Reanimation des Neugeborenen

Abstract

Although almost 10% of all newborn infants need some form of respiratory assistance after birth, only 1% will require more advanced forms of resuscitation. Because these rare events cannot always be anticipated, pediatricians and neonatologists may not be readily available and resuscitation will have to be performed by anesthesiologists. In recent years, international guidelines for neonatal resuscitation have been revised by the International Liaison Committee on Resuscitation (ILCOR), the American Academy of Pediatrics (AAP) and the American Heart Association (AHA), as well as the European Resuscitation Council (ERC). The revised guidelines describe a simplified resuscitation algorithm which emphasizes the central role of respiratory support and an increase in heart rate is judged to be the best marker for successful ventilation. In deliveries complicated by meconium-stained amniotic fluid, intrapartum suctioning of the oropharynx is no longer recommended and endotracheal suctioning is restricted to severely depressed babies. The new guidelines mention the use of the laryngeal mask airway (LMA) and CO(2) detectors without, however, making firm recommendations. The use of 100% oxygen in neonatal resuscitation is increasingly being challenged. In the rare event of a newborn whose heart rate drops below 60 beats/min, more advanced resuscitation (chest compressions using the 2-thumb-encircling-hands technique, epinephrine 10-30 mug/kgBW i.v.) will be required. Finally, the guidelines mention the possible neuroprotective effect of therapeutic hypothermia after asphyxia, but finally only recommend that hyperthermia should be avoided.

A Survey of Intravenous Sodium Bicarbonate in Neonatal Asphyxia among European Neonatologists: Gaps between Scientific Evidence and Clinical Practice

“…Despite the hyperosmolarity and carbon dioxide-generating properties of bicarbonate which might actually impair myocardial and cerebral function [18][19][20] , this belief permeated teaching of neonatal medical professional and clinical practice. Although present European guidelines for resuscitation at birth still allow the use of IVSB, recent updated guidelines from some countries do not even mention its use in the delivery room [10,11] . Moreover, updated reviews of the literature cast doubt on the usefulness of bicarbonate for acute correction of acidosis, and highlight the potential for IVSB to exacerbate myocardial and central nervous system damage [6,21,22] .…”

“…The International Liaison Committee on Resuscitation 2005 guidelines state that: 'Very rarely, a narcotic antagonist, sodium bicarbonate, or vasopressors may be useful during resuscitation' [8] . Coincidentally, national guidelines from the Netherlands, Germany and Canada do not even mention the use of IVSB during resuscitation [9][10][11] . However, in a recent study performed in our country (Spain), we showed that national/ international recommended resuscitation guidelines were only partially followed and that permeation of knowledge received during programmed cardiopulmonary resuscitation courses was not automatically put into practice [12] .…”