Torvik Ingrid Ask, Moshiro Robert, Ersdal Hege, Yeconia Anita, Mduma Raphael, Perlman Jeffrey, Linde Jørgen
Faculty of Health Sciences, Stavanger University, 4036 Stavanger, Norway.
Stavanger University Hospital, 4068 Stavanger, Norway.
Children (Basel). 2023 May 27;10(6):957. doi: 10.3390/children10060957.
Early bag-mask ventilation (BMV) administered to non-breathing neonates at birth in the presence of birth asphyxia (interruption of placental blood flow) has reduced neonatal mortality by up to 50% in low- and middle-income countries. The neurodevelopmental outcome of neonates receiving BMV remains unknown. Using the Malawi Developmental Assessment Tool (MDAT), infants who received BMV at birth were assessed at 6 months, evaluating gross motor, fine motor, language and social skills. A healthy cohort with no birth complications was assessed with the same tool for comparison. Mean age-adjusted MDAT z-scores were not significantly different between the groups. The number of children having developmental delay defined as a z-score ≤ -2 was significantly higher in the resuscitated cohort for the fine motor and language domain and overall MDAT z-score. The prevalence of clinical seizures post discharge was significantly higher in the resuscitated group and was associated with neurodevelopmental delay. Infants with developmental delay or seizures were more likely to have a 5 min Apgar < 7 and a longer duration of BMV. Most children receiving BMV at birth are developing normally at 6 months. Still, there are some children with impaired development among resuscitated children, representing a subgroup of children who may have suffered more severe asphyxia.
在低收入和中等收入国家，对出生时因窒息（胎盘血流中断）而无呼吸的新生儿尽早进行面罩正压通气（BMV）可将新生儿死亡率降低多达50%。接受BMV的新生儿的神经发育结局尚不清楚。使用马拉维发育评估工具（MDAT），对出生时接受BMV的婴儿在6个月时进行评估，评估其大运动、精细运动、语言和社交技能。使用相同工具对无出生并发症的健康队列进行评估以作比较。两组之间经年龄调整的MDAT z评分均值无显著差异。在复苏队列中，精细运动和语言领域以及总体MDAT z评分中，发育迟缓（定义为z评分≤ -2）的儿童数量显著更高。出院后临床癫痫发作的患病率在复苏组中显著更高，且与神经发育迟缓相关。发育迟缓或癫痫发作的婴儿更有可能5分钟阿氏评分<7分且BMV持续时间更长。大多数出生时接受BMV的儿童在6个月时发育正常。不过，复苏儿童中仍有一些发育受损的儿童，他们代表了可能遭受更严重窒息的儿童亚组。
