儿科学英文课件：04 neonatal HIE.ppt

* Pathogenesis and Pathophysiology Imbalance of cerebral blood flow (CBF) Normal term stable CBF: 50-60ml/min/100g Brain damage when CBF＜ 20ml/min/100g Hemisphere ↓ Terminal branches of cerebral artery ↓ (parasagittal injury, PVL) CNS, myocardium and adrenals ↑ Basal ganglia, thalamus, brainstem and cerebellum blood flow ↑ Redistribution of blood supply HI Blood flow ↓ severe * Pathogenesis and Pathophysiology Dysfunction of cerebrovascular autoregulation ICH HI brain injury HI Dysfunction of cerebrovascular autoregulation BP↑ 压力被动性脑血流 BP↓ Cerebral blood flow ↑ Cerebral blood flow ↓ * Pathogenesis and Pathophysiology Change of cerebral metabolism Roberton’s textbook of neonatology * * Pathology Early stage: hydocephalus Selective neuronal necrosis Thalamic/basal ganglia injury Parasagittal injury Full term Periventricular leukomalacia, PVL Preterm , local or diffuse injury Cerebral infarction Left, middle cerebral artery Preterm: periventricular white matter Full term: parasagittal * Clinical Manifestation Marks of acute hypoxic-ischemic insult Prolonged fetal bradycardia, etc. Low Apgar score at 5 minutes or later Low fetal scalp or cord PH Prolonger resuscitation with positive pressure ventilation Neurologic abnormalities (nonspecific) Decreased level of consciousness and seizure Brain dysfunction: abnormal pupillary responses, impaired extraocular movements, respiratory impairment, etc. Other: persistent stupor, abnormal muscle tone, ongoing feeding difficulties Multiorgan dysfunction (see Chap. Perinatal Asphyxia) * Grade of HIE Severity / Grade Mild Moderate Severe Consciousness Irritated or hyperalert Lethargy Coma Muscle tone Normal Hypotonic Severe hypotonic Moro’s reflex Exaggerated Suppressed Absent Sucking reflex Normal Suppressed Absent Seizure Myoclonus Common (±) Present / Sustained Central respiratory failure none Present Obvious Pupillary responses Normal or dilated Myosis, slow response Unequal or myd