Malinowski C
School of Allied Health Professions, Loma Linda University, CA 92350, USA.
Respir Care. 1995 May;40(5):575-86; discussion 586-7.
The need for delivery resuscitation of the newborn cannot be predicted in most cases; therefore it is judicious to train all providers who may be involved in the delivery of newborns to follow guidelines developed to improve outcome, especially in the presence of transitional asphyxia. The Neonatal Resuscitation Program emphasizes basic steps of warming, drying, suctioning, and adequately ventilating the newborn. It also addresses current theories regarding resuscitation of the low birthweight newborns, infants with meconium aspiration, and medication use. The NRP applies to all acute-care hospitals that provide delivery services and those at which a respiratory therapist is likely to be present in the high-risk delivery or unanticipated delivery-room resuscitation. Outcomes have not been well documented and more clinical research is needed to identify which therapeutic strategies promote the best survival in this population. A topic that should be included in the NRP of the future is exogenous surfactant delivery. Respiratory distress syndrome has been a significant cause of death and morbidity in prematurely born neonates. Exogenous surfactant therapy has had a dramatic effect on the death rate of premature infants and on the incidence of respiratory distress syndrome. Current methods of surfactant administration demand that personnel proficient in management of the low birthweight newborn be present. As hospitals with all levels of nurseries continue to receive the prematurely delivered newborn and better methods to administer surfactant are discovered, the NRP could add information and a skills laboratory on surfactant administration. A trained cadre of health professionals who are proficient in the specific resuscitation skills required in pediatric patients can make a difference. The infant and child have different anatomy, physiology, and disease etiology that need to be emphasized and understood by the pediatric caregiver. The Pediatric Advanced Life Support course focuses on early recognition and treatment of respiratory failure and shock. The possibility of improving outcome with properly trained prehospital providers is a topic of interest. Intubation in the field can be successful and may contribute to a reduction in mortality, although complications of field intubation need to be reduced.
在大多数情况下，无法预测新生儿是否需要进行分娩复苏；因此，明智的做法是培训所有可能参与新生儿分娩的医护人员，使其遵循为改善分娩结局而制定的指南，尤其是在出现过渡性窒息的情况下。新生儿复苏项目强调对新生儿进行保暖、擦干、吸痰和充分通气的基本步骤。它还涉及当前有关低出生体重新生儿、胎粪吸入婴儿的复苏及药物使用的理论。新生儿复苏项目适用于所有提供分娩服务的急症医院，以及那些在高危分娩或意外的产房复苏中可能有呼吸治疗师在场的医院。目前尚未有充分的结局记录，需要更多的临床研究来确定哪些治疗策略能使这一群体获得最佳的存活率。未来的新生儿复苏项目应纳入的一个主题是外源性表面活性剂的应用。呼吸窘迫综合征一直是早产新生儿死亡和发病的重要原因。外源性表面活性剂疗法对早产儿死亡率和呼吸窘迫综合征的发病率产生了显著影响。目前的表面活性剂给药方法要求有精通低出生体重新生儿管理的人员在场。随着各级育婴室的医院继续接收早产新生儿，并且发现了更好的表面活性剂给药方法，新生儿复苏项目可以增加有关表面活性剂给药的信息和技能培训。一批精通儿科患者所需特定复苏技能的训练有素的卫生专业人员能够发挥重要作用。婴儿和儿童有不同的解剖结构、生理机能和疾病病因，儿科护理人员需要对此加以强调并理解。儿科高级生命支持课程侧重于呼吸衰竭和休克的早期识别与治疗。经过适当培训的院前急救人员有可能改善结局，这是一个值得关注的话题。现场插管可以成功，可能有助于降低死亡率，不过需要减少现场插管的并发症。
