Gaertner Vincent D, Flemmer Sophie A, Lorenz Laila, Davis Peter G, Kamlin C Omar Farouk
Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia.
Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.
Arch Dis Child Fetal Neonatal Ed. 2018 Mar;103(2):F132-F136. doi: 10.1136/archdischild-2016-312311. Epub 2017 Jun 9.
Neonatal resuscitation guidelines recommend that newborn infants are stimulated to assist with the establishment of regular respirations. The mode, site of application and frequency of stimulations are not stipulated in these guidelines. The effectiveness of stimulation in improving neonatal transition outcomes is poorly described.
We conducted a retrospective review of video recordings of neonatal resuscitation at a tertiary perinatal centre. Four different types of stimulation (drying, chest rub, back rub and foot flick) were defined a priori and the frequency and infant response were documented.
A total of 120 video recordings were reviewed. Seventy-five (63%) infants received at least one episode of stimulation and 70 (58%) infants were stimulated within the first minute after birth. Stimulation was less commonly provided to infants <30 weeks' gestation (median (IQR) number of stimulations: 0 (0-1)) than infants born ≥30 weeks' gestation (1 (1-3); p<0.001). The most common response to stimulation was limb movement followed by infant cry and facial grimace. Truncal stimulation (drying, chest rub, back rub) was associated with more crying and movement than foot flicks.
Less mature infants are stimulated less frequently compared with more mature infants and many very preterm infants do not receive any stimulation. Most infants were stimulated within the first minute as recommended in resuscitation guidelines. Rubbing the trunk may be most effective but this needs to be confirmed in prospective studies.
新生儿复苏指南建议刺激新生儿以帮助建立规律呼吸。这些指南未规定刺激的方式、应用部位和频率。关于刺激对改善新生儿过渡结局的有效性描述甚少。
我们对一家三级围产期中心的新生儿复苏视频记录进行了回顾性分析。预先定义了四种不同类型的刺激（擦干、胸部摩擦、背部摩擦和足部轻弹），并记录了频率和婴儿反应。
共回顾了120份视频记录。75名（63%）婴儿至少接受了一次刺激，70名（58%）婴儿在出生后第一分钟内受到刺激。与孕周≥30周的婴儿相比，孕周<30周的婴儿接受刺激的情况较少（刺激次数的中位数（四分位间距）：0（0-1）比1（1-3）；p<0.001）。对刺激最常见的反应是肢体运动，其次是婴儿啼哭和面部 grimace（此处原文可能有误，若为“面部 grimace”可译为“面部表情痛苦”）。躯干刺激（擦干、胸部摩擦、背部摩擦）比足部轻弹引起更多的啼哭和运动。
与成熟度较高的婴儿相比，成熟度较低的婴儿接受刺激的频率较低，许多极早产儿未接受任何刺激。大多数婴儿按照复苏指南的建议在第一分钟内受到刺激。摩擦躯干可能最有效，但这需要在前瞻性研究中得到证实。
