新生儿呼吸困难 陈超 复旦大学儿科医院 新生儿科
新生儿呼吸困难 陈 超 复旦大学儿科医院 新生儿科
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, 口开3cm,约每20分钟一次宫缩,已破膜,并有 低热,37.90C。 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?
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， 37.9OC。 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!
• 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?
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 (3.0 ETT) Administer oxvgen If persistently bradycardic despite adequate ventilation cardiac compressions If no response, epinephrine per ett Immediate skilled resuscitation is essential to optimize outcomes
• Actions: – Suction, drying, stimulation. – If apneic, bag mask ventilation • If no response, intubation (3.0 ETT) – Administer oxygen – If persistently bradycardic despite adequate ventilation → cardiac compressions • If no response, epinephrine per ETT – Immediate, skilled resuscitation is essential to optimize outcomes
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 are the likely diagnoses? What actions should the neonatal team take now?
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%
• 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 0.35 oxygen is required to maintain saturations 9190 What is your next step?
Moderate grunting respirations increase, respiratory rate is 60 - 70 per minute, and 0.35 oxygen is required to maintain saturations 91%. What is your next step?
· Actions: Obtain chest radiograph Obtain arterial or capillary blood gas
• Actions: – Obtain chest radiograph – Obtain arterial or capillary blood gas
Capillary blood gas in 0.35: p H 7.29 Paco2 53 mm Hg Pao2 78 mm hs HCO3 21 mmol Has your diagnostic list changed? What is your next step?
Capillary blood gas in 0.35: pH 7.29 PaCO2 53 mm Hg PaO2 78 mm Hg HCO3 21 mmol What is your next step? Has your diagnostic list changed?