胎粪污染新生儿的临床管理课件.pptx

1、Care of the Meconium-Stained InfantObjectivesMeconium-Stained FluidDelivery room managementMeconium Aspiration SyndromeTreatment strategies after birthWhen is it NOT meconium?Meconium-Stained Fluid:BackgroundGreek word,“mekoni”opiumAristotle:association between meconium-stained fluid and neonatal“sl

2、eepy state”(neurologic depression)Sterile,black-green,intestinal“debris”Mostly term&post-term neonates(37 weeks)Very rare before 32 weeks gestationFrequency:8-25%of all deliveriesMeconium-Stained Fluid:PathophysiologyAssociated with fetal stress or advanced maturityAcute hypoxia:cord or placental ac

3、cidentsChronic hypoxia:post-term or small for gestational age neonates inadequate placental supply/functionPhysical exam can indicate timing of meconium passageUmbilical cord 2 hoursStaining of nails 6 hoursStaining of vernix 12-14 hoursHypoxic stressColonic stimulationPassage of meconiumFetal gaspi

4、ngRisk of Meconium AspirationMeconium-Stained Fluid:PathophysiologyMeconium-Stained Fluid:Delivery Room ManagementCurrent Neonatal Resuscitation Program GuidelinesFor VIGOROUS babiesPlace baby in sniffing positionSuction nose and mouthDry&Stimulate1.Good respiratory effort 2.Good tone 3.HR 100Crying

5、 BabyMeconium-Stained Fluid:Delivery Room ManagementCurrent Neonatal Resuscitation Program Guidelines*October 2015:ILCOR will release new recommendations in PediatricsFor NON-VIGOROUS babies*DO NOT STIMUATE!Endotracheal intubation&suctionPosition,Dry,StimulateContinue with regular resuscitationMecon

6、ium Aspiration Syndrome(MAS):United States Statistics5%of neonates with meconium-stained fluid25,000-30,000 cases annually1000 deaths(mortality rate 4%)1990-1997:Change in obstetrical practice:induction at 41 weeks gestation33%reduction in deliveries 41 weeks4-fold decrease in incidence of MAS(5.8%1

7、.5%)Meconium Aspiration Syndrome(MAS):PathophysiologyMeconium Aspiration Syndrome:ChinaFor all babies with respiratory distress:Chest XRayArterial blood gasPre&Post ductal oxygen saturationsECHO for suspected pulmonary hypertensionGlucoseDextrose IV fluidsBacterial blood culturesEmpiric antibiotics(

8、ampicillin&gentamicin)Diagnosis of MASDiagnosis of MASMeconium aspirated from below the vocal cordsRespiratory distressCXRPatchy opacities/consolidationsHyperinflation/barrel chestAtelectasisPneumothorax,pneumomediastinumHypoxemia,hypercapnia,acidosis on arterial blood gasPulmonary hypertensionPre&p

9、ost ductal oxygen saturation splittingECHO:shunting of deoxygenated blood through PDATreatment:Respiratory SupportMild Meconium Aspiration SyndromeHypoxiaComfortable tachypneaOxygen onlyUsually 95%Maintain higher systemic blood pressure dopamine,epinephrine,hydrocortisone,dobutamineSedation(fentanyl

10、,midazolam)Inhaled Nitric oxideExtraCorporeal Membrane Oxygenation(ECMO)Treatment:Pulmonary HypertensionMeconium Mimics:When it is NOT meconiumBile-stained amniotic fluidGastroschisisOmphaloceleOther gastrointestinal obstructionListeria-containing amniotic fluidYellow-green color similar to thin mec

11、oniumReferencesYeah TF.Core Concepts:Meconium Aspiration Syndrome:Pathogenesis and Curent Management.NeoReviews 2010;11;e503-512.Fanaroff AA.Meconium aspiration syndrome:historical aspects.Journal of Perinatology 2008;28;S3-S7.Bhat R,Vidyasager D.Delivery Room Management of Meconium-Stained Infant.C

12、lin Perinatol 2012;(39);817-831.Hutton EK,Thorpe J.Consequences of meconium stained amniotic fluid:What does the evidence tell us?Early Human Development.2014;(90);333-339.Sun B,Ma L,Liu X,Gao X,Ni L.Development of Neonatal Respiratory and Intensive Care:Chinese Perspectives.Neonatology 2012;101;77-82.Neonatal Resuscitation Program:6th Edition.American Academy of Pediatrics and American Heart Association.2011.