复苏无活力新生儿：羊水胎粪污染后政策变化影响分析。
Resuscitation of non-vigorous neonates born through meconium-stained amniotic fluid: post policy change impact analysis.
机构信息
Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.
Division of Newborn Medicine, Department of Paediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
出版信息
Arch Dis Child Fetal Neonatal Ed. 2021 May;106(3):324-326. doi: 10.1136/archdischild-2020-319771. Epub 2020 Sep 22.
BACKGROUND
We investigated the impact of policy change in delivery room resuscitation from routine endotracheal (ET) suctioning of non-vigorous neonates born through meconium-stained amniotic fluid (MSAF) to immediate non-invasive respiratory support.
DESIGN
Single-centre cohort study. Prospective group (October 2016-September 2017)-non-vigorous neonates born through MSAF managed according to the current (2015) guidance of commencing respiratory support without prior suctioning. Retrospective group (August 2015-July 2016)-non-vigorous neonates born through MSAF who underwent routine ET suctioning.
RESULTS
1138 neonates born through MSAF were analysed. No differences in the incidence of meconium aspiration syndrome (MAS), requirement of mechanical ventilation, inhaled nitric oxide or surfactant therapy were found between groups. Less neonatal intensive care unit (NICU) admissions were necessary in the prospective cohort compared with the retrospective group (19.1% vs 55.6%, respectively; p<0.05).
CONCLUSION
The policy change towards not routinely suctioning non-vigorous neonates born through MSAF at birth was not associated with an increase in the local incidence of MAS and was associated with fewer NICU admissions.
背景
我们研究了从常规气管内（ET）吸引非活力新生儿羊水胎粪污染（MSAF）到立即进行非侵入性呼吸支持的产房复苏政策变化的影响。
设计
单中心队列研究。前瞻性组（2016 年 10 月至 2017 年 9 月）-根据当前（2015 年）不进行吸痰即可开始呼吸支持的指南管理非活力通过 MSAF 出生的新生儿。回顾性组（2015 年 8 月至 2016 年 7 月）-非活力通过 MSAF 出生且接受常规 ET 吸痰的新生儿。
结果
分析了 1138 例通过 MSAF 出生的新生儿。两组间胎粪吸入综合征（MAS）的发生率、机械通气、吸入一氧化氮或表面活性剂治疗的需求均无差异。与回顾性组相比，前瞻性组新生儿重症监护病房（NICU）的入住率较低（分别为 19.1%和 55.6%；p<0.05）。
结论
在出生时不常规吸引非活力通过 MSAF 出生的新生儿的政策变化与当地 MAS 发生率的增加无关，与较少的 NICU 入院有关。
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