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

根据世界卫生组织(WHO)的数据，估计有90万人死于出生窒息 每年都有，是早期新生儿发病率和死亡率的主要原因之一。通风构成 窒息新生儿复苏的关键步骤。现行新生儿复苏指南 如果需要，建议在初始步骤30秒后开始通风。早期开始换气可能会有 有益的影响。持续的通胀呼吸可能有助于建立足够的功能剩余产能 并可在复苏过程中迅速改善生理参数。 现在建议所有早产儿延迟夹住脐带。世卫组织还支持延迟的脐带 钳夹在正常足月婴儿中的作用，然而它在新生儿窒息中的作用还没有得到很好的研究。需要 在这一人群中，复苏通常会阻止医生延迟夹住脐带。 在夹闭前使用完整的脐带进行通风，有助于稳定脑和肺的血液。 在早产羔羊中流动。改善脑血流可能是窒息的关键。 在这项建议中，我们计划研究使用完整的脐带和延迟夹住脐带的情况下启动通风。 一起，在近期因脐带闭塞窒息的羔羊。从理论上讲，它将结合 胎盘输注和及时复苏。一项评估SI或PPV的随机对照试验 在窒息的婴儿中延迟夹住脐带是理想的。然而，对适当同意的伦理担忧， 和实时测量脑氧量的可行性，流量和压力限制了执行 这样的研究。 与当前新生儿复苏实践的相关性： 延迟夹住脐带前的持续充气和正压通气是一种简单的干预措施 这不需要复杂的设备或培训，可以由资源较少的人员执行 设置也一样。这项研究将为脊髓管理的最佳方法提供重要的见解 呼吸机及其对新生儿窒息救治的影响 送货。

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.