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Role of Sustained Inflation and Delayed Cord Clamping in Resuscitation after Asphyxia

持续充气和延迟脐带结扎在窒息后复苏中的作用

基本信息

批准号：
9312133
负责人：
Jayasree Nair
金额：
$ 7.98万
依托单位：
STATE UNIVERSITY OF NEW YORK AT BUFFALO
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-07-07 至 2018-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9312133
关键词：
Address Air Albumins Asphyxia Asphyxia Neonatorum Birth Blood Circulation Blood Pressure Blood flow Brain Breathing Cardiac Output Cerebrovascular Circulation Cerebrum Cessation of life Clinical Closure by clamp Consent Economic Inflation Environmental air flow Equipment Ethics European Excision Fetus Functional Residual Capacity Future Guidelines Heart Rate Hematocrit procedure Hour Human Human Resources Infant Inflammation Injury Interleukin-6 Intervention Left Liquid substance Lung Lung Compliance Lung Inflammation Measures Metabolic acidosis Modeling Neonatal Mortality Newborn Infant Organ Oryctolagus cuniculus Output Oxygen Oxygen saturation measurement Perfusion Peripheral Resistance Physiological Placenta Placental Circulation Population Positive-Pressure Respiration Premature Infant Pulmonary Vascular Resistance Pulmonary Ventilation Randomized Clinical Trials Randomized Controlled Trials Recommendation Recovery Resources Resuscitation Risk Role Source Speed Structure of ductus venosus Structure of parenchyma of lung Syndrome Techniques Time Training Transfusion Umbilical cord structure Venous Ventilatory Depression Ventricular World Health Organization early onset foramen ovale hemodynamics improved insight lung injury neonatal morbidity neonatal resuscitation neonate phase change pressure prevent temporal measurement translational clinical trial translational study

项目摘要

Birth asphyxia, according to the World Health Organization (WHO), accounts for an estimated 900 000 deaths each year and is one of the primary causes of early neonatal morbidity and mortality. Ventilation constitutes the critical step in resuscitation of asphyxiated newborns. Current neonatal resuscitation guidelines recommend initiating ventilation if required after 30 sec of initial steps. Early onset of ventilation may have beneficial effects. A sustained inflation breath may help in establishing adequate functional residual capacity and may improve physiological parameters quickly during resuscitation. Delaying cord clamping is now recommended for all preterm infants. WHO also supports delayed cord clamping in normal term infants, however its role in birth asphyxia has not been well studied. The need for resuscitation often prevents the practitioner from delaying cord clamping in this population. Establishing ventilation with an intact cord, prior to clamping, helps to stabilize cerebral and pulmonary blood flows in preterm lambs. Improving cerebral blood flow may be critical in asphyxia. In this proposal, we plan to study initiation of ventilation with an intact cord and delayed cord clamping together, in near term lambs asphyxiated by cord occlusion. It would theoretically combine the advantages of placental transfusion and prompt resuscitation. A randomized controlled trial evaluating SI or PPV prior to delayed cord clamping in asphyxiated human infants is ideal. However, ethical concerns about proper consent, and feasibility of real time measurements of cerebral oximetry, flow and pressure limit the ability to perform such a study. Relevance to current practice in neonatal resuscitation: Sustained Inflation and Positive Pressure Ventilation prior to delayed cord clamping is a simple intervention that does not require sophisticated equipment or training and could be performed by personnel in low resource settings as well. This study will provide critical insight into the optimal approach to cord management and ventilation and influence future recommendations for management of the asphyxiated human neonate at delivery.

根据世界卫生组织（WHO）的数据，估计有90万人死于出生窒息