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Submitted by zybernav on Sun, 03/16/2008 - 09:37.

ภาวะฉุกเฉินของทารกแรกเกิด

โดย นพ. วิจิตร ประพาศพงษ์

วัตถุประสงค์ของการเรียนรู้

อธิบายสรีระวิทยาของทารกแรกเกิดได้
สามารถประเมินทารกแรกเกิดได้
การช่วยชีวิตทารกแรกเกิด (neonatal resuscitation)

สรีระวิทยาของทารกแรกเกิด

เมื่อทารกคลอดออกมาต้องพึ่งพาตนเอง ระบบต่างๆ ของร่างกายต้องทำหน้าที่เองและยังพัฒนาไม่สมบูรณ์ เมื่อเรารู้การเปลี่ยนแปลงของทารกแรกเกิดก็จะสามารถช่วยใด้ทารกมีโอกาสรอดมากขึ้น

ระบบการไหลเวียนเลือด

ในขณะที่ทารกอยู่ในครรภ์ปอดยังไม่ทำงาน การไหลเวียนของโลหิตจะต้องอาศัยรก เลือดแดงจากรกจะไหลเวียนผ่าน umbilical vein ตรงเข้าสู่ตับเข้าสู่ inferior venacava โดยผ่านทาง ductus venosus เข้าสู่หัวใจห้องบนขวาเลือดจากหัวใจห้องล่างขวาจะไหลเข้าสู่ pulmonary artery ผ่าน ductus arteriosus เข้าสู่ desending aorta ไปเลี้ยงส่วนต่าง ๆของร่างกายแล้วกลับเข้าสู่ umbilical artery 2 เส้นเข้าสู่รก

เมื่อทารกเกิดแล้ว สายสะดือถูกตัด ระบบการไหลเวียน จะมีการเปลี่ยน
แปลงอย่างมาก ระบบการไหลเวียนเลือดเหมือนผู้ใหญ่โดยทั่วไปเมื่อทารกมีอายุประมาณ 8 สัปดาห์

รูปภาพ แสดงการไหลเวียนเลือดของทารกในครรภ์

อุณหภูมิร่างกาย

ทารกแรกเกิดมีอุณหภูมิร่างกายประมาณ 37.2 องศาเซลเซียส
หลังคลอดได้สักครู่ทารกก็จะมีอุณหภูมิต่ำลง เนื่องจากทารกมีการสูญเสียความร้อนออกจากร่างกายให้กับสิ่งแวดล้อมการสูญเสียความร้อนมักเกิดได้ง่ายเพราะฉนวนความร้อน คือ subcutaneous fat มีน้อย และศูนย์ควบคุมอุณหภูมิร่างกายยังไม่สมบูรณ์

แผนภูมิแสดงผลกระทบเมื่อทารกอยู่ในที่เย็น

ระบบหายใจ (Respiratory system)
ทารกในครรภ์ปอดยังไม่ทำหน้าที่หายใจแต่จะมีการเคลื่อนไหวของปอดเล็กน้อย การแลกเปลี่ยนก๊าซจะผ่านทางกระแสเลือดกับมารดาโดยผ่านทางรก และทารกเริ่มหายใจครั้งแรกใน 30 วินาที แรกที่คลอดออกมา ดังนั้นปัญหาของทารกแรกเกิดส่วนใหญ่มักเกิดจากปัญหาทางด้านระบบทางเดินหายใจมากที่สุด

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