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DOI: 10.1055/s-2007-970072
© Georg Thieme Verlag KG Stuttgart · New York
Neue Reanimationsrichtlinien der ILCOR bei Früh- und Reifgeborenen: Kritische Diskussion und Vorschläge zur praktischen Umsetzung
ILCOR's New Resuscitation Guidelines in Preterm and Term Infants: Critical Discussion and Suggestions for ImplementationPublication History
Publication Date:
20 March 2007 (online)
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Zusammenfassung
Reanimationsempfehlungen des International Liaison Committee on Resuscitation (ILCOR) werden in fünfjährigen Abständen aktualisiert. Eine Änderung der Evidenzlage bezüglich der Reanimation von Neugeborenen besteht insbesondere im Hinblick auf folgende Themen: Höhe der inspiratorischen Sauerstoffkonzentration, Absaugen von mekonium-haltigem Fruchtwasser während der Geburt, anzustrebende Beatmungsvolumina, induzierte Hypothermie nach schwe-rer Asphyxie. Nicht in allen Fällen hat die neue Datenlage auch zu einer eindeutigen Empfehlung für oder wider eine Intervention geführt. Deshalb werden in der vorliegenden Arbeit die ILCOR-Empfehlungen im Originalton zitiert und im Hinblick auf deren praktische Umsetzung diskutiert und interpretiert. Dabei schlagen die Autoren dieser Arbeit vor, eine Reanimation unabhängig vom Gestationsalter mit Raumluft zu beginnen und nur bei klinischem Bedarf die inspiratorische Sauerstoffkonzentration zu erhöhen, die Praxis des intranatalen Absaugens bei mekoniumhaltigem Fruchtwasser beizubehalten und eine therapeutische Hypothermie nach stattgehabter Asphyxie bei reifen Neugeborenen entsprechend dem Protokoll einer der veröffentlichten randomisierten, kontrollierten Studien durchzuführen. Ein Mano-meter zur Messung des Beatmungsdruckes, ein Sauerstoffmischer (‘oxygen blender’) und ein Pulsoxymeter sollten zum Standardmonitoring im Erstversorgungsraum gehören. Die überwiegende Mehrzahl der ILCOR-Empfehlungen wird lediglich übersetzt zitiert und, wo erforderlich, im Hinblick auf die praktische Umsetzung im klinischen Kontext kommentiert.
Abstract
Recommendations of the International Liaison Committee on Resuscitation (ILCOR) become updated every five years with changing evidence resulting in revised recommendations for clinical practice. New data exist concerning the adequate oxygen concentration to be used in the delivery room, the management of imminent meconium aspiration, ventilation strategies and the role of body temperature during and after resuscitation of preterm and term newborn infants. Only in some cases new evidence has led to clear-cut recommendations for or against specific interventions. Therefore the present publication cites the original ILCOR-recommendations and discusses these with regard to their practical implementation. The authors of the present work suggest to commence resuscitation independendly of gestational age with room air and adjust the inspiratory oxygen concentration thereafter on clinical grounds. The authors also advocate the retention of the presently performed intranatal suction procedure in cases of meconium-stained amniotic fluid and the use of therapeutic hypothermia following perinatal asphyxia in term newborns according to the protocol of one of the published randomized, controlled trials. Standard equipment for neonatal resuscitation should include pressure gauge for monitoring of inspiratory pressures, oxygen blender, and pulse oxymeter. The predominant majority of ILCOR-recommendations have only been cited and have been commented with respect to their practical implementation within the clinical context.
Schlüsselwörter
neonatale Reanimation - Mekonium - Asphyxie - Hypothermie - ILCOR-Empfehlungen
Keywords
neonatal resuscitation - meconium - asphyxia - hypothermia - ILCOR recommendations
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Korrespondenzadresse
T. Hoehn
Klinik für Allgemeine Pädiatrie, Neonatologie und Pädiatrische Intensivmedizin
Universitätsklinikum Düsseldorf
Moorenstr. 5 40225 Düsseldorf
Email: thomas.hoehn@uni-duesseldorf.de