Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands,
The Ritchie Centre, Hudson Institute for Medical Research, Melbourne, Victoria, Australia.
Neonatology. 2019;115(4):392-397. doi: 10.1159/000497421. Epub 2019 Apr 11.
Noninvasive ventilation for preterm infants at birth has been recommended and universally adopted. The umbilical cord is often clamped immediately in order to provide the support the infant needs for stabilization. However, recent scientific data from experimental studies that involve animals in transition and human studies using physiological measurements at birth have increased awareness as to how little we know about how these interventions interact and integrate with the infant's changing physiology. It has become clear that in apneic infants the larynx is closed immediately after birth, which can completely negate the effect of noninvasive ventilation of the lung. For this reason, stimulating and supporting spontaneous breathing could enhance the success of noninvasive ventilation. Animal data also demonstrated that the large swings in blood pressure, blood flow, and oxygenation caused by immediate cord clamping can be avoided by postponing cord clamping until lung aeration has been established. In this review we will focus on these "game changers" that have the potential to completely change the approach used in stabilizing preterm infants at birth.
推荐并普遍采用了在出生时对早产儿进行无创通气。为了给婴儿提供稳定所需的支持，通常会立即夹住脐带。然而，最近涉及过渡中的动物的实验研究和使用出生时生理测量的人体研究的数据，使人们越来越意识到，我们对这些干预措施如何与婴儿不断变化的生理相互作用和整合知之甚少。很明显，在窒息的婴儿中，声门在出生后立即关闭，这可能完全抵消肺的无创通气的效果。出于这个原因，刺激和支持自发呼吸可以提高无创通气的成功率。动物数据还表明，通过延迟脐带夹闭直到肺部充气建立，可以避免立即夹闭脐带引起的血压、血流和氧合的大幅波动。在这篇综述中，我们将重点关注这些“游戏规则改变者”，它们有可能彻底改变出生时稳定早产儿的方法。
