Lista G, Castoldi F
NICU Ospedale dei Bambini V. Buzzi, ICP Milano, Italy.
Minerva Pediatr. 2010 Jun;62(3 Suppl 1):17-8.
At birth the transition by the fetal situation to neonatal life occurs. The real mechanism of lung liquid reabsorption and lung aereation at birth, in the past attributed only to the epithelial sodium channel function, has recently been linked to the first important breaths too and to the following changes in transpulmonary pressure. If this quite easily happens in the term baby, the preterm infants and all the babies with poor respiratory effort may have a delayed achievement of an adequate functional residual capacity (FRC). Premature delivery is always associated to the failure of respiratory transition and preterm babies frequently need a respiratory support (e.g., N-CPAP). Actual recommendations do not consider to mimic the physiologic changes that usually happen to the term neonate at birth. The application at birth of the sustained lung inflation (SLI) (a peak pressure of 25-30 cm H2O for 10-20 seconds), with nasopharyngeal tube or an adequately sized mask and a Neo-puff device, followed by the application of a continuous adequate PEEP (e.g., 5 cmH2O) is effective in the achievement of the FRC in animal studies and in the reduction of the need of mechanical ventilation (MV) in preterm infants at risk for RDS. Large RCTs are needed to verify the real efficacy of SLI in the delivery room to prevent the need of mechanical ventilation and to improve respiratory outcomes of preterm infants at risk for RDS.
出生时会发生从胎儿状态到新生儿生活的转变。过去认为出生时肺液重吸收和肺通气的真正机制仅归因于上皮钠通道功能，最近也与最初的重要呼吸以及随后跨肺压的变化有关。如果足月婴儿很容易发生这种情况，那么早产儿和所有呼吸努力不佳的婴儿可能会延迟达到足够的功能残气量（FRC）。早产总是与呼吸转变失败相关，早产儿经常需要呼吸支持（例如，鼻塞持续气道正压通气）。目前的建议并未考虑模拟足月新生儿出生时通常发生的生理变化。在出生时使用持续肺膨胀（SLI）（25 - 30 cm H₂O的峰值压力持续10 - 20秒），通过鼻咽管或尺寸合适的面罩以及新生儿复苏气囊装置，随后应用持续适当的呼气末正压通气（例如，5 cmH₂O），在动物研究中对于实现功能残气量以及降低有呼吸窘迫综合征风险的早产儿机械通气（MV）需求是有效的。需要大型随机对照试验来验证持续肺膨胀在产房预防机械通气需求以及改善有呼吸窘迫综合征风险的早产儿呼吸结局方面的实际疗效。
