Escrig-Fernández Raquel, Zeballos-Sarrato Gonzalo, Gormaz-Moreno María, Avila-Alvarez Alejandro, Toledo-Parreño Juan Diego, Vento Máximo
Department of Neonatology, Hospital Universitari i Politècnic La Fe, 106 Fernando Abril Martorell Avenue, 46026 Valencia, Spain.
Department of Neonatology, Hospital Gregorio Marañón, 28009 Madrid, Spain.
Children (Basel). 2023 Feb 10;10(2):351. doi: 10.3390/children10020351.
The fetal-to-neonatal transition poses an extraordinary challenge for extremely low birth weight (ELBW) infants, and postnatal stabilization in the delivery room (DR) remains challenging. The initiation of air respiration and the establishment of a functional residual capacity are essential and often require ventilatory support and oxygen supplementation. In recent years, there has been a tendency towards the soft-landing strategy and, subsequently, non-invasive positive pressure ventilation has been generally recommended by international guidelines as the first option for stabilizing ELBW in the delivery room. On the other hand, supplementation with oxygen is another cornerstone of the postnatal stabilization of ELBW infants. To date, the conundrum concerning the optimal initial inspired fraction of oxygen, target saturations in the first golden minutes, and oxygen titration to achieve desired stability saturation and heart rate values has not yet been solved. Moreover, the retardation of cord clamping together with the initiation of ventilation with the patent cord (physiologic-based cord clamping) have added additional complexity to this puzzle. In the present review, we critically address these relevant topics related to fetal-to-neonatal transitional respiratory physiology, ventilatory stabilization, and oxygenation of ELBW infants in the delivery room based on current evidence and the most recent guidelines for newborn stabilization.
从胎儿到新生儿的过渡对极低出生体重（ELBW）婴儿构成了巨大挑战，在产房（DR）进行产后稳定处理仍然具有挑战性。开始呼吸空气和建立功能残气量至关重要，且通常需要通气支持和氧气补充。近年来，有一种倾向于采用软着陆策略，随后，国际指南普遍推荐无创正压通气作为产房内稳定ELBW婴儿的首选方法。另一方面，补充氧气是ELBW婴儿产后稳定处理的另一个基石。迄今为止，关于最佳初始吸入氧分数、首个黄金分钟内的目标饱和度以及为达到所需的稳定饱和度和心率值进行氧滴定的难题尚未得到解决。此外，延迟脐带结扎以及在脐带通畅时开始通气（基于生理学的脐带结扎）给这个难题增添了更多复杂性。在本综述中，我们根据当前证据和最新的新生儿稳定处理指南，批判性地探讨与产房内ELBW婴儿从胎儿到新生儿过渡性呼吸生理学、通气稳定和氧合相关的这些重要话题。
