Resuscitation of the newborn

Article Abstract:

In spite of intensive attention and advanced technology, fetal asphyxia can occur during labor and delivery, which can result in brain damage or death. Intubation (passage of a breathing tube into the windpipe) and positive pressure ventilation are commonly used for poorly breathing infants, but these techniques have not been extensively evaluated. This article reviews the physiology of breathing and aspects of medical care for affected newborns. Studies which have measured lung expansion, including the duration of inspiration and pressure-volume relationships, are reviewed. Studies of respiration during resuscitation suggest that techniques using intubation result in pressure changes which are different from those in spontaneous breathers and which may be less effective. The findings of these studies are discussed. Usage of face masks to which breathing bags are attached is described. Treatment of newborns should include ensuring maintenance of body temperature and checking for deformities which would impede respiration. If heart rate is over 80 beats per minute, resuscitation should be delayed for one minute, during which stimulation or mild suction may be performed. Other aspects of resuscitation, including use of 100 percent oxygen, external cardiac massage, and medication, are discussed. Babies who fail to breathe spontaneously for up to 20 minutes may still develop normally, and resuscitation should be maintained for 20 to 30 minutes. Resuscitation is more often needed for more immature infants, and the techniques appropriate for these newborns are reviewed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation

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Endotracheal resuscitation of neonates using a rebreathing bag

Article Abstract:

Birth asphyxia remains a major cause of illness and death in newborns. Methods for resuscitation of newborns have not been well studied. Studies which have been conducted have limited the extent of pressures or volumes used during ventilation. In this study, the effectiveness of an endotracheal tube (a tube placed into the windpipe from the mouth) supplied with oxygen and a rebreathing bag was studied was evaluated. Chest movement, rather than preset volumes or pressures, was used as the primary determinant of inflation. Thirty newborns were studied. An average pressure of 40 centimeters (cm) H2O (water) was needed initially to inflate the lungs, but this subsequently decreased to 29 cm H2O, possibly due to clearance of fluid from the lungs. The technique used also resulted in better initial inflation than was found in other studies, probably due to the use of higher pressures. Lack of development of functional residual capacity (extra volume in the lungs ordinarily not used during normal breathing) during resuscitation was significantly associated with development of hyaline membrane disease, requiring artificial ventilation in premature infants. The study suggests that higher pressures are appropriate in the early stages of resuscitating newborns. Furthermore, resuscitation devices which develop positive end expiratory pressure might be beneficial for premature infants. More research on these issues is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Asphyxia neonatorum

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Apnoea, bradycardia, and oxygen saturation in preterm infants

Article Abstract:

Apnea of prematurity, the temporary cessation of breathing in premature infants, is common among babies with low birth weight and is associated with long term illness. However, the immediate effects of apnea on the provision of oxygen to the blood (oxygenation) in newborns are not known. Measuring oxygenation in the newborn has been difficult, but may be accurately accomplished by pulse oximetry, a photoelectric device which can determine the amount of oxygen in the blood. The effects of apnea on oxygen levels in the blood were assessed using pulse oximetry in 27 premature infants. In addition, the effects of bradycardia (slowed heart rate) and methylxanthine drugs on the apnea and oxygenation were also assessed. A total of 1,029 apnea attacks were analyzed. A reduction in blood levels of oxygen was associated with the duration of apnea; reductions of up to 40 percent occurred during apneic episodes of less than 10 seconds duration. Blood oxygen levels were reduced to a greater extent during episodes of apnea that resulted in bradycardia. These findings demonstrate the difficulties associated with establishing warning signs for apnea. For infants with recurrent apnea, heart rate and blood oxygen levels should be monitored, rather than simply detecting episodes of apnea. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Prevention, Causes of, Physiological aspects, Oxygen, Oxygen in the body, Bradycardia, Apnea neonatorum

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