Binkhorst Mathijs, van Elsäcker Elroy, Matthijsse René P, Antonius Tim, Timmermans Nienke A, Te Pas Arjan B, de Boode Willem P, Hogeveen Marije
Division of Neonatology, Department of Pediatrics, Radboud University Medical Center, Radboud Institute for Health Sciences (RIHS), Amalia Children's Hospital, Nijmegen, the Netherlands.
Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands.
J Perinatol. 2025 May 13. doi: 10.1038/s41372-025-02320-2.
Neonatal resuscitation guidelines recommend initiating chest compressions (CC) in newborns at birth if heart rate (HR) remains <60 bpm after 30 s of ventilation. This threshold is based on expert opinion and scant animal data. Our aim was to systematically evaluate the existing evidence and appraise current insights regarding thresholds for starting CC during bradycardia at birth. A recent scoping review synthesized the evidence on various aspects of neonatal CC until November 2021. We updated this review, focusing on HR thresholds for CC, with a new systematic literature search in MEDLINE, Embase, and the Cochrane Database of Systematic Reviews until March 2024. No studies comparing HR thresholds for CC commencement at birth were identified. Consequently, we decided to review the literature more narratively, covering a wider range of topics within this subject matter. Relevant papers from the initial search were used and additional sources of information were sought using snowballing procedures. Numerous publications were identified, containing pathophysiological considerations, in vitro experiments, animal data, and some human data. Preliminary findings from a recent mathematical model study conducted in our center were also briefly considered. All this information enabled a thorough discussion on the rationale for CC during neonatal bradycardia. Finally, a survey was disseminated among knowledgeable neonatal clinicians and researchers to evaluate their perspectives on initiating CC for neonatal bradycardia. Of 183 survey respondents, 137 (74.9%) indicated they would wait longer than the currently recommended 30 s of assisted ventilation before starting CC in newborns with a HR (rising) between 30 and 60 bpm, acknowledging effective ventilation as a priority. We conclude that clinical evidence is lacking, though reconsideration of the threshold to initiate CC for bradycardia at birth seems justified based on available data. This is supported by the views of many surveyed professionals. Randomized trials in human infants and appropriate newborn animal models are warranted.
新生儿复苏指南建议，如果出生时新生儿在通气30秒后心率（HR）仍<60次/分钟，则开始进行胸外按压（CC）。这个阈值基于专家意见和极少的动物数据。我们的目的是系统地评估现有证据，并评估关于出生时心动过缓开始进行胸外按压的阈值的当前见解。最近一项范围综述综合了截至2021年11月关于新生儿胸外按压各个方面的证据。我们更新了这项综述，重点关注胸外按压的心率阈值，在MEDLINE、Embase和Cochrane系统评价数据库中进行了新的系统文献检索，直至2024年3月。未发现比较出生时开始胸外按压的心率阈值的研究。因此，我们决定更具叙述性地回顾文献，涵盖该主题内更广泛的主题。使用了初始搜索中的相关论文，并通过滚雪球程序寻找其他信息来源。确定了大量出版物，包括病理生理学考量、体外实验、动物数据和一些人体数据。还简要考虑了我们中心最近进行的一项数学模型研究的初步结果。所有这些信息使得能够对新生儿心动过缓期间进行胸外按压的基本原理进行全面讨论。最后，向知识渊博的新生儿临床医生和研究人员进行了一项调查，以评估他们对新生儿心动过缓开始进行胸外按压的看法。在183名调查受访者中，137名（74.9%）表示，对于心率（上升）在30至60次/分钟之间的新生儿，他们会在开始胸外按压之前等待超过目前建议的30秒辅助通气时间，承认有效通气是优先事项。我们得出结论，虽然缺乏临床证据，但根据现有数据，重新考虑出生时心动过缓开始进行胸外按压的阈值似乎是合理的。许多接受调查的专业人员的观点也支持这一点。有必要在人类婴儿和合适的新生动物模型中进行随机试验。
