Clinical manifestations of neonatal asphyxia and Apgar score of neonatal primary hypoxia;
Heart rate (p); Breathe (r); Muscle tension (a);
Reaction (g) of bouncing the soles of feet or inserting a catheter into the nose; Skin color (1). Diagnostic score 0 ~ 3 is severe asphyxia; 4 ~ 7 is divided into mild asphyxia; 8 ~ 10 points, no asphyxia, 5 minutes score is still lower than 6 points, more likely to damage the nervous system. The order of treatment and resuscitation plan (ABCDE plan) for hypoxic-ischemic encephalopathy and intracranial hemorrhage complications cannot be reversed. The first three items are the most important, in which A is fundamental, B is key, and E runs through the whole recovery process. Breathing, heart rate and skin color are the three major indexes of asphyxia resuscitation evaluation, which follow the procedures of evaluation → decision → measures until the resuscitation is completed. Initial resuscitation treatment: ① placed in a warm place; (2)pose； ③ Clean the respiratory tract; 4 dry the whole body; ⑤ tactile stimulation. Breathe spontaneously, and the heart rate is > 100 beats/min: evaluate skin color, such as ruddy skin color or cyanosis of hands and feet only, and continue to observe; If the skin is cyanotic, inhale 80% ~ 100% oxygen and observe. No spontaneous breathing and/or heart rate < 100 beats/min: ① pressurized oxygen supply with mask 15 ~ 30 seconds. ② If there is anesthesia inhibition, observe the respiratory heart rate after giving naloxone, and if there is still respiratory inhibition, give it again. ③ If there is no narcotic drug inhibition, observe spontaneous breathing and evaluate the heart rate. If the heart rate is greater than 100 beats/min, continue to observe when spontaneous breathing occurs; If the heart rate is 60 ~ 100 beats/min, and there is an increasing trend, continue to use the mask to pressurize oxygen inhalation; If the heart rate is 60 ~ 100 beats/min, and there is no increasing trend, or the heart rate is less than 60 beats/min, perform tracheal intubation to pressurize oxygen inhalation and press the heart for 30 seconds. If there is still no improvement, epinephrine should be used, and it should be repeated every 5 minutes if necessary until the heart rate is greater than 100 beats/min, and the administration should be stopped. ④ Sodium bicarbonate should be given when there is metabolic acidosis, dilating agent should be given when there is bleeding and hypovolemia, and dopamine should be given when there is continuous shock. The infants with severe asphyxia should be delayed in feeding, and intravenous rehydration should be 50 ~ 60 ml/(kg d).
Apgar score standard signs of newborns are scored within one minute after birth (once evaluated) 0: 1: 2: heart rate (P) 0 < 100 beats/min ≥ 100 beats/min. Breathing (r) without breathing is superficial, crying is weak and breathing is good. The muscle tension of crying sound (a) the limb flexes and moves, and it responds well to kicking the sole of the foot or inserting a catheter into the nose (g), but responds well to some actions (a) the skin color is blue or pale, the trunk is red, the limbs are purple and the body is red, with a total score of 65,438+00.
Neonatal hypoxic-ischemic encephalopathy
Etiology of neonatal asphyxia and hypoxia
Clinical manifestations: Symptoms and signs of nervous system appear within 0/2 hours after birth.
Consciousness disorder (excitement and lethargy → dullness → coma)
Seizure (none → frequent → frequent)
Primitive reflex (normal → weakened → disappeared)
Auxiliary examination of EEG: It is helpful to determine the severity of brain lesions, judge the prognosis and distinguish convulsions.
Blood biochemistry: The determination of serum creatine phosphokinase brain isoenzyme (CPK-BB) showed that the normal value was < 10U/L, and it increased when brain tissue was damaged. It is helpful to determine the severity of brain tissue injury and judge the prognosis.
Brain ultrasound examination: the ventricle can be found to be shrunk or disappeared (suggesting brain edema), and there is a hyperechoic area around the ventricle, especially behind the outer corner of the lateral ventricle (caused by softening and edema of white matter around the ventricle), and local or scattered hyperechoic areas can be seen in local or extensive cerebral parenchymal ischemia areas. This kind of examination is simple and cheap, and can be operated at the bedside, and can be used for a series of follow-up. Head CT examination: It is valuable for the diagnosis of brain edema, cerebral infarction and intracranial hemorrhage. The suitable examination time is 2 ~ 5 days after birth. MRI or 1HMRS examination: it is helpful to diagnose lesions in some parts (such as parasagittal area of cerebral cortex, thalamus, basal ganglia infarction, etc.). ) not detected by ultrasound and CT.
accessory examination
Treatment and support therapy-correct hypoglycemia: the daily liquid volume of glucose is controlled at 60 ~ 80 ml/kg according to 6 ~ 8 mg/(kg mim). Anticonvulsive therapy (1) phenobarbital sodium (2) diazepam: The above drugs can be added when the effect is not obvious, and the possibility of respiratory depression should be paid attention to when the two drugs are used together. The treatment of brain edema (1) is mainly to limit fluid volume. (2) Furosemide: the dosage is 1mg/kg each time, and it can be used repeatedly for 4-6 hours if necessary. (3) Mannitol: intravenous injection of 0.25 ~ 0.5g/kg every 4 ~ 6 hours. (4) Dexamethasone: the daily dosage is 0.5 ~ 1 mg/kg, and the dosage is reduced after 48 hours, generally only for 3 ~ 5 days. At present, whether it is used is still controversial and is generally not advocated.