Department of Woman's and Child's Health, University of Padua, Azienda Ospedaliera di Padova, Via Giustiniani 3, 35128, Padua, Italy.
Independent statistician, Solagna, Italy.
BMC Pediatr. 2018 Sep 20;18(1):306. doi: 10.1186/s12887-018-1279-4.
Stimulation is the most common intervention during neonatal resuscitation at birth, but scarce information is available on the actual methods, timing and efficacy of this basic step. To evaluate the occurrence, patterns and response to tactile stimulation at birth in a low-resource setting.
We reviewed 150 video recordings of neonatal resuscitation at Beira Central Hospital (Beira, Mozambique). Timing, method, duration and response to tactile stimulation were evaluated.
One hundred two out of 150 neonates (68.0%) received stimulation, while the remaining 48 (32.0%) received positive pressure ventilation and/or chest compressions directly. Overall, 546 stimulation episodes (median 4 episodes per subject, IQR 2-7) were performed. Median time to the first stimulation episode was 134 s (IQR 53-251); 29 neonates (28.4%) received stimulation within the first minute after birth. Multiple techniques of stimulation were administered in 66 neonates (64.7%), while recommended techniques (rubbing the back or flicking the soles of the feet) only in 9 (8.8%). Median duration of stimulation was 17 s (IQR 9-33). Only 9 neonates (8.8%) responded to stimulation.
In a low-resource setting, stimulation of newly born infants at birth is underperformed. Adherence to international guidelines is low, resulting in delayed initiation, inadequate technique, prolonged duration and low response to stimulation. Back rubs may provide some benefits, but large prospective studies comparing different methods of stimulation are required.
刺激是新生儿出生时复苏最常用的干预措施，但关于基本步骤的实际方法、时机和效果的信息很少。本研究旨在评估在资源匮乏的环境中出生时触觉刺激的发生、模式和反应。
我们回顾了莫桑比克贝拉中央医院（贝拉）150 份新生儿复苏的视频记录。评估了触觉刺激的发生、时机、方法、持续时间和反应。
150 例新生儿中有 102 例（68.0%）接受了刺激，而其余 48 例（32.0%）直接接受了正压通气和/或胸外按压。共有 546 次刺激（中位数为每个新生儿 4 次，IQR 2-7）。首次刺激的中位时间为 134 秒（IQR 53-251）；29 例新生儿（28.4%）在出生后 1 分钟内接受了刺激。66 例新生儿（64.7%）采用了多种刺激技术，而仅 9 例（8.8%）采用了推荐技术（背部摩擦或足底拍打）。刺激的中位持续时间为 17 秒（IQR 9-33）。仅有 9 例新生儿（8.8%）对刺激有反应。
在资源匮乏的环境中，新生儿出生时的刺激实施不足。国际指南的遵循率较低，导致刺激的启动延迟、技术不当、持续时间延长，以及对刺激的反应率低。背部摩擦可能会带来一些益处，但需要进行比较不同刺激方法的大型前瞻性研究。
