Center for Neonatal Care and the Department of Neonatology, Florida Hospital for Children, Orlando, Florida 32804, USA.
Respir Care. 2011 Sep;56(9):1360-7; discussion 1367-8. doi: 10.4187/respcare.01433.
Resuscitation of newborn infants occurs in approximately 10% of the more than 100 million infants born annually worldwide. The techniques used during resuscitation, such as positive-pressure ventilation and supplemental oxygen, may revive many infants, but have the potential to harm their lungs. In recent years increasing attention has been applied to providing lung protection from the first breath. This paper reviews the currently available medical evidence concerning modifying aspects of delivery room management that are thought to mitigate lung injury. These include: F(IO(2)) < 1.0; early use of continuous positive airway pressure (CPAP) and PEEP; optimizing pressure and/or volume during ventilation; sustained inflations; need for and timing of surfactant therapy; and airway management of meconium-stained amniotic fluid. Although the evidence against 100% oxygen use is of low quality, it has been enough to alter the recommendations for oxygen use in the delivery room. It is suggested (not mandated) to use room air initially when resuscitating a term-gestation infant, and to use F(IO(2)) < 1.0 in premature infants, with F(IO(2)) adjustments depending on oximetry values. Recent studies have not indicated better outcomes in premature infants in whom CPAP or PEEP is applied in the delivery room. Optimal peak ventilatory pressure and tidal volume have yet to be delineated. Although an intriguing therapy, sustained inflations have not been shown to markedly improve outcomes. Prophylactic use of surfactant in small, premature infants remains the accepted standard. Immediate placement on CPAP after surfactant instillation has yet to demonstrate clear-cut advantages. Finally, intrapartum oropharyngeal and nasopharyngeal suctioning of meconium-stained amniotic fluid does not improve outcomes in meconium-stained infants. Moreover, routine intubation and intratracheal suctioning of apparently vigorous meconium-stained infants do not improve outcomes. In summary, although multiple therapies are touted as protecting the lungs in the delivery room "from the first breath," to date there are scant supportive data.
全世界每年有超过 1 亿名婴儿出生，其中约有 10%需要进行复苏。复苏过程中使用的正压通气和补充氧气等技术可以使许多婴儿复苏，但也有可能对其肺部造成伤害。近年来，人们越来越关注从第一口气开始提供肺部保护。本文综述了目前关于改变产房管理方面的医学证据，这些方面被认为可以减轻肺损伤。这些方面包括：吸入氧浓度（F(IO(2))）<1.0；早期使用持续气道正压通气（CPAP）和呼气末正压（PEEP）；通气时优化压力和/或容量；持续膨胀；表面活性物质治疗的需求和时机；以及胎粪污染羊水的气道管理。尽管使用 100%氧气的证据质量较低，但足以改变产房内使用氧气的建议。建议（非强制）在复苏足月婴儿时最初使用空气，在早产儿中使用 F(IO(2))<1.0，并根据氧饱和度值调整 F(IO(2))。最近的研究并未表明在产房内应用 CPAP 或 PEEP 的早产儿有更好的结局。最佳的峰值通气压力和潮气量尚未确定。尽管持续膨胀是一种有趣的治疗方法，但尚未表明其明显改善结局。预防性使用表面活性物质治疗小早产儿仍然是公认的标准。在表面活性物质注入后立即放置 CPAP 尚未显示出明显的优势。最后，胎粪污染羊水的产时口咽和鼻咽抽吸并不能改善胎粪污染婴儿的结局。此外，对明显有活力的胎粪污染婴儿进行常规插管和气管内抽吸并不能改善结局。总之，尽管有多种治疗方法被吹捧为在产房“从第一口气开始”保护肺部，但迄今为止，支持这些方法的数据很少。
