Zusammenfassung
Beim Übergang vom intrauterinen zum neonatalen Leben müssen 3–6% aller Neugeborenen unterstützt werden. Damit stellt die neonatale Erstversorgung eine der häufigsten medizinischen Interventionen dar. Mittels eines Fragebogens wurden das verwendete Equipment und das dazugehörige Verwendungsprotokoll bei der Erstversorgung von Neugeborenen in Österreich erhoben und mit den im Jahr 2005 publizierten Richtlinien des European Resuscitation Council verglichen. Alle 20 kontaktierten Abteilungen beantworteten den Fragebogen. Erfragt wurden die Verwendung von Pulsoxymetrie, Beatmungsbeutel („self-inflating“/“flow-inflating“/“T-piece device“), CO2-Detektor zur Tubuslagekontrolle, Sauerstoffblender, Larynxmaske, oralem Airway, Klarsichtfolie zur Verhinderung des Wärmeverlusts bei der Erstversorgung von Frühgeborenen unter 28 Schwangerschaftswochen sowie die initiale Sauerstoffkonzentration bei der Erstversorgung von Reifgeborenen. Letztere variierte zwischen 21% und 100%. Bei 17 Abteilungen (85%) kamen Sauerstoffblender, bei den übrigen Flowmeter zur Anwendung. Alle 20 Abteilungen (100%) verwendeten Pulsoxymetrie, 9 (45%) „self-inflating-bags“, 9 (45%) „T-piece devices“ und 2 beide Beatmungshilfen. Einen oralen Airway bei schwieriger Maskenbeatmung nutzten 10 Abteilungen (50%), eine Larynxmaske als Alternative zur Intubation 8 (40%) und einen CO2-Detektor zur Tubuslagekontrolle 6 (30%). Klarsichtfolien zur Verhinderung des Wärmeverlusts wurden in 11 Abteilungen (55%) eingesetzt. Dem internationalen Trend entsprechend zeigte sich auch in Österreich eine große Variationsbreite des verwendeten Equipments. Dies reflektiert die allgemein ungenügende Datenlage zur Erstversorgung von Neugeborenen.
Abstract
Approximately 3%–6% of all newborn infants require some form of resuscitation at birth, making neonatal resuscitation one of the commonest medical interventions. An internationally agreed consensus statement and various guidelines advise how newborn infants should be resuscitated and suggest equipment to use. The aim of this study was to compare the current standard of neonatal resuscitation in Austria with the neonatal resuscitation guidelines published in 2005. A questionnaire was sent to Austrian neonatal units with delivery rooms. The questionnaire evaluated the use of positive pressure ventilation devices, pulse oximetry, laryngeal mask, oral (Guedel) airway, oxygen blenders, use of supplementary oxygen in term infants, CO2 detectors and polyethylene wrapping for infants ≤ 28 weeks. All 20 neonatal units contacted answered the questionnaire. The initial oxygen concentration during resuscitation of term infants ranged between 21% and 100%. A total of 17 (85%) departments used oxygen blenders, the others a flow meter. Pulse oximetry was used in 20 (100%) departments, nine (45%) used a self-inflating-bag and a T-piece device. Two departments used either the self-inflating or the T-piece device and none used the flow-inflating bag. An oral airway (Guedel) was used in 10 (50%) and a laryngeal mask in eight (40%) departments. CO2 detectors were in use in six (30%) and polyethylene wrapping in 11 (55%) departments. This survey shows that, in line with the international trend, a wide-ranging variety of equipment is used also in Austria, reflecting the lack of data on neonatal resuscitation.
Abbreviations
- ERC:
-
European Resuscitation Council
- ILCOR:
-
International Liaison Committee on Resuscitation
- LMA:
-
Larynxmaske
- NICN:
-
Neonatal Intermediate Care Nursery
- SaO2 :
-
Sauerstoffsättigung des arteriellen Blutes
- SSW:
-
Schwangerschaftswoche
Literatur
American Heart Association (2006) 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: neonatal resuscitation guidelines. Pediatrics 117(5):e1029–e1038
Aziz HF, Martin JB, Moore JJ (1999) The pediatric disposable end-tidal carbon dioxide detector in endotracheal intubations in newborns. J Perinatol 19(2):110–113
Bennett S, Finer NN, Rich W, Vaucher Y (2005) A comparison of three neonatal resuscitation devices. Resuscitation 67(1):113–118
Biarent D, Bingham R, Richmond S et al (2005) European Resuscitation Council guidelines for resuscitation 2005. Section 6. Paediatric life support. Resuscitation [Suppl 1] 67:S97–S133
Davis PG, Tan A, O’Donnell CP, Schulze A (2004) Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis. Lancet 364(9442):1329–1333
Dawson JA, Davis PG, O’Donnell CP et al (2007) Pulse oximetry for monitoring infants in the delivery room: a review. Arch Dis Child Fetal Neonatal Ed 92(1):F4–F7
East CE, Colditz PB, Begg LM, Brennecke SP (2002) Update on intrapartum fetal pulse oximetry. Aust N Z J Obstet Gynaecol 42(2):119–124
Finer NN, Rich W, Craft A, Henderson C (2001) Comparison of methods of bag and mask ventilation for neonatal resuscitation. Resuscitation 49(3):299–305
Hansmann G, Humpl T, Zimmermann A et al (2007) ILCOR’s new resuscitation guidelines in preterm and term infants: critical discussion and suggestions for implementation. Klin Padiatr 219(2):50–57
Huang CC, Yonetani M, Lajevardi N et al (1995) Comparison of postasphyxial resuscitation with 100% and 21% oxygen on cortical oxygen pressure and striatal dopamine metabolism in newborn piglets. J Neurochem 64(1):292–298
Iriondo M, Thio M, Buron E et al (2009) A survey of neonatal resuscitation in Spain: gaps between guidelines and practice. Acta Paediatr 98:786–791
Kamlin CO, O’Donnell CP, Davis PG, Morley CJ (2006) Oxygen saturation in healthy infants immediately after birth. J Pediatr 148(5):585–589
Kamlin CO, Dawson JA, O’Donnell CP et al (2008) Accuracy of pulse oximetry measurement of heart rate of newborn infants in the delivery room. J Pediatr 152(6):756–760
Knobel RB, Vohra S, Lehmann CU (2005) Heat loss prevention in the delivery room for preterm infants: a national survey of newborn intensive care units. J Perinatol 25(8):514–518
Laptook AR, Watkinson M (2008) Temperature management in the delivery room. Semin Fetal Neonatal Med 13(6):383–391
Lenclen R, Mazraani M, Jugie M et al (2002) Use of a polyethylene bag: a way to improve the thermal environment of the premature newborn at the delivery room. Arch Pediatr 9(3):238–244
Leone TA, Rich W, Finer NN (2006) A survey of delivery room resuscitation practices in the United States. Pediatrics 117(2):e164–e175
Morley C (2007) New Australian neonatal resuscitation guidelines. J Paediatr Child Health 43(1–2):6–8
NN (2005) International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Part 7: Neonatal resuscitation. Resuscitation 67(2–3):293–303
O’Donnell CP, Stenson BJ (2008) Respiratory strategies for preterm infants at birth. Semin Fetal Neonatal Med 13(6):401–409
O’Donnell C, Davis P, Morley C (2004) Positive end-expiratory pressure for resuscitation of newborn infants at birth. Cochrane Database Syst Rev 4:CD004341
O’Donnell CP, Davis PG, Morley CJ (2004) Neonatal resuscitation: review of ventilation equipment and survey of practice in Australia and New Zealand. J Paediatr Child Health 40(4):208–212
O’Donnell CP, Davis PG, Morley CJ (2004) Positive pressure ventilation at neonatal resuscitation: review of equipment and international survey of practice. Acta Paediatr 93(5):583–588
O’Donnell CP, Davis PG, Morley CJ (2005) Use of supplementary equipment for resuscitation of newborn infants at tertiary perinatal centres in Australia and New Zealand. Acta Paediatr 94(9):1261–1265
O’Donnell CP, Kamlin CO, Davis PG et al (2007) Clinical assessment of infant colour at delivery. Arch Dis Child Fetal Neonatal Ed 92(6):F465–F467
Rabi Y, Yee W, Chen SY, Singhal N (2006) Oxygen saturation trends immediately after birth. J Pediatr 148(5):590–594
Repetto JE, Donohue PAC, Baker SF et al (2001) Use of capnography in the delivery room for assessment of endotracheal tube placement. J Perinatol 21(5):284–247
Singhal N, McMillan DD, Yee WH et al (2001) Evaluation of the effectiveness of the standardized neonatal resuscitation program. J Perinatol 21(6):388–392
Solas AB, Kutzsche S, Vinje M, Saugstad OD (2001) Cerebral hypoxemia-ischemia and reoxygenation with 21% or 100% oxygen in newborn piglets: effects on extracellular levels of excitatory amino acids and microcirculation. Pediatr Crit Care Med 2(4):340–345
Solas AB, Kalous P, Saugstad OD (2004) Reoxygenation with 100 or 21% oxygen after cerebral hypoxemia-ischemia-hypercapnia in newborn piglets. Biol Neonate 85(2):105–111
Solas AB, Munkeby BH, Saugstad OD (2004) Comparison of short- and long-duration oxygen treatment after cerebral asphyxia in newborn piglets. Pediatr Res 56(1):125–131
Stark AR (2004) Levels of neonatal care. Pediatrics 114(5):1341–1347
Vohra S, Frent G, Campbell V et al (1999) Effect of polyethylene occlusive skin wrapping on heat loss in very low birth weight infants at delivery: a randomized trial. J Pediatr 134(5):547–551
Vohra S, Roberts RS, Zhang B et al (2004) Heat loss prevention (HeLP) in the delivery room: a randomized controlled trial of polyethylene occlusive skin wrapping in very preterm infants. J Pediatr 145(6):750–753
Danksagung
Wir danken allen teilnehmenden neonatologischen Abteilungen: Universitätskliniken für Kinder- und Jugendheilkunde Graz, Innsbruck und Wien, St. Johanns-Spital und Paracelsus-Privatuniversität Salzburg, Landesspitäler Bregenz, Dornbirn, Eisenstadt, Klagenfurt, Leoben, Linz, Oberwart und Villach, Krankenhaus St. Josef in Braunau, Krankenhaus der Barmherzigen Schwestern vom Heiligen Kreuz Wels, Thermenklinikum Mödling, Zentralklinikum St. Pölten, Krankenhaus der Staturstadt Wiener Neustadt, Gottfried von Preyer’sches Kinderspital Wien, Donauspital im Sozialmedizinischen Zentrum Ost der Stadt Wien sowie Kinderklinik Glanzing im Wilhelminenspital Wien.
Interessenkonflikt
Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Additional information
Dr. Schmölzer wird teilweise durch ein Royal Women’s Hospital Postgraduate Research Degree Scholarship, ein Monash International Postgraduate Research Scholarship sowie ein Research Grant von der Steirischen Landesregierung unterstützt.
Rights and permissions
About this article
Cite this article
Schmölzer, G., Olischar, M., Raith, W. et al. Erstversorgung von Neugeborenen. Monatsschr Kinderheilkd 158, 471–476 (2010). https://doi.org/10.1007/s00112-010-2171-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00112-010-2171-y