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

据世界卫生组织（世卫组织）估计，出生窒息造成90万人死亡 这是新生儿早期发病和死亡的主要原因之一。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秒后开始通气。早期通气可能会导致 有益效果。持续的充气呼吸可能有助于建立足够的功能残气量 并且可以在复苏期间快速改善生理参数。 现在建议所有早产儿延迟脐带夹紧。世卫组织还支持延迟脐带血供应 钳夹在正常足月婴儿中的作用，但其在出生窒息中的作用尚未得到充分研究。需要 复苏术通常会阻止医生延迟这一人群的脐带夹紧。 在夹闭前，用完整的脐带建立通气，有助于稳定脑和肺血液 在早产羔羊中流动。改善脑血流可能是窒息的关键。 在这个建议中，我们计划研究在完整的脐带和延迟的脐带夹闭的情况下开始通气 一起，在近期羔羊窒息的脐带闭塞。从理论上讲，它将联合收割机的优点 胎盘输血和迅速复苏一项随机对照试验，评价了 在窒息的人类婴儿中延迟脐带夹紧是理想的。然而，关于适当同意的伦理问题， 和脑血氧定量、流量和压力的真实的时间测量的可行性限制了执行 这样的研究。 与当前新生儿复苏实践的相关性： 延迟脐带夹闭前的持续充气和正压通气是一种简单的干预措施 不需要复杂的设备或培训，可以由资源较少的人员执行 设置也是。这项研究将为脐带管理的最佳方法提供重要的见解， 窒息新生儿管理的未来建议. 交付.

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.