Ziino A J, Davies M W, Davis P G
Royal Women's Hospital, Melbourne, Australia, 132 Grattan St, Carlton, Melbourne, Australia.
Cochrane Database Syst Rev. 2003;2002(2):CD003849. doi: 10.1002/14651858.CD003849.
Epinephrine is a cardiac stimulant with complex effects on the heart and blood vessels. It has been used for decades in all age groups to treat cardiac arrest and bradycardia. Despite formal guidelines for the use of epinephrine in neonatal resuscitation, the evidence for these recommendations has not yet been rigorously scrutinised. While it is understood that this evidence is in large part derived from animal models and the adult human population, the contribution from work in the neonatal population remains unclear. In particular, it remains to be determined if any randomised studies in neonates have helped to establish if the administration of epinephrine in the context of apparent stillbirth or extreme bradycardia might influence mortality and morbidity.
bulletTo determine if the administration of epinephrine to apparently stillborn and extremely bradycardic newborns reduces mortality and morbidity Secondary objectives: bulletTo determine the effect of intravenous versus endotracheal administration on mortality and morbidity bulletTo determine the effect of high dose versus standard dose epinephrine on mortality and morbidity, where high dose is defined as any dose greater than the current recommended standard dose of 0.1 to 0.3ml/kg of a 1:10,000 solution of epinephrine bulletTo determine whether the effect of epinephrine on mortality and morbidity varies with gestational age, i.e. term (greater than or equal to 37 weeks) versus pre-term (less than 37 weeks)
Searches were made of Medline from 1966 to December 2002, CINAHL (from 1982), Current Contents (from 1988), EMBASE, and the Cochrane Controlled Trials Register (2002, issue 4). Bibliographies of conference proceedings were reviewed and unpublished studies were sought by hand searching the conference proceedings of the Society for Pediatric Research and the European Society for Pediatric Research from 1993 to 2002.
Randomised and quasi-randomised controlled trials of newborns, both pre-term and term, receiving epinephrine for unexpected apparent stillbirth or extreme bradycardia.
No studies were found meeting the criteria for inclusion in this review
No studies were found meeting the criteria for inclusion in this review.
REVIEWER'S CONCLUSIONS: We found no randomised, controlled trials evaluating the administration of epinephrine to the apparently stillborn or extremely bradycardic newborn infant. Similarly, we found no randomised, controlled trials which addressed the issues of optimum dosage and route of administration of epinephrine. Current recommendations for the use of epinephrine in newborn infants are based only on evidence derived from animal models and the human adult literature. Randomised trials in neonates are urgently required to determine the role of epinephrine in this population.
肾上腺素是一种对心脏和血管有复杂作用的心脏兴奋剂。几十年来，它一直被用于各年龄组治疗心脏骤停和心动过缓。尽管有关于肾上腺素在新生儿复苏中使用的正式指南，但这些建议的证据尚未得到严格审查。虽然人们知道这些证据在很大程度上来自动物模型和成年人群体，但新生儿群体研究的贡献仍不清楚。特别是，对于在明显死产或极度心动过缓情况下给予肾上腺素是否会影响死亡率和发病率，是否有任何新生儿随机研究有助于确定这一点仍有待确定。
项目符号确定对明显死产和极度心动过缓的新生儿给予肾上腺素是否能降低死亡率和发病率 次要目标：项目符号确定静脉注射与气管内给药对死亡率和发病率的影响 项目符号确定高剂量与标准剂量肾上腺素对死亡率和发病率的影响，其中高剂量定义为任何大于当前推荐标准剂量（1:10,000肾上腺素溶液0.1至0.3ml/kg）的剂量 项目符号确定肾上腺素对死亡率和发病率的影响是否随胎龄而变化，即足月儿（大于或等于37周）与早产儿（小于37周）
检索了1966年至2002年12月的Medline、CINAHL（从1982年起）、《现刊目次》（从1988年起）、EMBASE和Cochrane对照试验注册库（2002年第4期）。审查了会议论文集的参考文献，并通过手工检索1993年至2002年儿科研究学会和欧洲儿科研究学会的会议论文集来查找未发表的研究。
对因意外明显死产或极度心动过缓而接受肾上腺素治疗的早产儿和足月儿进行的随机和半随机对照试验。
未找到符合本综述纳入标准的研究。
未找到符合本综述纳入标准的研究。
我们未找到评估对明显死产或极度心动过缓的新生儿给予肾上腺素的随机对照试验。同样，我们也未找到解决肾上腺素最佳剂量和给药途径问题的随机对照试验。目前关于新生儿使用肾上腺素的建议仅基于来自动物模型和成人文献的证据。迫切需要在新生儿中进行随机试验以确定肾上腺素在该人群中的作用。
