新生儿呼吸-陈超.ppt

新生儿呼吸困难陈超复旦大学儿科医院新生儿科
一位31岁孕妇,G2P1,怀孕已29周,孕期检查正常,今天上午感觉开始宫缩,住院检查,宫口开3cm,约每20分钟一次宫缩,已破膜, 并有低热, 。
产科医师请新生儿科医师会诊,这位孕妇可能要早产,怎么处理?
各位医师有什么建议?
Actions:
Attempt to delay delivery
Tocolysis at discretion of obstetrician
Ensure culture and therapy for possible chorioamnionitis
Antenatal corticosteroids
The single most important neonatal intervention
Ensure that adequate neonatal resuscitation is available
Cooperation between pediatricians and obstetricians is essential!
A single dose of antenatal corticosteroids is administered, along with antibiotic therapy and indomethacin tocolysis.
However, labour continues to progress,
the mother delivers a male infant weighing 1100 grams.
A neonatal resuscitation team is present at the delivery. Heart rate at delivery was 80 per minute and the infant initially is apneic.
What actions should the neonatal team take?
Actions:
Suction, drying, stimulation.
If apneic, bag mask ventilation
If no response, intubation ( ETT)
Administer oxygen
If persistently bradycardic despite adequate ventilation  pressions
If no response, epinephrine per ETT
Immediate, skilled resuscitation is essential to optimize es.
The infant begins to breath regularly in response to stimulation, the heart rate is now 156.
but he is persistently mildly cyanotic, with mild intercostal chest retractions and mild grunting respirations.
What actions should the neonatal team take now?
What are the likely diagnoses?
Differential Diagnosis:
NRDS
Neonatal sepsis with pneumonia
Pneumothorax secondary to resuscitation
Retained fetal lung fluid / transitional respirations
Actions:
Begin monitoring of oxygen saturations
Maintain oxygen saturations 88 – 92%
Keep NPO and place intravenous line
Draw blood culture and begin antibiotic therapy
Assess blood pressure, blood sugar etc
Observe for 1 – 2 hours
as long as symptoms remain mild and oxygen <30%
Moderate grunting respirations increase,
respiratory rate is 60 - 70 per minute,
and oxygen is req