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DOI: 10.1055/s-0031-1284472
Geburtshilfliche Anästhesie – Erstversorgung und Reanimation von Neugeborenen
Resuscitation of Newborn InfantsPublication History
Publication Date:
03 August 2011 (online)
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Zusammenfassung
Die erfolgreiche Versorgung und Reanimation von Neugeborenen basiert auf Vorbereitung, genauer Evaluation und prompter Unterstützung entsprechend den kürzlich aktualisierten Empfehlungen durch trainierte Personen. Der wesentliche Schritt der normalen postnatalen Adaptation ist die erfolgreiche Entfaltung der Lunge während der ersten Atemzüge, weil erst danach venöses Blut nahezu vollständig zur Lunge gelangt und ein Gasaustausch stattfindet. Liegt eine Störung der Adaptation vor, muss deshalb durch geeignete Maßnahmen zunächst die Ventilation gesichert werden. Primär wird mit Raumluft (bei Termingeborenen) bzw. niedrigen Sauerstoff-Fraktionen (bei Frühgeborenen) beatmet. Im weiteren Verlauf wird so viel Sauerstoff gegeben, daß physiologische Werte der Sauerstoffsättigung resultieren. Kardiale Kompression wird erst nach suffizienter Beatmung und in einem Verhältnis zur Ventilation von 3:1 durchgeführt. Wesentlicher Bestandteil der Erstversorgung von Neugeborenen ist die konsequente Anwendung wärmeerhaltender Maßnahmen, da Neugeborene allein durch Hypothermie vital bedroht sind. Eine therapeutische Hypothermie darf daher erst nach erfolgreicher Reanimation in Absprache mit dem weiterversorgenden Perinatalzentrum erwogen werden.
Abstract
Successful resuscitation of newborn infants depends on adequate preparation, exact evaluation and prompt initiation of support according to the recently updated recommendations by trained personnel. The key step in postnatal adaptation is the initiation of breathing with a subsequent increase in pulmonary blood flow and pulmonary gas exchange. Therefore, in compromised newborn infants, adequate ventilation is the most important step in cardiopulmonary resuscitation. Ventilation should be initiated with room air in term infants and with low concentrations of supplemental oxygen in preterm infants. Subsequently, oxygen supplementation should always be guided by pulse oximetry. Chest compressions are only effective if adequate ventilation has been ensured. The compression ventilation ratio remains 3:1. The prevention of heat loss and maintaining a normal body temperature by adequate measures is an essential part of the care for healthy as well as asphyxiated infants. Therapeutic hypothermia should only be initiated after successfull resuscitation and consultation with the regional neonatal intensive care unit.
Kernaussagen
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Die wichtigste Voraussetzung für eine normale Adaptation ist das Einsetzen der Atmung. Effektive Beatmung ist die wichtigste Voraussetzung für eine erfolgreiche Reanimation.
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Bei jeder Geburt muss eine in der Reanimation trainierte Person ausschließlich für die Versorgung des Neugeborenen zur Verfügung stehen. Ein geeigneter Reanimationsplatz und erforderliches Material muss vorbereitet sein.
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Neugeborene saugt man nur ab, wenn eine Verlegung der Atemwege vorliegt. Bei mekoniumhaltigem Fruchtwasser werden Neugeborene nur dann abgesaugt, wenn sie beeinträchtigt sind.
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Evaluation und Unterstützung eines beeinträchtigten Neugeborenen müssen prompt erfolgen. Bei Apnoe, Schnappatmung oder angestrengter Atmung müssen bereits in den ersten 60 s nach Geburt die initialen Schritte zur Stabilisierung und 5 Beatmungen erfolgen.
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Eine ineffektive Beatmung kann man verbessern durch:
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Lagerung in ”Schnüffelposition“
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Applikation der Maske ohne Kompression des Mundbodens
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ausreichende Beatmungsdrücke
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ausreichende Inspirationszeit
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Beatmung über nasopharyngealen TubusLarynxmaske
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Intubation
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Initiale Beatmung von Termingeborenen mit Raumluft, von Frühgeborenen mit 30 % Sauerstoff. Weitere Sauerstoffzufuhr: so, dass ein physiologischer Anstieg der Sättigung resultiert.
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Bei effektiver Beatmung steigt prompt die Herzfrequenz.
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Erst wenn die Lunge ventiliert wird (sichtbare Thoraxexkursion), beginnt man bei einer Herzfrequenz unter 60/min mit Thoraxkompression. Auch bei intubierten Neugeborenen wechselt man im Verhältnis 3 : 1 zwischen Kompression und Beatmung.
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Adrenalin wird bevorzugt intravenös (Nabelvenenkatheter) oder intraossär mit 10–30 μg/kg gegeben. Endotracheal: mindestens 100 μg/kg.
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Nach einer Reanimation ist die Indikation zur therapeutischen Hypothermie zu klären.
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