Neonatal resuscitation

At birth approximately 10 % of term or near-term neonates require initial stabilization maneuvers to establish a cry or regular breathing, maintain a heart rate greater than 100 beats per minute (bpm), and good color and muscular tone. About 1 % requires ventilation and very few infants receive chest compressions or medication. However, birth asphyxia is a worldwide problem and can lead to death or serious sequelae. Recently, the European Resuscitation Council (ERC) and the International Liaison Committee on Resuscitation (ILCOR) published new guidelines on resuscitation at birth. These guidelines review specific questions such as the use of air or 100 % oxygen in the delivery room, dose and routes of adrenaline delivery, the peripartum management of meconium-stained amniotic fluid, and temperature control. Assisted ventilation in preterm infants is briefly described. New devices to improve the care of newborn infants, such as the laryngeal mask airway or CO2 detectors to confirm tracheal tube placement, are also discussed. Significant changes have occurred in some practices and are included in this document.     

新生儿复苏指南

第一部分 指南目标和原则 一、确保每次分娩时至少有1名熟练掌握新生儿复苏技术的医护人员在场。二、加强产儿科合作,在高危产妇分娩前儿科医师要参加分娩或手术前讨论;在产床前等待分娩及实施复苏;负责复苏后新生儿的监护和查房等。产儿科医师共同保护胎儿向新生儿的平稳过渡。三、在卫生行政领导干预下将复苏指南及常规培训制度化,以进行不断的培训、复训、定期考核,并配备复苏器械;各级医院须建立由行政管理人员、产科、儿科医师、助产士（师）及麻醉师组成的院内复苏领导小组。四、在ABCDE复苏原则下,新生儿复苏可分为4个步骤：（1）快速评估和初步复苏;（2）正压通气和氧饱和度监测;（3）气管插管正压通气和胸外按压;（4）药物和/或扩容。第二部分新生儿复苏指南一、复苏准备 1. 每次分娩时有1名熟练掌握新生儿复苏技术的医护人员在场,其职责是照料新生儿。 2. 复苏1名严重窒息儿需要儿科医师和助产士（师）各1人。 3. 多胎分娩的每名新生儿都应由专人负责。 4. 复苏小组每个成员需有明确的分工,均应具备熟练的复苏技能。 5．新生儿复苏设备和药品齐全,单独存放,功能良好。     

Neonatal resuscitation capacity in Nepal

Aim: Perinatal asphyxia is a major contributor to the nearly 4 million neonatal deaths worldwide each year in resource‐limited settings. Neonatal resuscitation, a proven method for preventing newborn deaths, is effective only when local caregivers have proper training and access to essential supplies. There are few published data describing neonatal resuscitation capacity in Nepal, where neonatal mortality rates are high. The goal of this study was to quantify neonatal resuscitation capacity at birthing sites in urban and rural Nepal. Methods: Seventeen birth centres ranging from tertiary care hospitals to rural health posts were evaluated. Assessments included standardised interviews of health‐care workers and evaluation of newborn resuscitation areas. The availability of essential resuscitation tools was recorded. Results: Eleven of the 17 health centres conducted deliveries on‐site. Of those, 45% had posted and visible resuscitation algorithms; 72% had infant warmers; 91% had mechanical suction machines; 36% had bulb suctions and 82% had bag‐mask ventilation devices available. Tertiary hospitals were much better equipped compared with smaller health centres. None of the health‐care workers who attended home deliveries had access to algorithms, warming devices, suction or bag‐mask ventilation devices. Conclusions: Availability of appropriate resuscitation supplies was variable in health centres providing delivery services on‐site and was severely deficient among health staff attending to home deliveries. Limited availability of resuscitation equipment may contribute to the high neonatal mortality rates seen in Nepal. Sustainable training programmes and distribution of neonatal resuscitation equipment are critical priorities in this region.     

Neonatal resuscitation: raising the bar

PURPOSE OF REVIEW: To provide an overview of neonatal resuscitation practices with an emphasis on interventions that are not currently accepted or adapted into existing resuscitation guidelines. RECENT FINDINGS: Current resuscitation guidelines do not contain specific guidelines for the approach to the extremely low birth weight infant. The differences in environment and management between the neonatal ICU and delivery room are striking and are magnified in the resuscitation of extremely low birth weight infants for whom maintenance of a neutral thermal environment is essential. The use of a polyethylene wrap applied at delivery has been shown to reduce the occurrence of hypothermia and decrease mortality. There is substantial evidence that term and near-term newborn infants can be effectively resuscitated with room air, and recent follow-up studies have demonstrated that this approach is not associated with increased significant differences in neurologic handicap, somatic growth, or developmental milestones when compared with the use of 100% oxygen. The safety and potential benefits of this approach require prospective evaluation in the premature and especially extremely low birth weight infant. There is preexisting evidence that demonstrates that the use of prolonged inflations and t-piece resuscitators may be advantageous during resuscitation, but not all guidelines support these interventions. Although regulated continuous positive airway pressure, pulse oximeters, and blenders are routinely used once an infant is admitted to the neonatal ICU, none of these interventions is recommended in the delivery area. Although prospective studies have demonstrated that the use of colorimetric CO2 detectors significantly decreases the time to recognize misplaced endotracheal tubes placed during resuscitation, their use is not required by current guidelines. The duration of an intubation attempt during resuscitation had never been prospectively evaluated, and our recent findings suggest that a limit of 30 seconds is well tolerated and provides adequate time for a successful attempt. SUMMARY: There is significant potential for improvement in current resuscitation environments and interventions that will only be realized through further prospective research.     

新生儿心肺复苏：血流动力学的关键作用

研究表明,约10％的新生儿需要帮助其建立有效通气,而仅有0．1％的新生儿需要心肺复苏（CPR）或复苏药物的干预,其中以早产儿居多。最近一项研究表明,在一个具备训练有素复苏队伍的Ⅲ级医疗中心,仅有0．6％的新生儿在复苏中需用肾上腺素。     

新生儿心肺复苏:血流动力学的关键作用

研究表明,约10%的新生儿需要帮助其建立有效通气,而仅有0.1%的新生儿需要心肺复苏(CPR)或复苏药物的干预,其中以早产儿居多。最近一项研究表明,在一个具备训练有素复苏队伍的Ⅲ级医疗中心,仅有0.6%的新生儿在复苏中需用肾上腺素。该研究指出,在复苏过程中需用肾上腺素的新生儿其死亡率高达41%,且近期会发生神经系统疾病(57%缺氧缺血性脑病和癫疒间)。延长胸外按压及使用肾上腺素10min后仍无生命体征的新生儿死亡率高达83%,而存活者约93%留有中到重度后遗症。在产房内实施胸外按压和(或)联合药物复苏所带来的不良后果使学者开始思考:是否要为新生儿CPR制定胸外按压及药物应用的最佳方案。因无法预     

Neonatal cardiopulmonary resuscitation project in Japan

In July 2007, the Neonatal Cardiopulmonary Resuscitation (NCPR) program in Japan was launched to ensure that all staff involved in perinatal and neonatal medicine can learn and practice NCPR based on the Consensus on Science with Treatment Recommendations developed by the International Liaison Committee on Resuscitation. In 1978 in North America, a working group on pediatric resuscitation was formed by the American Heart Association Emergency Cardiac Care Committee and concluded that the resuscitation of newborns required a different strategy than the resuscitation of adults. The original first edition of the Neonatal Resuscitation Program textbook was published in 1987. The NCPR program consists of three courses for health‐care providers and two courses for instructors. A course and B course are for newly certified health‐care providers and course S is for health‐care providers who are renewing their certification. As of 31 March 2019, 3,227 advanced instructors (I instructor) and 1,877 basic instructors (J instructor) were trained to teach A, B, and S courses to health‐care providers on the basis of their license. In total 7,075 A courses and 4,012 B courses were held; 131 651 people attended A course or B course of the NCPR program, and 77 367 were certified. A total of 1,865 S courses, which were developed in 2015, were held and 12 875 people attended this course. Here, we introduce the background, purpose, history, and content of the development of the NCPR program in Japan.     

新生儿复苏指南(2011年北京修订)

第一部分指南目标和原则一、确保每次分娩时至少有1名熟练掌握新生儿复苏技术的医护人员在场.二、加强产儿科合作,在高危产妇分娩前儿科医师要参加分娩或手术前讨论;在产床前等待分娩及实施复苏;负责复苏后新生儿的监护和查房等.产儿科医师共同保护胎儿,完成向新生儿的平稳过渡.     

Neonatal resuscitation in delivery room: new advances]

The need for resuscitation of a distressed newborn in delivery room is more and more easily predictable. The two principal reasons are improvement of obstetrical survey and best perinatal regionalisation. Perinatal asphyxia and premature labour, especially before 32 weeks of gestational age, are the more frequent situation needing resuscitation at birth. A good survey of pregnancy and labor, verification of availability and efficiency of care devices and material in the delivery room are essential. In all guidelines respiratory resuscitation is today the priority in the first minutes. Non invasive positive pressure ventilation and early use of exogenous surfactant are the recent advances for the care of very premature baby in delivery room. Having a neonatal ventilator and pulse oximetry monitoring is recommended and can improve results. For the pregnant woman and the baby, maternal transfer if no contra-indications exist and when it is possible, is preferred to postnatal transportation in case of very premature labor or high risk pregnancy. In all the other situations neonatal transport must be strictly organised and realised by well-trained pediatric team, with adapted material and in the best conditions for security and comfort. The goal is to prevent any rupture until arrival in the referring neonatal intensive car unit.