Baik-Schneditz Nariae, Pichler Gerhard, Schwaberger Bernhard, Mileder Lukas, Avian Alexander, Urlesberger Berndt
Division of Neonatology, Department of Paediatrics, Medical University of Graz, Graz, Styria, Austria.
Research Unit for Neonatal Micro- and Macrocirculation, Department of Paediatrics, Medical University of Graz, Graz, Styria, Austria.
Front Pediatr. 2017 Aug 10;5:171. doi: 10.3389/fped.2017.00171. eCollection 2017.
Current European Guideline for resuscitation recommends a centrally positioned umbilical venous catheter as the best option for administering necessary drugs. Especially in preterm infants, a frequently used alternative is the peripheral venous catheter.
Two randomized controlled studies were conducted at the Division of Neonatology, Medical University of Graz. During neonatal resuscitation, a standardized protocol was filled out by an uninvolved observer including time points after birth of all attempts of venous puncture, time point of successful venous puncture, and total number of needed attempts. Arterial oxygen saturation (SpO) and heart rate (HR) were measured using pulse oximetry at the right hand/wrist. In each neonate, either NIRO 200NX (Hamamatsu, Japan) or INVOS 5100C (Covidien-Medtronic, USA) were used to measure cerebral tissue oxygenation index (cTOI) and cerebral regional oxygen saturation (crSO), respectively. SpO, HR, and cTOI/crSO during and 1 min before and after successful venous punctures were analyzed.
70 protocols were reviewed. Data of 61 preterm neonates were analyzed. Mean gestational age was 31.5 ± 2.2 weeks, and the mean birth weight was 1,527 ± 541 g. In median, it needed one attempt [interquartile range (IQR) 1-2] to establish a peripheral venous catheter. In median, intravenous (IV) catheterization was successfully established 5 (IQR 4-9) min after birth. SpO and cTOI/crSO rose significantly following the percentiles during the first 10 min after the birth. HR did not change significantly.
Peripheral IV catheterization during postnatal stabilization of preterm infants is feasible and successful in most of the cases at first attempt.
当前欧洲复苏指南推荐将中心位置的脐静脉导管作为给予必要药物的最佳选择。尤其是在早产儿中，常用的替代方法是外周静脉导管。
在格拉茨医科大学新生儿科进行了两项随机对照研究。在新生儿复苏期间，由一名不相关的观察者填写标准化方案，包括出生后所有静脉穿刺尝试的时间点、成功静脉穿刺的时间点以及所需尝试的总数。使用脉搏血氧仪在右手/手腕处测量动脉血氧饱和度（SpO）和心率（HR）。在每个新生儿中，分别使用NIRO 200NX（日本滨松）或INVOS 5100C（美国科惠力-美敦力）测量脑组织氧合指数（cTOI）和脑局部氧饱和度（crSO）。分析成功静脉穿刺期间以及穿刺前1分钟和穿刺后1分钟的SpO、HR和cTOI/crSO。
审查了70份方案。分析了61例早产儿的数据。平均胎龄为31.5±2.2周，平均出生体重为1527±541克。建立外周静脉导管的中位数为1次尝试[四分位间距（IQR）1 - 2]。静脉插管在出生后中位数5（IQR 4 - 9）分钟成功建立。出生后的前10分钟内，SpO和cTOI/crSO随百分位数显著上升。HR没有显著变化。
早产儿出生后稳定期的外周静脉插管在大多数情况下首次尝试是可行且成功的。
