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Klin Padiatr 2007; 219(2): 50-57
DOI: 10.1055/s-2007-970072
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© 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 ImplementationG. Hansmann 1 , 5 , T. Humpl 2 , A. Zimmermann 3 , C. Bührer 4 , R. Wauer 5 , H. Stannigel 6 , T. Hoehn 6
  • 1Department of Pediatrics, University of California San Francisco, California, USA
  • 2Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Canada
  • 3Neugeborenen-Intensivstation, Klinikum rechts der Isar, Kinderklinik und Poliklinik der TU München
  • 4Universitäts-Kinderspital beider Basel, Basel, Schweiz
  • 5Klinik für Neonatologie, Campus Mitte, Charité Universitätsmedizin Berlin
  • 6Klinik für Allgemeine Pädiatrie, Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Düsseldorf
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Publication 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

Literatur

  • 1 AHCPR . Classification of evidence classes.  http://cochrane.de/de/gradesys.htm
    Google Scholar
  • 2 Ambalavanan N, Carlo WA. Ventilatory strategies in the prevention and management of bronchopulmonary dysplasia.  Semin Perinatol. 2006;  30 192-199
    CrossrefPubMedGoogle Scholar
  • 3 American Heart Association Guidelines 2005 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; Part 13: Neonatal Resuscitation Guidelines.  Circulation. 2005;  112 (24_suppl) IV188-IV195
    PubMedGoogle Scholar
  • 4 American Heart Association, American Academy of Pediatrics . 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: neonatal resuscitation guidelines.  Pediatrics. 2006;  117 e1029-e1038
    CrossrefPubMedGoogle Scholar
  • 5 Bancalari E. Changes in the pathogenesis and prevention of chronic lung disease of prematurity.  Am J Perinatol. 2001;  18 1-9
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Bastek TK, Richardson DK, Zupancic JA, Burns JP. Prenatal consultation practices at the border of viability: a regional survey.  Pediatrics. 2005;  116 407-413
    CrossrefPubMedGoogle Scholar
  • 7 Bhende MS, Thompson AE. Evaluation of an end-tidal CO2 detector during pediatric cardiopulmonary resuscitation.  Pediatrics. 1995;  95 395-399
    PubMedGoogle Scholar
  • 8 Bjorklund LJ, Ingimarsson J, Curstedt T, John J, Robertson B, Werner O, Vilstrup CT. Manual ventilation with a few large breaths at birth compromises the therapeutic effect of subsequent surfactant replacement in immature lambs.  Pediatr Res. 1997;  42 ((3)) 348-355
    CrossrefPubMedGoogle Scholar
  • 9 Blackmon LR, Stark AR. American Academy of Pediatrics Committee on Fetus and Newborn . Hypothermia: a neuroprotective therapy for neonatal hypoxic-ischemic encephalopathy.  Pediatrics. 2006;  117 942-948
    CrossrefPubMedGoogle Scholar
  • 10 Booth C, Premkumar MH, Yannoulis A, Thomson M, Harrison M, Edwards AD. Sustainable use of continuous positive airway pressure during the first week after delivery in extremely preterm infants.  Arch Dis Child Fetal Neonatal. , Ed 2006 Jul 13; [Epub ahead of print]
    PubMedGoogle Scholar
  • 11 Carson BS, Losey RW, Bowes Jr WA, Simmons MA. Combined obstetric and pediatric approach to prevent meconium aspiration syndrome.  Am J Obstet Gynecol. 1976;  126 712-715
    PubMedGoogle Scholar
  • 12 Davis PG, Tan A, O’Donnell CP, Schulze A. Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis.  Lancet. 2004;  364 1329-1333
    CrossrefPubMedGoogle Scholar
  • 13 Dohlen G, Carlsen H, Blomhoff R, Thaulow E, Saugstad OD. Reoxygenation of hypoxic mice with 100% oxygen induces brain nuclear factor-kappa B.  Pediatr Res. 2005;  58 941-945
    CrossrefPubMedGoogle Scholar
  • 14 Edwards AD, Azzopardi DV. Therapeutic hypothermia following perinatal asphyxia.  Arch Dis Child Fetal Neonatal Ed. 2006;  91 F127-F131
    CrossrefPubMedGoogle Scholar
  • 15 Eicher DJ, Wagner CL, Katikaneni LP, Hulsey TC, Bass WT, Kaufman DA, Horgan MJ, Languani S, Bhatia JJ, Givelichian LM, Sankaran K, Yager JY. Moderate hypothermia in neonatal encephalopathy: efficacy outcomes.  Pediatr Neurol.. 2005;  32 11-17
    CrossrefPubMedGoogle Scholar
  • 16 Empfehlung 024-01 . Frühgeburt an der Grenze der Lebensfähigkeit des Kindes.  Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin. 1999;  http://www.uni-duesseldorf.de/WWW/AWMF/
    PubMedGoogle Scholar
  • 17 European Resuscitation Council Guidelines for Resuscitation 2005 . Section 6. Paediatric life support.  Resuscitation. 2005;  67S1 S97-S133
    PubMedGoogle Scholar
  • 18 Finer NN, Rich WD. Neonatal resuscitation: raising the bar.  Curr Opin Pediatr. 2004;  16 157-162
    CrossrefPubMedGoogle Scholar
  • 19 Gage JE, Taeusch Jr HW, Treves S, Caldicott W. Suctioning of upper airway meconium in newborn infants.  JAMA. 1981;  246 2590-2592
    CrossrefPubMedGoogle Scholar
  • 20 Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM, Polin RA, Robertson CM, Thoresen M, Whitelaw A, Gunn AJ. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial.  Lancet. 2005;  365 663-670
    CrossrefPubMedGoogle Scholar
  • 21 Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care . Part 11: neonatal resuscitation. The American Heart Association in collaboration with the International Liaison Committee on Resuscitation.  Circulation. 2000;  102 I343-57
    PubMedGoogle Scholar
  • 22 Hageman JR, Conley M, Francis K, Stenske J, Wolf I, Santi V, Farrell EE. Delivery room management of meconium staining of the amniotic fluid and the development of meconium aspiration syndrome.  J Perinatol. 1988;  8 127-131
    PubMedGoogle Scholar
  • 23 Halamek LP, Morley C. Continuous positive airway pressure during neonatal resuscitation.  Clin Perinatol. 2006;  33 83-98
    PubMedGoogle Scholar
  • 24 Hansmann G, Humpl T, Zimmermann A. Neugeborenen-Notfälle: Basale kardioulmonale Reanimation.  Z Geburtsh Neonatol. 2004;  208 43-56
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Hansmann G. Neonatal resuscitation on air: it is time to turn down the oxygen tanks.  Lancet. 2004;  364 1293-1294 , (erratum Lancet 2005; 365: 386)
    CrossrefPubMedGoogle Scholar
  • 26 Hermansen MC, Hermansen MG. Pitfalls in neonatal resuscitation.  Clin Perinatol. 2005;  32 ((1)) 77-95
    PubMedGoogle Scholar
  • 27 Higgins RD, Raju TN, Perlman J, Azzopardi DV, Blackmon LR, Clark RH, Edwards AD, Ferriero DM, Gluckman PD, Gunn AJ, Jacobs SE, Eicher DJ, Jobe AH, Laptook AR, LeBlanc MH, Palmer C, Shankaran S, Soll RF, Stark AR, Thoresen M, Wyatt J. Hypothermia and perinatal asphyxia: executive summary of the National Institute of Child Health and Human Development workshop.  J Pediatr. 2006;  148 170-175
    CrossrefPubMedGoogle Scholar
  • 28 Ingimarsson J, Bjorklund LJ, Curstedt T, Gudmundsson S, Larsson A, Robertson B, Werner O. Incomplete protection by prophylactic surfactant against the adverse effects of large lung inflations at birth in immature lambs.  Intensive Care Med. 2004;  30 ((7)) 1446-1453
    PubMedGoogle Scholar
  • 29 International Liaison Committee on Resuscitation; Part 7: Neonatal Resuscitation.  Resuscitation. 2005;  67 293-303
    CrossrefPubMedGoogle Scholar
  • 30 International Liaison Committee on Resuscitation . The International Liaison Committee on Resuscitation (ILCOR) consensus on science with treatment recommendations for pediatric and neonatal patients: neonatal resuscitation.  Pediatrics. 2006;  117 e978-e988
    CrossrefPubMedGoogle Scholar
  • 31 Introduction to the International Guidelines Part 1 2000 for CPR and ECC: a consensus on science.  Circulation. 2000;  102 I1-I11
    PubMedGoogle Scholar
  • 32 Kamlin CO, O'Donnell CP, Davis PG, Morley CJ. Oxygen saturation in healthy infants immediately after birth.  J Pediatr. 2006;  148 585-589
    CrossrefPubMedGoogle Scholar
  • 33 Munkeby BH, Borke WB, Bjornland K, Sikkeland LI, Borge GI, Halvorsen B, Saugstad OD. Resuscitation with 100% O2 increases cerebral injury in hypoxemic piglets.  Pediatr Res. 2004;  56 783-790
    CrossrefPubMedGoogle Scholar
  • 34 Niermeyer S, Kattwinkel J, Van Reempts P. et al. . International Guidelines for Neonatal Resuscitation: An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines.  Pediatrics. 2000;  106 E29
    CrossrefPubMedGoogle Scholar
  • 35 Österreichische Gesellschaft für Kinder- und Jugendheilkunde . Erstversorgung von Frühgeborenen an der Grenze der Lebensfähigkeit.  Monatsschrift Kinderheilkunde. 2005;  153 711-715 http://www.docs4you.at/Content.Node/Spezialbereiche/Neonatologie/Erstversorgung_von_Fruehgeborenen.pdf
    PubMedGoogle Scholar
  • 36 Perlman JM, Kattwinkel J. Delivery room resuscitation past, present, and the future.  Clin Perinatol. 2006;  33 1-9
    PubMedGoogle Scholar
  • 37 Rabi Y, Yee W, Chen SY, Singhal N. Oxygen saturation trends immediately after birth.  J Pediatr. 2006;  148 590-594
    CrossrefPubMedGoogle Scholar
  • 38 Ramji S, Ahuja S, Thirupuram S, Rootwelt T, Rooth G, Saugstad OD. Resuscitation of asphyxic newborn infants with room air or 100% oxygen.  Pediatr Res. 1993;  34 809-812
    CrossrefPubMedGoogle Scholar
  • 39 Ramji S, Rasaily R, Mishra PK, Narang A, Jayam S, Kapoor AN, Kambo I, Mathur A, Saxena BN. Resuscitation of asphyxiated newborns with room air or 100% oxygen at birth: a multicentric clinical trial.  Indian Pediatr. 2003;  40 510-517
    PubMedGoogle Scholar
  • 40 Salhab WA, Wyckoff MH, Laptook AR, Perlman JM. Initial hypoglycemia and neonatal brain injury in term infants with severe fetal acidemia.  Pediatrics. 2004;  114 361-366
    CrossrefPubMedGoogle Scholar
  • 41 Saugstad OD, Rootwelt T, Aalen O. Resuscitation of asphyxiated newborn infants with room air or oxygen: an international controlled trial: the Resair 2 study.  Pediatrics. 1998;  102 e1
    CrossrefPubMedGoogle Scholar
  • 42 Saugstad OD, Ramji S, Vento M. Resuscitation of depressed newborn infants with ambient air or pure oxygen: a meta-analysis.  Biol Neonate. 2005;  87 27-34
    CrossrefPubMedGoogle Scholar
  • 43 Berger TM, Büttiker V, Fauchère J-C, Holzgreve W, Kind C, Largo R, Moessinger A, Zimmermann R. Schweizerische Gesellschaft für Neonatologie 2002 . Empfehlungen zur Betreuung von Frühgeborenen an der Grenze der Lebensfähigkeit (Gestationsalter 22-26 SSW).  http://www.paediatrie-links.de/extreme Fruechen Schweiz Leitlinie2002.pdf
    PubMedGoogle Scholar
  • 44 Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF, Fanaroff AA, Poole WK, Wright LL, Higgins RD, Finer NN, Carlo WA, Duara S, Oh W, Cotten CM, Stevenson DK, Stoll BJ, Lemons JA, Guillet R, Jobe AH. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy.  N Engl J Med. 2005;  353 1574-1584
    CrossrefPubMedGoogle Scholar
  • 45 Shimabuku R, Ota A, Pereyra S, Veliz B, Paz E, Nakachi G, More M, Oliveros M. Hyperoxia with 100% oxygen following hypoxia-ischemia increases brain damage in newborn rats.  Biol Neonate. 2005;  88 168-171
    CrossrefPubMedGoogle Scholar
  • 46 Sola A, Deulofeut R. Oxygen and oxygenation in the delivery room.  J Pediatr. 2006;  148 564-565
    PubMedGoogle Scholar
  • 47 Temesvari P, Karg E, Bodi I, Nemeth I, Pinter S, Lazics K, Domoki F, Bari F. Impaired early neurologic outcome in newborn piglets reoxygenated with 100% oxygen compared with room air after pneumothorax-induced asphyxia.  Pediatr Res. 2001;  49 812-819
    CrossrefPubMedGoogle Scholar
  • 48 Thomson MA. Continuous positive airway pressure and surfactant; combined data from animal experiments and clinical trials.  Biol Neonate. 2002;  81 (Suppl 1) 16-9
    PubMedGoogle Scholar
  • 49 Vain NE, Szyld EG, Prudent LM, Wiswell TE, Aguilar AM, Vivas NI. Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial.  Lancet. 2004;  364 597-602
    CrossrefPubMedGoogle Scholar
  • 50 Vento M, Asensi M, Sastre J, Garcia-Sala F, Pallardo FV, Vina J. Resuscitation with room air instead of 100% oxygen prevents oxidative stress in moderately asphyxiated term neonates.  Pediatrics. 2001;  107 642-647
    CrossrefPubMedGoogle Scholar
  • 51 Vento M, Asensi M, Sastre J, Lloret A, Garcia-Sala F, Vina J. Oxidative stress in asphyxiated term infants resuscitated with 100% oxygen.  J Pediatr. 2003;  142 240-246
    CrossrefPubMedGoogle Scholar
  • 52 Vento M, Sastre J, Asensi MA, Vina J. Room-air resuscitation causes less damage to heart and kidney than 100% oxygen.  Am J Respir Crit Care Med. 2005;  172 1393-1398
    CrossrefPubMedGoogle Scholar
  • 53 Zupan J. Perinatal mortality and morbidity in developing countries.  A global view. Med Trop (Mars). 2003;  63 366-368
    PubMedGoogle Scholar

Korrespondenzadresse

T. Hoehn

Klinik für Allgemeine Pädiatrie, Neonatologie und Pädiatrische Intensivmedizin

Universitätsklinikum Düsseldorf

Moorenstr. 5 40225 Düsseldorf

Email: thomas.hoehn@uni-duesseldorf.de