Department of Pediatrics, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Research and Development Center for New Medical Frontiers, Department of Advanced Medicine, Division of Neonatal Intensive Care Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
Semin Fetal Neonatal Med. 2022 Apr;27(2):101349. doi: 10.1016/j.siny.2022.101349. Epub 2022 Apr 30.
There are no standardized procedures for the resuscitation of micropreemies but respiratory and circulatory stabilization immediately after birth should be prioritized. Without aggressive support by positive pressure ventilation, establishing effective respiration among micropreemies is not possible. The first step in postnatal stabilization is initiated by positive airway pressure with a bag and mask. Once the heart rate increases above 100 beats/m, intratracheal intubation should be achieved because it is unusual for a micropreemie to breathe spontaneously or by non-invasive respiratory support for a protracted duration. Until further information is available, initial FiO should be between 0.3 and 0.6, and titrated to achieve SpO obtained from healthy term infants for the first 10 min of life. Temperature control of infants is also critical for successful resuscitation and heat-loss minimizing procedures should be used e.g. with insulating bags. After securing the intratracheal tube, the infants should be transferred to the NICU for further procedures, including pulmonary surfactant installation and umbilical cord catheterization. Procedures in a delivery room under a radiant warmer should be limited to the initial resuscitation. In NICUs, the infants should be placed into a closed incubator to maintain high environmental temperature and humidity as well as decrease exposure to intervention and noise. Increased number of staff will also be needed to stabilize the infants further in the NICU. Finally, appropriate equipment (e.g. appropriate sized laryngoscopes) should be made readily available, along with regular practical training and education, whether in person or through SIM courses which are essential for all staff to achieve competence in successful resuscitation of the newborn micropreemie.
对于早产儿的复苏没有标准化的程序，但应优先考虑出生后立即进行呼吸和循环稳定。如果不通过正压通气进行积极支持，早产儿就无法建立有效的呼吸。出生后稳定的第一步是通过气囊和面罩进行正压通气。一旦心率增加到 100 次/分以上，就应该进行气管内插管，因为早产儿不太可能自发呼吸或通过非侵入性呼吸支持持续很长时间。在获得更多信息之前，初始 FiO 应在 0.3 到 0.6 之间，并根据需要进行滴定，以达到健康足月婴儿在生命的前 10 分钟内获得的 SpO。控制婴儿的体温对于成功复苏也是至关重要的，应使用最小化热量损失的程序，例如使用隔热袋。在确认气管内导管位置后，应将婴儿转移到 NICU 进行进一步的程序，包括肺表面活性剂的安装和脐静脉导管插入术。在辐射保暖器下的产房内进行的程序应限于初始复苏。在 NICU 中，应将婴儿放入封闭的孵化器中，以保持高环境温度和湿度，并减少暴露于干预和噪音中。还需要增加更多的工作人员，以便在 NICU 中进一步稳定婴儿。最后，应随时准备好适当的设备（例如适当尺寸的喉镜），并进行定期的实践培训和教育，无论是亲自进行还是通过 SIM 课程进行，这对于所有工作人员在成功复苏新生儿早产儿方面达到胜任能力都是必不可少的。
