乌干达复苏新生儿出生后的血氧饱和度：一项基于视频的观察性研究。
Oxygen saturation after birth in resuscitated neonates in Uganda: a video-based observational study.
机构信息
Paediatric Department, Queen Silvia's Hospital for Children and Young People, Gothenburg, Sweden.
Centre for International Health, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
出版信息
BMJ Paediatr Open. 2022 Jan;6(1). doi: 10.1136/bmjpo-2021-001225.
BACKGROUND
Monitoring of peripheral capillary oxygen saturation (SpO) during neonatal resuscitation is standard of care in high-resource settings, but seldom performed in low-resource settings. We aimed to measure SpO and heart rate during the first 10 min of life in neonates receiving positive pressure ventilation (PPV) according to the Helping Babies Breathe (HBB) protocol and compare results with SpO and heart rate targets set by the American Heart Association (AHA).
METHODS
A cross-sectional study was conducted at Mulago National Referral Hospital, Kampala, Uganda, as a substudy of the NeoSupra Trial. SpO and heart rate were measured on apnoeic neonates (≥34 weeks) who received PPV according to HBB (room air). Those who remained distressed after PPV received supplemental oxygen (O). All resuscitations were video recorded and data were extracted by video review at 1 min intervals until 10 min post partum. Data were analysed for all observations and separately for only observations before and during PPV.
RESULTS
49 neonates were analysed. Median SpO at 5 min (n=39) was 67% (49-88) with 59% of the observations below AHA target of 80%. At 10 min median SpO (n=44) was 93% (80-97) and 32% were below AHA target of 85%. When only observations before and during PPV were analysed, median SpO at 5 min (n=18) was 52% (34-66) and 83% were below AHA target. At 10 min (n=15), median SpO was 72% (57-89) and 67% were below AHA target. Median heart rates were above AHA target of 100 beats/min at all time intervals.
CONCLUSIONS
A high proportion of neonates resuscitated with PPV after birth failed to reach the AHA SpO target in this small sample, implying an increased risk of hypoxic-ischaemic encephalopathy. Further studies in low-resource settings are needed to evaluate baseline data and the need for supplemental O and optimal SpO during PPV.
TRIAL REGISTRATION NUMBER
This is a substudy to the trial 'Neonatal Resuscitation with Supraglottic Airway Trial (NeoSupra)'; ClinicalTrials.gov Registry (NCT03133572).
背景
在高资源环境中，监测新生儿复苏期间外周毛细血管氧饱和度（SpO）是标准的护理措施，但在低资源环境中很少进行。我们的目的是测量根据《帮助婴儿呼吸》（HBB）方案接受正压通气（PPV）的新生儿在生命的前 10 分钟内的 SpO 和心率，并将结果与美国心脏协会（AHA）设定的 SpO 和心率目标进行比较。
方法
这是乌干达坎帕拉穆拉戈国家转诊医院进行的一项横断面研究，是《新生儿超音波试验》（NeoSupra Trial）的子研究。对接受 HBB（空气）的无呼吸新生儿（≥34 周）进行 SpO 和心率测量。那些在接受 PPV 后仍感到不适的婴儿接受补充氧气（O）。所有复苏均进行视频记录，并在 1 分钟间隔进行视频回顾以提取数据，直到产后 10 分钟。对所有观察值进行分析，并分别对仅在接受 PPV 之前和期间的观察值进行分析。
结果
共分析了 49 名新生儿。5 分钟时（n=39）中位数 SpO 为 67%（49-88），59%的观察值低于 AHA 目标 80%。10 分钟时中位数 SpO（n=44）为 93%（80-97），32%低于 AHA 目标 85%。仅分析接受 PPV 之前和期间的观察值时，5 分钟时中位数 SpO（n=18）为 52%（34-66），83%低于 AHA 目标。10 分钟时中位数 SpO 为 72%（57-89），67%低于 AHA 目标。所有时间间隔内的中位数心率均高于 AHA 目标 100 次/分钟。
结论
在这个小样本中，接受 PPV 复苏的新生儿中有很大比例未能达到 AHA 的 SpO 目标，这意味着发生缺氧缺血性脑病的风险增加。需要在低资源环境中进行进一步的研究，以评估基线数据以及在接受 PPV 时补充 O 和最佳 SpO 的需求。
试验注册
这是《新生儿复苏与声门上气道试验》（NeoSupra）试验的子研究；ClinicalTrials.gov 注册号（NCT03133572）。
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