Afjeh Seyyed-Abolfazl, Sabzehei Mohammad-Kazem, Esmaili Fatemeh
Pediatric Infections Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran ; Mahdieh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Hamedan University of Medical Sciences, Hamedan, Iran.
Iran J Pediatr. 2013 Dec;23(6):675-80.
Timely identification and prompt resuscitation of newborns in the delivery room may cause a decline in neonatal morbidity and mortality. We try to identify risk factors in mother and fetus that result in birth of newborns needing resuscitation at birth.
Case notes of all deliveries and neonates born from April 2010 to March 2011 in Mahdieh Medical Center (Tehran, Iran), a Level III Neonatal Intensive Care Unit, were reviewed; relevant maternal, fetal and perinatal data was extracted and analyzed.
During the study period, 4692 neonates were delivered; 4522 (97.7%) did not require respiratory assistance. One-hundred seven (2.3%) newborns needed resuscitation with bag and mask ventilation in the delivery unit, of whom 77 (1.6%) babies responded to bag and mask ventilation while 30 (0.65%) neonates needed endotracheal intubation and 15 (0.3%) were given chest compressions. Epinephrine/volume expander was administered to 10 (0.2%) newborns. In 17 patients resuscitation was continued for >10 mins. There was a positive correlation between the need for resuscitation and following risk factors: low birth weight, preterm labor, chorioamnionitis, pre-eclampsia, prolonged rupture of membranes, abruptio placentae, prolonged labor, meconium staining of amniotic fluid, multiple pregnancy and fetal distress. On multiple regression; low birth weight, meconium stained liquor and chorioamnionitis revealed as independent risk factors that made endotracheal intubation necessary.
Accurate identification of risk factors and anticipation at the birth of a high-risk neonate would result in adequate preparation and prompt resuscitation of neonates who need some level of intervention and thus, reducing neonatal morbidity and mortality.
在产房及时识别并迅速复苏新生儿可能会降低新生儿发病率和死亡率。我们试图确定母亲和胎儿中导致新生儿出生时需要复苏的危险因素。
回顾了2010年4月至2011年3月在伊朗德黑兰马赫迪耶医疗中心（一家三级新生儿重症监护病房）分娩的所有产妇及新生儿的病历；提取并分析了相关的母亲、胎儿及围产期数据。
在研究期间，共分娩4692例新生儿；4522例（97.7%）不需要呼吸辅助。107例（2.3%）新生儿在产房需要用面罩气囊通气进行复苏，其中77例（1.6%）婴儿对面罩气囊通气有反应，30例（0.65%）新生儿需要气管插管，15例（0.3%）接受了胸外按压。10例（0.2%）新生儿使用了肾上腺素/扩容剂。17例患者的复苏持续时间超过10分钟。复苏需求与以下危险因素之间存在正相关：低出生体重、早产、绒毛膜羊膜炎、先兆子痫、胎膜早破、胎盘早剥、产程延长、羊水胎粪污染、多胎妊娠和胎儿窘迫。多元回归分析显示，低出生体重、羊水胎粪污染和绒毛膜羊膜炎是需要气管插管的独立危险因素。
准确识别危险因素并对高危新生儿出生时进行预判，将有助于为需要一定程度干预的新生儿做好充分准备并迅速进行复苏，从而降低新生儿发病率和死亡率。
