Berkelhamer Sara K, Vali Payam, Nair Jayasree, Gugino Sylvia, Helman Justin, Koenigsknecht Carmon, Nielsen Lori, Lakshminrusimha Satyan
Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States.
Department of Pediatrics, University California Davis School of Medicine, Sacramento, CA, United States.
Front Pediatr. 2022 Feb 21;10:828130. doi: 10.3389/fped.2022.828130. eCollection 2022.
Over half a million newborn deaths are attributed to intrapartum related events annually, the majority of which occur in low resource settings. While progress has been made in reducing the burden of asphyxia, novel approaches may need to be considered to further decrease rates of newborn mortality. Administration of intravenous, intraosseous or endotracheal epinephrine is recommended by the Newborn Resuscitation Program (NRP) with sustained bradycardia at birth. However, delivery by these routes requires both advanced skills and specialized equipment. Intramuscular (IM) epinephrine may represent a simple, low cost and highly accessible alternative for consideration in the care of infants compromised at birth. At present, the bioavailability of IM epinephrine in asphyxia remains unclear.
Four term fetal lambs were delivered by cesarean section and asphyxiated by umbilical cord occlusion with resuscitation after 5 min of asystole. IM epinephrine (0.1 mg/kg) was administered intradeltoid after 1 min of positive pressure ventilation with 30 s of chest compressions. Serial blood samples were obtained for determination of plasma epinephrine concentrations by ELISA.
Epinephrine concentrations failed to increase following administration IM injection. Delayed absorption was observed after return of spontaneous circulation (ROSC) in half of the studies.
Inadequate absorption of epinephrine occurs with IM administration during asphyxial cardiac arrest, implying this route would be ineffective in infants who are severely compromised at birth. Late absorption following ROSC raises concerns for risks of side effects. However, the bioavailability and efficacy of intramuscular epinephrine in less profound asphyxia may warrant further evaluation.
每年有超过50万例新生儿死亡归因于分娩期相关事件，其中大多数发生在资源匮乏地区。虽然在减轻窒息负担方面已取得进展，但可能需要考虑采用新方法以进一步降低新生儿死亡率。新生儿复苏项目（NRP）建议在出生时出现持续性心动过缓时静脉注射、骨内注射或气管内注射肾上腺素。然而，通过这些途径给药既需要先进的技术，也需要专门的设备。肌肉注射肾上腺素可能是一种简单、低成本且易于获取的替代方法，可用于出生时情况不佳的婴儿护理。目前，窒息时肌肉注射肾上腺素的生物利用度仍不明确。
对4只足月胎羊进行剖宫产，通过脐动脉阻断使其窒息，心脏停搏5分钟后进行复苏。在进行30秒胸外按压并给予正压通气1分钟后，于三角肌内注射肌肉注射肾上腺素（0.1mg/kg）。通过酶联免疫吸附测定法（ELISA）获取系列血样以测定血浆肾上腺素浓度。
肌肉注射后肾上腺素浓度未升高。在半数研究中，自主循环恢复（ROSC）后观察到吸收延迟。
窒息性心脏骤停时肌肉注射肾上腺素吸收不足，这意味着该途径对出生时严重情况不佳的婴儿无效。ROSC后吸收延迟引发了对副作用风险的担忧。然而，肌肉注射肾上腺素在较轻程度窒息中的生物利用度和疗效可能值得进一步评估。
