Decisive judgment, quick action, tacit cooperation.
Jingle bell, jingle bell, neonatal intensive care unit (NICU) received the obstetric department**, and was told that an elderly woman with a straight line of fetal monitoring was about to undergo emergency cesarean section, the mother was advanced and the fetus was born 35+6 weeks prematurely, and the pregnancy examination showed that there was a fetal heart development malformation.
With clinical experience, the neonatal intensive care unit team immediately activated the emergency rescue plan, and the deputy chief physician Feng Xiao.
3. The doctor on duty, Li Xue, the general hospitalist, Lai Yupeng, and the specialist Zhu Naixiang rushed to the operating room as soon as possible to make rescue preparations, and at the same time notified the NICU to prepare a series of first-aid equipment such as radiation tables and ventilators.
Hao Hao (pseudonym) was in critical condition after birth, his whole body was bruised, no spontaneous breathing, his limbs were floppy, and his heart rate was only 20 minutes, and the resuscitation team judged that the newborn was severely asphyxiated and was a dying baby, and immediately started the resuscitation process of the dying baby, with positive tracheal intubation, chest compressions, and epinephrine ......A series of treatments were intense and orderly.
With the tacit cooperation of the team, after a few minutes of rescue, Haohao's heartbeat gradually recovered, his complexion gradually improved, and everyone's hearts gradually calmed down. After the successful resuscitation of the neonatal, under the positive pressure ventilation of endotracheal intubation, Hao Hao was urgently transferred to the Neonatal Intensive Care Unit (ICU) for further **.
Relay for life, beat time, and regain a new life.
In the neonatal intensive care unit, combined with the history of severe asphyxia at birth, the doctor team fully assessed that it reached the standard of hypothermia**, and hypothermia** was required to protect neurological function.
Feng Xiaosan, the head of the neonatology department, led the team to formulate a rescue plan. After obtaining the consent of the family, the attending doctor issued a medical order, and the person in charge coordinated, and carried out emergency bedside color ultrasound, emergency biochemistry and other related examinations in an orderly manner, and after excluding Haohao's contraindications about hypothermia**, he was given hypothermia** within 1 hour of his birth.
Destiny hangs by a thread, multidisciplinary collaboration.
After assisted ventilation in SIMV+PSV mode of invasive ventilator, Haohao's condition was not relieved, and the inhaled oxygen concentration once reached 100% to maintain oxygenation, and the medical staff immediately instilled alveolar surfactant (PS) with endotracheal intubation, and gradually increased the ventilator parameters, but the child's blood oxygen saturation could not remain normal, and the SPO2 fluctuation of the right upper limb was 80% 88%, and the SPO2 fluctuation of the lower limb was 60% 75%, and the bedside B ultrasound examination was carried out. Confirmed Haohao's diagnosis of neonatal persistent pulmonary hypertension (PPHN)!
PPHN is the final pathological state of clinical neonatal mortality caused by multiple diseases, and the risk of death is extremely high in the neonatal disease spectrum, and Haohao's condition is very critical at the moment.
Everyone's hanging hearts began to tense again.
From the afternoon to more than 8 o'clock in the evening, he has been paying close attention to the progress of Haohao's condition, and he does not dare to relax the tight strings at all times, and all of them are doing their best to inject life power into Haohao with their actions.
Feng Xiaosan immediately made a decision to immediately add nitric oxide (ino) to reduce pulmonary hypertension, and actively took comprehensive measures such as anti-infection, intravenous nutrition, and maintaining a stable internal environment.
After a night of thrilling treatment, Haohao's blood oxygen gradually stabilized, and the medical staff breathed a sigh of relief. In the morning, Haohao's father came to his side with a heavy heart, he lay quietly on the radiation platform, cooperating with the doctor's brother and sister's care, Haohao's father clenched his fists, his face was heavy, and listened carefully to Feng Xiaosan's condition, "We are not willing to give up any baby, as long as there is a glimmer of hope for life, Haohao's desire for life also requires us not to give up, and then we must overcome all difficulties and cooperate with our team's **" Feng Xiaosan said.
After invasive ventilator-assisted ventilation, intratracheal injection of pulmonary surfactant, ino inhalation, hypothermia**, and synchronous monitoring with amplitude electroencephalogram and ECG monitor, under the careful care of medical staff, Haohao safely passed the most difficult 72 hours. Haohao's nervous system abnormalities gradually improved, PPHN also improved, invasive ventilator**7 days later, the non-invasive ventilator was successfully changed to continue to assist breathing, and the condition slowly stabilized, which made everyone full of hope for the next treatment.
Round-the-clock, careful care, scientific care.
Under the leadership of Liu Ying, the members of the nursing team of the neonatal intensive care unit conducted several discussions on Haohao's infection, airway management, feeding, nursing, umbilical vein maintenance and other issues, and formulated a complete nursing plan in accordance with the individualized nursing strategy, and implemented them one by one. Nurse Liu Ying flipped through a large number of literature and books, and led the nursing team and interns of the department to conduct bedside rounds every day, linking theory with practice, and constantly improving everything, so that everyone could consolidate their knowledge and become proficient in operation in practice.
After 16 days of meticulous ** and nursing, Haohao's condition was controlled, his respiratory function slowly improved, the ventilator was invasively changed to non-invasive, to nasal low-flow oxygen inhalation, and finally oxygen was gradually stopped, and the blood oxygen saturation was stabilized in a normal state, and it also transitioned from nasogastric feeding to self-sucking.
Work together, do it sincerely, and move forward.
Haohao's parents came to Haohao's bed again, and this time, Haohao's mother looked at the sleeping Haohao and shed tears, Haohao's father said, "When I came in to see Xiaobao for the first time, I saw him lying on the rescue table, we were really desperate, and every day was torment." However, Feng Xiaosan and the medical staff will tell us about the baby's condition every day, giving us confidence. As he spoke, his eyes moistened.
Feng Xiaosan patted Haohao's father on the shoulder and said: "Thank you for your trust and cooperation with us, some joy is indescribable, but our efforts will eventually be rewarded, and we will continue to break through the ** level next."
Because Haohao had a history of severe asphyxia at birth, we carried out electroencephalogram monitoring, did head MRI examination, and in order to improve the long-term prognosis, we gave early sensory integration training, touch and other ** training to promote Haohao's nerve recovery.
Wei Hongyan, the nurse in charge of Beijing Children's Hospital, who came back from studying, gave Haohao training every day.
Benevolence and love will turn pain and weakness into well-being.
The Neonatal Intensive Care Unit (NICU) of Zhuhai People's Hospital, as a critical neonatal treatment center in Zhuhai, has a professional team of personnel and equipment, and the successful rescue benefits from the accumulation of daily emergency treatment capabilities. Severe asphyxia combined with PPHN is a critical case with high difficulty in treatment and great risk of death among neonatal diseases. Haohao's successful treatment not only reflects the first-class technology and nursing level of medical staff, but also reflects the sense of responsibility, warmth and love of medical staff, and at the same time is inseparable from the persistence and high trust of parents. In the neonatal intensive care unit, many ultra-low birth weight infants, neonatal respiratory distress syndrome (NRDS), severe asphyxia, meconium aspiration syndrome, neonatal sepsis and other serious diseases have been treated, striving to let every baby be reborn and escort the baby's health.
Feng Xiaosan said that in order to better escort the newborns in Zhuhai, the neonatal department of our hospital has added advanced hardware instruments and equipment, continuously trained and strengthened the treatment ability of medical staff, and continuously improved the comprehensive service level.
The successful treatment of the dying baby reflects the first aid level and comprehensive rescue ability of our medical staff, and we will continue to move forward and have the confidence to provide life and health protection for newborns in Zhuhai and surrounding areas.
What is hypothermia**?
Sub-low temperature ** is the use of physical cooling, so that the core temperature is maintained at 30-35 °C, in order to achieve the purpose of **. The hypothermia of neonatal blood oxygen ischemic encephalopathy (HIE)** is an active cooling method, which refers to the use of a specific medical thermostat to reduce the child's core temperature to a sub-hypothermic state of 33 34 for a certain period of time under close supervision, and maintain it for 72 hours, and then slowly rewarm to achieve neuroprotective effect. It is currently an effective method for neonatal hypoxic-ischemic encephalopathy (HIE).
Neonatal asphyxia is often accompanied by serious complications, severe condition, high mortality rate, if not rescued in time, the child may directly lead to death due to severe asphyxia at any time, even if survived, hypoxic-ischemic encephalopathy due to asphyxia is also a disabling hard injury of the child. At present, the only effective and reliever method recognized by the medical community is hypothermia**, and it is best to start within 6 hours of birth**, and the sooner neuroprotection is initiated, the better. Use sub-hypothermia** early to do neuroprotection, so that children with severe asphyxia do not lose at the starting line.
What is nitric oxide**?
Persistent pulmonary hypertension (PPHN) in neonates is caused by abnormally elevated pulmonary vascular resistance after birth, resulting in right-to-left shunting of blood through the neonatal circulatory pathway. This results in severe hypoxemia that may not be relieved by conventional respiratory support. PPHN is a common critical illness in the neonatal intensive care unit.
As a vasoactive molecule, ino has vasodilatorial effects. Therefore, INO has been widely used in neonatal respiratory distress syndrome and acute pulmonary hypertension. In recent years, with the in-depth study of ino, it has been found that ino also has certain effects on the cerebrovascular and central nervous system. After inhaling ino and reaching the alveoli in children with PPHN, guanylate cyclase can be activated, which accelerates the outflow rate of calcium ions and relaxes vascular smooth muscle, thereby reducing pulmonary vascular resistance and reducing pulmonary artery pressure. Pulmonary surfactant combined with inhaled ino and conventional** is more conducive to the recovery of respiratory function indexes, the decrease of pulmonary artery systolic blood pressure, and the shortening of respiratory support** time and hospital stay in children.
The Department of Neonatology has been using the INO inhalation technology for many years, and has successfully treated many newborns with serious diseases, and has rich clinical experience.