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1、Neonatal Resuscitation Guidelines,华西第二医院麻醉科 杨平亮,The terms newborn and neonate are intended to apply to any infant during the initial hospitalization. .,The term newly born is intended to apply specifically to an infant at the time of birth,1、Approximately 10% of newborns require some assistance to b
2、egin breathing at birth. 2、About 1% require extensive resuscitative measures（多方面的复苏措施）.,a rapid assessment,1、 Was the baby born after a full-term gestation（ 足月妊娠）? 2、Is the amniotic fluid（羊水） clear of meconium （胎粪）and evidence of infection? 3、 Is the baby breathing or crying? 4、 Does the baby have g
3、ood muscle tone?,4 categories of action in sequence,A. Stabilization稳定 (provide warmth, position, clear airway, dry, stimulate, reposition) B. Ventilation C. Chest compressions D. Administration of epinephrine and/or volume expansion（给肾上腺素/扩容）,The decision to progress,assessment of 3 vital signs: 1、
4、respirations 2、heart rate 3、 color 30 seconds is allotted(分开的) to complete each step, reevaluate, and decide whether to progress,Initial Steps第一步,The initial steps of resuscitation are to provide warmth by placing the baby under a radiant辐射的 heat source, position the head in a “sniffing”嗅 position t
5、o open the airway, clear the airway with a bulb syringe球形注射器or suction catheter, and dry the baby and stimulate breathing.,Temperature Control,The goal is to achieve normothermia and avoid iatrogenic hyperthermia. additional warming techniques be used,such as covering plastic wrapping 塑料袋and placing
6、 him or her under radiant heat Temperature must be monitored closely,Clearing the Airway of Meconium,no longer advise routine intrapartum 产时suctioning for infants A vigorous infant is defined as one who has strong respiratory efforts, good muscle tone, and a heart rate 100 beats per minute (bpm). En
7、dotracheal suctioning for infants who are not vigorous should be performed immediately after birth,Administration of Oxygen,oxygen is recommended whenever positive-pressure ventilation is indicated If resuscitation begins with room air, oxygen be available to use if there is no appreciable可看到的 impro
8、vement within 90 seconds after birth.,Positive-Pressure Ventilation,If the infant remains apneic or gasping窒息喘息 if the heart rate remains 100 bpm 30 seconds after administering the initial steps if the infant continues to have persistent central cyanosis中心性紫绀 despite administration of supplementary
9、oxygen.,Assisted Ventilation of Preterm Infants早产儿,most apneic preterm infants can be ventilated with an initial inflation pressure of 20 to 25 cm H2O, but 30 to 40cm H2O may be required in some term babies without spontaneous ventilation Assisted ventilation rates of 40 to 60 breaths per minute ven
10、tilation should promptly achieve or maintain a heart rate 100 bpm.,Devices,Effective ventilation can be achieved with a flow-inflating bag, a self-inflating bag, or with a T-piece Laryngeal mask airways (LMAs)喉罩,Endotracheal Tube Placement,1、bag-mask面罩 ventilation is ineffective or prolonged 2、chest
11、 compressions are performed 3、endotracheal administration of medications is desired 4、For special resuscitation circumstances, such as congenital diaphragmatic hernia 先天性膈疝or extremely low birth weight(1000 g),Chest Compressions,heart rate that is 60bpm despite adequate ventilation with supplementar
12、y oxygen for 30 seconds. Compressions should be delivered on the lower third of the sternum a depth of approximately大约 one third of the anterior-posterior前后 diameter of the chest.,techniques,compression with 2 thumbs with fingers encircling the chest and supporting the back (2 thumbencircling hands
13、technique) or compression with 2 fingers with a second hand supporting the back. 3:1 ratio 120 events per minute,Medications,heart rate remains 60 bpm administration of epinephrine volume expansion buffers, a narcotic antagonist, or vasopressors may be useful after resuscitation.,Route and Dose of E
14、pinephrine,the IV route should be used as soon as venous access is established. The recommended IV dose is 0.01 to 0.03 mg/kg per dose The concentration of epinephrine for either route should be 1:10 000 (0.1 mg/mL).,Volume Expansion,blood loss infant appears to be in shock (pale skin, poor perfusio
15、n, weak pulse) has not responded adequately to other resuscitative measures. isotonic 等渗crystalloid rather than albumin白蛋白 is the solution of choice for volume expansion The recommended dose is 10 mL/kg,Naloxone纳络酮,is not recommended as part of initial resuscitative efforts The preferred route is IV
16、 or intramuscular The recommended dose is 0.1 mg/kg,Withholding and Discontinuing,gestation, birth weight, or congenital anomalies are associated with almost certain early death Unacceptably high morbidity is likely among the rare survivors extreme prematurity (gestational age 23 weeks or birth weight 400 g), anencephaly, and chromosomal染色体 abnormalities incompatible with life, such as trisomy 13.三体,indicate resuscitation,a high rate of survival and acceptable morbidity, resuscitation is nearl
