Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
The Ritchie Center, MIMR-PHI Institute of Medical Research, Melbourne, Australia.
Resuscitation. 2018 Jun;127:37-43. doi: 10.1016/j.resuscitation.2018.03.030. Epub 2018 Mar 23.
To evaluate the direct effect of repetitive tactile stimulation on breathing effort of preterm infants at birth.
This randomized controlled trial compared the effect of repetitive stimulation on respiratory effort during the first 4 min after birth with standard stimulation based on clinical indication in preterm infants with a gestational age of 27-32 weeks. All details of the stimulation performed were noted. The main study parameter measured was respiratory minute volume, other study parameters assessed measures of respiratory effort; tidal volumes, rate of rise to maximum tidal volumes, percentage of recruitment breaths, and oxygenation of the infant.
There was no significant difference in respiratory minute volume in the repetitive stimulation group when compared to the standard group. Oxygen saturation was significantly higher (87.6 ± 3.3% vs 81.7 ± 8.7%, p = .01) while the amount of FiO given during transport to the NICU was lower (28.2 (22.8-35.0)% vs 33.6 (29.4-44.1)%, p = .04). There was no significant difference in administration of positive pressure ventilation (52% vs 78%, p = .13), or the duration of ventilation (median (IQR) time 8 (0-118)s vs 35 (13-131)s, p = .23). Caregivers decided less often to administer caffeine in the delivery room to stimulate breathing in the repetitive stimulation group (10% vs 39%, p = .036).
Although the increase in respiratory effort during repetitive stimulation did not reach significance, oxygenation significantly improved with a lower level of FiO at transport to the NICU. Repetitive tactile stimulation could be of added value to improve breathing effort at birth.
评估重复触觉刺激对 27-32 孕周早产儿出生时呼吸努力的直接影响。
本随机对照试验比较了 27-32 孕周早产儿出生后 4 分钟内重复刺激与基于临床指征的标准刺激对呼吸努力的影响。记录了所有刺激的详细信息。主要研究参数为呼吸分钟量，其他研究参数评估呼吸努力的措施；潮气量、最大潮气量上升率、募集呼吸百分比和婴儿氧合。
与标准组相比，重复刺激组的呼吸分钟量无显著差异。氧饱和度显著升高（87.6±3.3% vs 81.7±8.7%，p=0.01），而转运至新生儿重症监护病房（NICU）时给予的 FiO 量较低（28.2（22.8-35.0）% vs 33.6（29.4-44.1）%，p=0.04）。接受正压通气（52% vs 78%，p=0.13）或通气时间（中位数（IQR）时间 8（0-118）s vs 35（13-131）s，p=0.23）无显著差异。在重复刺激组，护理人员在分娩室决定给予咖啡因以刺激呼吸的次数较少（10% vs 39%，p=0.036）。
尽管重复刺激引起的呼吸努力增加没有达到显著性，但转运至 NICU 时 FiO 水平较低，氧合显著改善。重复触觉刺激可能对改善出生时的呼吸努力有额外的价值。
