Evidence-Based Analysis for the Resuscitation of Newborn Infants with Perinatal Asphyxia_Chinese Journal of Evidence-Based Medicine

Authors：

廖志 ¹ , 万朝敏 ²

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Keywords：

Newborn infants; Asphyxia; Resuscitation; Systematic review; Randomized controlled trials; Clinical evidence

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目的　评价不同复苏方法和不同药物、氧疗、物理疗法等对新生儿窒息复苏和复苏后的预防措施的有效性和安全性.
方法　计算机检索Cochrane Library(2004年第3期),MEDLINE(1966～2002年) 关于新生儿窒息复苏时不同复苏方法、氧气的应用、以及不同药物、剂量、给药途径治疗和预防新生儿窒息的系统评价、随机和半随机对照试验.
结果　正压通气时使用100%氧气和应用室内空气的复苏效果并无差异.胎粪污染羊水(MSAF)与较高的新生儿缺血缺氧性脑病(HIE)的发生率有关,而气管内有胎粪者无论稀稠均与胎粪吸入综合征发生率无关.窒息复苏后预防性给予亚低温疗法、抗惊厥药、纳洛酮、多巴胺等在降低新生儿病死率,继发HIE的严重程度等方面与对照组相比无显著差异.应用肺表面活性物质(PS)预防和治疗新生儿呼吸窘迫综合征(RDS),可减少死亡率和并发症.
结论　应用PS预防和治疗RDS可明显减少新生儿死亡率,且胎龄 lt;32周的早产儿预防用药比治疗用药效果更好;目前尚无充分证据证明窒息复苏后预防性给予亚低温疗法、抗惊厥药、纳洛酮、多巴胺等治疗的有效性.

Citation： 廖志,万朝敏. Evidence-Based Analysis for the Resuscitation of Newborn Infants with Perinatal Asphyxia. Chinese Journal of Evidence-Based Medicine, 2004, 04(9): 648-651. doi: Copy

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1. ［1］Saugsted OD, Rootwelt T, Aalen O. Resuscitation of asphyxiated infants with room air or oxygen:an international controlled trial: the resair 2 study[J]. Pediatrics, 1998; 102(1): 130.
2. ［2］Tan A, Schulze A, O’Donnell CPF, Davis PG. Air versus oxygen for resuscitation of infants at birth (Cochrane Review)[M/CD]. In: The Cochrane Library, Issue 3, 2004.
3. ［3］Pierce J, Gaudier FL, Sanchez-Ramos L. Intrapartum amino infusion for meconium-aab2stained fluid: meta-analysis of prospective clinical trials[J]. Obstet Gynecol, 2000; 95: 1 051.
4. ［4］Wiswell TE. Expanded uses of surfactant therapy[J]. Clin Perinatol, 2001; 28: 695.
5. ［5］Ziino AJA, Davies MW, Davis PG. Epinephrine for the resuscitation of apparently stillborn or extremely bradycardic newborn infants (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.
6. ［6］Paradisis M, Osborn DA. Adrenaline for prevention of morbidity and mortality in preterm infants with cardiovascular compromise (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.
7. ［7］Yeo CL, TickhopeDI. Outcome of resuscitated apparently stillborn: a ten years review [J]. J Pediatr Child Health, 1994; 30: 129.
8. ［8］Osborn DA, Evans N. Early volume expansion for prevention of morbidity and mortality in very preterm infants (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.
9. ［9］Askie LM, Henderson-Smart DJ. Early versus late discontinuation of oxygen in preterm or low birth weight infants (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.
10. ［10］Chen ZL, Xu HQ. Application ofcurrent resuscitation in delivery room [J]. Journal of Neonatology (Chinese), 1992; 7(1): 56.
11. ［11］Jacobs S, Hunt R, Tarnow-Mordi W, Inder T, Davis P. Cooling for newborns with hypoxic ischaemic encephalopathy (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.
12. ［12］Zhou WH, Xiao M, Zhang XD. Selecting cooling temperature of head for heart function inasphyxited newborns [J]. Chinese Journal of Pediatrics, 2003; 41(6): 460-462.
13. ［13］Thoresen M, Wyatt J. Keeping a cool head, posthypoxic hypothermia-an old idea revisted [J]. Acta Paediatr, 1997; 86(10): 1 029.
14. ［14］Yanamoto H, Nakahara I. Combination of intraischemia and postischemia and persistent neuroprotection against temporary focal ischemia in rat [J]. Stroke, 1999; 30(12): 2 720.
15. ［15］Evans DJ, Levene MI. Anticonvulsants for preventing mortality and morbidity in full term newbones with perinatal asphyxia (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.
16. ［16］Lotze A,Mitcbell BR, Bulas DI, et al. Multicenter study of surfactant (beractant) use in the treatment of term infants with severe respiratory failure [J]. J Pediatr, 1998; 132: 40.
17. ［17］Wiswell TE, Knight GR, Finer NN. A multicenter, randomized, controlled trial comparing Surfaxin (Lucinactant) lavage with standard care for treatment of meconium aspiration syndrome [J]. Pediatrics,2002; 9(6): 1 081.
18. ［18］Egbert J, Brand R, Walti H. Mortality,severe respiratory distress syndrome and chronic lung disease of the newborn are reduced more after the prophylactic than after the therapeutic administration of the surfactant curosurf [J]. Pediatrics, 1997; 100: 1e4.
19. ［19］Soll RF. Synthetic surfactant for respiratory distress syndrome in preterm infants (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.
20. ［20］McGuire W, Fowlie PW, Evans DJ. Naloxone for preventing morbidity and mortality in newborn infants of greater than 34 weeks’ gestation with suspected perinatal asphyxia (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.
21. ［21］Hunt R, Osborn D. Dopamine for prevention of morbidity and mortality in term newborn infants with suspected perinatal asphyxia (Cochrane Review) [M/CD]. In: The Cochrane Library, Issue 3, 2004.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Analysis for the Resuscitation of Newborn Infants with Perinatal Asphyxia

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