Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
Resuscitation. 2012 Sep;83(9):1135-9. doi: 10.1016/j.resuscitation.2012.01.036. Epub 2012 Feb 6.
To evaluate compliance with neonatal resuscitation guidelines during resuscitation of preterm infants by video recording of delivery room management and monitoring physiologic parameters.
The delivery room management of preterm infants at birth was recorded by an independent researcher. Physiological parameters (airway pressures, gas flow, tidal volume, heart rate and oxygen saturation) were measured, use of supplemental oxygen was noted and a video of the resuscitation was recorded. All signals were digitised and recorded using specially designed software. The delivery room management was then evaluated and compared with the local resuscitation guidelines.
Thirty-four infants were included with a mean (SD) gestational age of 30.6 (3.2) weeks and birth weight of 1292 (570) g. Time from birth to initial evaluation was longer than recommended (65 (15) s). Respiratory support was started at 70 (23) s. In 7/34 infants (21%), interventions were performed according to guidelines. In 25/34 infants (74%), one or more respiratory interventions were not performed according to guidelines. In 10/34 infants (29%), one or more non-respiratory interventions (mainly related to the prevention of heat loss) were not performed according to guidelines. The presence and adequacy of spontaneous breathing was difficult to judge clinically. In almost all occasions (96%) the information from the respiratory function monitor was not used.
Neonatal caregivers often deviate from resuscitation guidelines. Respiratory function monitoring parameters were often not used during resuscitation. A difficult part of neonatal resuscitation is subjectively assessing spontaneous breathing.
通过记录分娩室管理和监测生理参数的视频，评估早产儿复苏时对新生儿复苏指南的依从性。
由独立研究者记录早产儿出生时的分娩室管理情况。测量生理参数（气道压力、气流、潮气量、心率和血氧饱和度），记录补充氧气的使用情况，并录制复苏过程的视频。所有信号均使用专门设计的软件进行数字化和记录。然后对分娩室管理进行评估，并与当地复苏指南进行比较。
共纳入 34 例婴儿，平均（SD）胎龄为 30.6（3.2）周，出生体重为 1292（570）g。从出生到首次评估的时间长于推荐时间（65（15）s）。呼吸支持在 70（23）s 时开始。在 7/34 例（21%）婴儿中，根据指南进行了干预。在 25/34 例（74%）婴儿中，未根据指南进行一项或多项呼吸干预。在 10/34 例（29%）婴儿中，未根据指南进行一项或多项非呼吸干预（主要与预防热量散失有关）。临床上很难判断自主呼吸的存在和充分性。几乎在所有情况下（96%），都没有使用呼吸功能监测器的信息。
新生儿护理人员经常偏离复苏指南。在复苏过程中，呼吸功能监测参数经常未被使用。新生儿复苏的一个难点是主观评估自主呼吸。
