetal stress or advanced maturity Acute hypoxia: cord or placental accidents Chronic hypoxia: post-term or small for gestational age neonates inadequate placental supply/function Physical exam can indicate timing of meconium passage Umbilical cord 2 hours Staining of nails 6 hours Staining of vernix 12-14 hours Meconium-Stained Fluid:Pathophysiology Meconium-Stained Fluid:Delivery Room Management Current Neonatal Resuscitation Program Guidelines For VIGOROUS babies Good respiratory effort Good tone HR 100 Crying Baby Meconium-Stained Fluid:Delivery Room Management Current Neonatal Resuscitation Program Guidelines *October 2015: ILCOR will release new recommendations in Pediatrics For NON-VIGOROUS babies* Meconium Aspiration Syndrome (MAS):United States Statistics 5% of neonates with meconium-stained fluid 25,000-30,000 cases annually 1000 deaths (mortality rate 4%) 1990-1997: Change in obstetrical practice: induction at 41 weeks gestation 33% reduction in deliveries 41 weeks 4-fold decrease in incidence of MAS (5.8%  1.5%) Meconium Aspiration Syndrome (MAS):Pathophysiology Meconium Aspiration Syndrome:China For all babies with respiratory distress: Chest XRay Arterial blood gas Pre Post ductal oxygen saturations ECHO for suspected pulmonary hypertension Glucose Dextrose IV fluids Bacterial blood cultures Empiric antibiotics (ampicillin gentamicin) Diagnosis of MAS Diagnosis of MAS Meconium as