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Analysis of Causes of Neonatal Asphyxia and Neonatal Resuscitation Paper 1 Abstract Objective: To analyze the obstetric causes of neonatal asphyxia and the effect of effective and timely neonatal cardiopulmonary resuscitation on infants. Methods The obstetric causes and delivery modes of 25 cases of neonatal asphyxia were analyzed, and the asphyxiated newborns were resuscitated according to the internationally recognized ABCDE resuscitation scheme, and the therapeutic effect was evaluated. Results 25/kloc-0 cases of asphyxiated infants were actively rescued by medical staff, except for/kloc-0 cases of severe asphyxiated infants who died after being rescued (sudden acute amniotic fluid embolism in pregnant women), the rest were successfully revived.
Conclusion: Only by implementing measures to prevent neonatal asphyxia in time, judging the occurrence of neonatal asphyxia as early as possible and mastering neonatal resuscitation technology can we reduce the incidence and mortality of neonatal asphyxia, improve the success rate of neonatal asphyxia rescue and improve the quality of obstetrics.
Keywords cardiopulmonary resuscitation; asphyxia neonatorum
Neonatal asphyxia refers to hypoxemia, hypercapnia and metabolic acidosis caused by spontaneous respiratory insufficiency or respiratory depression after birth, which is one of the important causes of neonatal death and child disability. [1] The duration of asphyxia plays a key role in the prognosis of infants. Therefore, clinical medical staff should be familiar with the causes of neonatal resuscitation and master various treatment methods correctly and skillfully on the basis of racing against time. The clinical data of 25 1 asphyxiated newborns born in the obstetrics department of Japanese hospitals from June 5th to October 6th to September 30th, 2003 are analyzed as follows:
1 data and methods
1. 1 general information
A total of 16 1 day was collected from October to September in 2003, among which 16 166 cases were newborns, including 25 cases of asphyxia. The incidence was 65438 0.55%. Among them, 237 cases were mild asphyxia, accounting for 94.4%, and 4 cases were severe asphyxia/kloc-0, accounting for 5.6%.
1.2 diagnostic criteria
Apgar scoring system was put forward by anesthesiologist Dr. Apgar in 1953, which is an effective and reliable index to evaluate the situation and recovery of newborns. Apgar score after birth 1 min, mild asphyxia is 4-7, and severe asphyxia is 0-3.
1.3 method
The rescue of neonatal asphyxia must race against time, and should be evaluated and resuscitated immediately after birth. It should be carried out by obstetricians, pediatricians, midwives (teachers) and anesthesiologists, not after Apgar score 1 minute.
Recovery plan [1]: adopt internationally recognized ABCDE plan, A: clean respiratory tract; B: establish breathing; C: maintain normal circulation; D: medication; E: evaluation. The first three items are the most important, in which A is fundamental and B is key, and evaluation 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.
1.3. 1 people and goods. Environmental preparation
Every delivery has 1 medical staff who are proficient in neonatal resuscitation. Newborn resuscitation equipment and medicines are complete and stored separately, with good functions. The temperature of delivery room and operating room should be kept at about 27-30℃. Turn off the air conditioner in summer and preheat the radiant heating table.
1.3.2 recovery steps and procedures
Clean the oral and nasal secretions immediately after the baby is born, and quickly evaluate four indicators within a few seconds: 1) Is it full-term? 2) Is amniotic fluid clear? 3) Are you breathing and crying? 4) Is the muscle tone good? If any of the above 1 items is No, the following initial recovery will be performed.
1.3.2. 1 keep warm: put the newborn on a radiation warm table or take heat preservation measures according to local conditions, or wrap the newborn with a preheated blanket to reduce heat loss. For very low birth weight < 1500 g, medical units with conditions can put the body and limbs below the head into clean plastic bags, or cover them with plastic film on the radiation heating table, and then continue the initial resuscitation of other steps after posing. Because it will cause respiratory depression, high temperature should also be avoided.
Posture: Put the newborn's head in a slightly extended position (nasal inhalation position).
Suction: Before shoulder dystocia, the midwife squeezes the secretions of the newborn's mouth, pharynx and nose by hand. After delivery, clean the secretion with a suction ball or straw (12F or 14F), first by swallowing and then through the nasal cavity. Excessive aspiration may lead to laryngeal spasm and vagus bradycardia, and delay spontaneous breathing. The depth and suction time of the pipette should be limited (10S), and the negative pressure of the pipette should not exceed100mmhg (1mmhg = 0.133kpa). Treatment of amniotic fluid polluted by meconium: When amniotic fluid is polluted by meconium: No matter whether meconium is thick or thin, the newborn should be evaluated for vitality as soon as it is delivered; When you are full of energy (definition of vitality: regular breathing, good muscle tone and heart rate greater than 100 beats/min), continue the initial resuscitation; If there is no vitality, use meconium suction tube for endotracheal suction.
Stimulation: pat or flick the soles of newborns' feet or rub their backs twice with their hands to induce spontaneous breathing. If these efforts are ineffective, it means that the newborn is in secondary apnea and needs positive pressure ventilation with airbag mask.
1.3.2.2 positive pressure ventilation with airbag mask: if the newborn still has apnea or sobs; If the heart rate is lower than 100 beats/min, positive pressure ventilation should be performed with 100% oxygen immediately. After 30 seconds of total positive pressure ventilation, if there is spontaneous breathing and the heart rate is ≥ 100 beats/min, the positive pressure ventilation can be gradually reduced and stopped. If spontaneous breathing is insufficient, or the heart rate is lower than 100 beats/min, it is necessary to continue to use airbag mask or tracheal intubation for positive pressure ventilation, and check the corrective ventilation operation. If the heart rate is less than 60 beats/min, intubate positive pressure ventilation, and start chest compressions (press under the sternum with both thumbs 1/3, the frequency is 90 beats/min, and the compression depth is 1/3).
1.3.2.3 The drug was fully ventilated with 100% oxygen and pressed for 30 seconds, but the heart rate was still less than 60 beats/min. Umbilical vein catheter (or umbilical vein), 0 1-0.3ml/kg 1:65438+ is preferred. Inject 0.5- 1ml/kg 1: 10000 solution into trachea, and repeat 1 time if necessary for 3-5min each time. When newborns with hypovolemia, suspected blood loss or shock do not respond to other resuscitation measures, consider expanding blood volume. (Selection of expansion agent: isotonic crystallization solution can be selected, and normal saline is recommended. A large amount of blood loss requires transfusion of isotype blood or O-red cell suspension with negative cross-matching with children. ) sodium bicarbonate is generally not recommended for recovery.
1.3.2.4 To evaluate the children after resuscitation, it is still necessary to monitor their body temperature, breathing, heart rate, blood pressure, urine output, skin color and resuscitation success indicators: [2] The general situation is stable, the heart rate 120 beats/min, the heart sound is regular, clear, powerful and regular, and spontaneous breathing is restored.
Cause analysis of neonatal asphyxia and results of neonatal resuscitation
2. 1 Resuscitation treatment results
In this group, except for/kloc-0, 25/kloc-0 cases of asphyxiated children were successfully resuscitated after active rescue and treatment by medical staff.
2.2 Analysis of the causes of neonatal asphyxia The causes of neonatal asphyxia are complicated, which can be caused by a single cause or a combination of many reasons. In this paper, the mode of delivery and obstetric factors are statistically analyzed (see table 1 and table 2 respectively):
Table 1 Relationship between delivery mode and neonatal asphyxia
As shown in table 1, it shows that the incidence of neonatal asphyxia in vaginal delivery is the highest, which is significantly higher than that in natural delivery and cesarean section. As can be seen from Table 2, the incidence of neonatal asphyxia caused by umbilical cord factor is the highest. Among them, umbilical cord around the neck and umbilical cord prolapse are the most common. Other causes are: premature rupture of membranes, uterine contraction, premature delivery, fetal distress, abnormal labor process, prenatal and intrapartum eclampsia and oligohydramnios. It can be seen that umbilical cord factor is the most common factor leading to neonatal asphyxia.
3 discussion
The basic physiological change of neonatal asphyxia is hypoxia, which destroys the acid-base balance of maintaining the internal environment, changes the distribution of brain tissue water, changes the cerebral blood flow, and then causes tissue ischemia. Multifocal brain ischemia is an important cause of brain injury. Therefore, it is of great significance to understand the factors of neonatal asphyxia and intervene as soon as possible to reduce neonatal asphyxia, improve the success rate of neonatal asphyxia resuscitation and reduce neonatal brain tissue damage. [2.3]
The analysis results show that the incidence of neonatal asphyxia in vaginal delivery is the highest, reaching 6.6%. Therefore, it is the key to prevent neonatal asphyxia to combine various factors and choose the delivery mode in time and correctly. Among obstetric causes, umbilical cord abnormality is the first factor leading to neonatal asphyxia, accounting for 29.88%. Abnormal umbilical cord, including umbilical cord entanglement, too short, torsion, prolapse or mechanical compression, can lead to different degrees of acute hypoxia in the fetus. [4] Before delivery, perinatal health care should be strengthened. Umbilical cord entanglement is mainly found by B-ultrasound, so the fetal heart rate should be closely monitored to guide pregnant women to count fetal movements. The main postpartum symptoms mostly occur in the active stage and the second stage of labor. The umbilical cord around the neck or around the body can cause the umbilical cord to be too short, which will delay the connection of the fetal head, resulting in different degrees of prolonged or delayed labor, especially in the second stage of labor, which can cause secondary uterine inertia and fetal distress, manifested as abnormal fetal heart rate. Therefore, fetal heart monitoring is particularly important in the observation of labor process. As long as the labor process is closely observed, the fetal heart rate is closely monitored, B-ultrasound examination is carried out in time, and the delivery mode is correctly selected, the occurrence of neonatal asphyxia can be avoided. [5]
In addition, the risk factors that may cause neonatal asphyxia, such as uterine contraction, fetal distress, premature rupture of membranes and premature delivery, should be monitored and treated to avoid neonatal asphyxia as much as possible. Timely and accurate evaluation of asphyxiated newborns and active and effective treatment measures can reduce infant mortality.
refer to
Shen Xiaoming, Wang Weiping. Pediatrics 7 th edition. People's publishing house. 2009: 97- 102.
[2] Yan,,, et al. Analysis of causes of neonatal asphyxia. Journal of Beichuan Medical College, Vol.25, No.3, p.239..
[3] Sun Aizhi. Clinical observation of psychological nursing intervention on asphyxia of parturient and newborn. Journal of Practical Nursing, 2003, 19 (9): 40.
Tian. Relationship between amniotic fluid pollution, fetal heart monitoring and neonatal asphyxia. Progress in Obstetrics and Gynecology, 2007, l6(9) 709 -7 10.
Zhou changju Fetal distress caused by umbilical cord abnormality [J] Journal of Practical Obstetrics and Gynecology1990,6 (6):19.
[6] Li Wenfeng. 120 comprehensive analysis of the causes of neonatal asphyxia China Practical Medicine 20 10 Vol.5 No.3.80 。
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