Oude Alink Michelle B, Moors Xavier R J, de Jonge Rogier C J, Hartog Dennis Den, Houmes Robert Jan, Stolker Robert Jan
Department of Anaesthesiology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Anaesthesiology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands; Helicopter Emergency Medical Services, Erasmus University Medical Center, Rotterdam, The Netherlands.
Air Med J. 2020 Nov-Dec;39(6):489-493. doi: 10.1016/j.amj.2020.08.002. Epub 2020 Aug 20.
Emergency medical service (EMS) is responsible for prehospital care encompassing all ages, irrespective of injury cause or medical condition, which includes peripartum emergencies. When patients require care more advanced than the level provided by the national EMS protocol, an EMS physician-staffed Dutch helicopter emergency medical service (HEMS) may be dispatched. In the Netherlands in 2016, there were 21.434 planned home births guided by midwives alone without further obstetric assistance, accounting for 12.7% of all births that year. However, there are no clear data available thus far regarding neonates requiring emergency care with or without HEMS assistance. This article reviews neonates during our study period who received medical care after birth by HEMS.
A retrospective chart review was performed including neonates born on the day of the dispatch between January 2012 and December 2017 who received additional medical care from the Rotterdam HEMS.
Fifty-two neonates received medical care by HEMS. The majority (73.1%) were full-term (Gestational age > 37 weeks). Home delivery was intended in 63.5%, 20% of whom experienced an uncomplicated delivery but had a poor start of life. The majority of unplanned deliveries (n = 17) were preterm (70.6%). Two were born by resuscitative hysterotomy; 1 survived in good neurologic condition, and the other died at the scene. Fifteen neonates (28.9%) required cardiopulmonary resuscitation; in 2 cases, no resuscitation was started on medical grounds, and 12 of the other 13 resuscitated neonates regained return of spontaneous circulation. In 33 (63.5%) of the neonates, respiratory interventions were required; 8 (15.4%) were intubated before transport. Death was confirmed in 5 (9.6%) neonates, all preterm.
During the study period, 52 neonates required medical assistance by HEMS. The 5 infants who died were all preterm. In this cohort, adequate basic life support was implemented immediately after birth either by the attending midwife, EMS, or HEMS on arrival. This suggests that prehospital first responders know the basic skills of neonatal life support.
紧急医疗服务（EMS）负责为包括所有年龄段的患者提供院前护理，无论损伤原因或医疗状况如何，其中包括围产期紧急情况。当患者需要的护理超出国家EMS协议所提供的水平时，可能会派遣配备医生的荷兰直升机紧急医疗服务（HEMS）。2016年在荷兰，有21434例仅由助产士指导的计划在家分娩，没有进一步的产科协助，占该年所有分娩的12.7%。然而，到目前为止，尚无关于需要或不需要HEMS协助的新生儿紧急护理的明确数据。本文回顾了我们研究期间由HEMS在出生后提供医疗护理的新生儿情况。
进行了一项回顾性病历审查，纳入2012年1月至2017年12月期间在派遣当天出生、并接受鹿特丹HEMS额外医疗护理的新生儿。
52例新生儿接受了HEMS的医疗护理。大多数（73.1%）为足月儿（胎龄>37周）。63.5%的分娩计划在家中进行，其中20%的分娩过程顺利，但出生后情况不佳。大多数非计划分娩（n = 17）为早产儿（70.6%）。2例通过复苏性子宫切开术出生；1例存活且神经功能良好，另1例在现场死亡。15例新生儿（28.9%）需要心肺复苏；2例因医学原因未开始复苏，其他13例复苏的新生儿中有12例恢复了自主循环。33例（63.5%）新生儿需要呼吸干预；8例（15.4%）在转运前进行了插管。5例（9.6%）新生儿被确认死亡，均为早产儿。
在研究期间，52例新生儿需要HEMS的医疗协助。死亡的5例婴儿均为早产儿。在该队列中，出生后立即由在场的助产士、EMS或到达现场的HEMS实施了充分的基本生命支持。这表明院前急救人员掌握新生儿生命支持的基本技能。
