Golden Moments: Management Of Premature Baby In The Delivery Room

Abstract

Premature infants often experience difficulties adapting to postnatal life. The most relevant ones are related to establishing an adult type cardiorespiratory circulation and acquiring hemodynamic stability, aerating the lung and attaining a functional residual capacity, performing an adequate gas exchange and switching to an oxygen enriched metabolism, and keeping an adequate body temperature. In recent years a body of evidence supports a trend towards gentle management in the delivery room aiming to reduce damage especially to the lungs in the so-called first golden minutes. Herewith, we describe and update four of the most relevant interventions performed in the delivery room: delayed cord clamping, non-invasive ventilation, individualized oxygen supplementation, and maintaining an adequate body temperature so as to avoid hyperthermia and/or hypothermia.

Keywords

• Preterm infant,postnatal transition,resuscitation,delivery room management

Altın Dakikalar: Prematüre Bebeğin Doğum Salonunda Yönetimi

Abstract

Prematüre bebekler; erişkin tipi kardiyovasküler dolaşım ve hemodinamik stabilitenin sağlanması, akciğerlerin uygun fonksiyonel rezidüel kapasite sağlanacak şekilde havalandırılması, alveoler gaz değişiminin uygun şekilde yapılması, oksijenden zengin metabolizmaya geçiş ve vücut ısısının korunması gibi postnatal hayata adaptasyon mekanizmalarını gerçekleştirmede sıklıkla güçlükler yaşamaktadırlar. Son yıllarda altın dakikalar olarak adlandırılan hayatın ilk birkaç dakikasında doğum salonu yönetiminin nazik bir şekilde yapılmasının özellikle akciğerler olmak üzere diğer organ sistemlerinde gelişebilecek hasarı azalttığına dair birçok kanıt ortaya sürülmüştür. Bu derlemede amaç hayatın ilk altın dakikalarında sıklıkla uygulanan; gecikmiş kord klemplenmesi, non-invazif ventilasyon, bireyselleştirilmiş oksijen tedavisi, uygun vücut ısısının sağlanması gibi doğum salonu uygulamaları konusunda bilgilerimizin güncellenmesidir.

Keywords

• Preterm bebek,canlandırma,doğum salonu uygulamaları

References

1. Vento M, Cheung PY, Aguar M. The first golden minutes of the extre- mely-low-gestational-age neonate: a gentle approach. Neonatology 2009;95:286–98.
2. Perlman JM, Wyllie J, Kattwinkel J, Atkins DL, Chameides L, Goldsmith JP, et al. Part 11: Neonatal resuscitation: 2010 International Consensus on Cardiopul-monary Resuscitation and Emergency Cardiovascular Care Science with treat-ment recommendations. Circulation 2010;122:516– 38.
3. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European consensus guidelines on the management of neonatal respi- ratory distress syndrome in preterm infants 2013 update. Neonatology 2013;103:353–68.
4. Dawson JA, Kamlin CO, Vento M, Wong C, Cole TJ, Donath SM, et al. Defining the reference range for oxygen saturation for infants after birth. Pediatrics 2010;125:1340–7.
5. Peltonen T. Placental transfusion e advantage and disadvantage. Eur J Pediatr 1981;137:141-69.
6. Bhatt S, Alison BJ, Wallace EM, Crossley KJ, Gill AW, Kluckow M, et al. Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs. J Physiol 2013;591:2113–26.
7. Rabe H, Diaz-Rosello JL, Duley L, Dowswell T. Effect of timing of umbili- cal cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 2012 Aug 15;8:CD003248.
8. Niermeyer S, Velaphi S. Promoting physiologic transition at birth: re- examin-ing resuscitation and the timing of cord clamping. Semin Fetal Neonatal Med 2013;18:385–92.

9. Raju TNK. Timing of umbilical cord clamping after birth for optimizing placental transfusion. Curr Opin Pediatr 2013;25:180–7.
10. Hillman N, Kallapur SG, Jobe AH. Physiology of transition from intrauteri- ne to extrauterine life. Clin Perinatol 2012;39:769–83.
11. Auten RL, Vozzelli M, Clark RH. Volutrauma. What is it, and how do we avoid it? Clin Perinatol 2001;28:505–15.
12. Hooper SB, Siew ML, Kitchen MJ, te Pas AB. Establishing functional re- sidual capacity in the non-breathing infants. Semin Fetal Neonatal Med 2013;18: 336–43.
13. Jobe A, Ikegami M, Jacobs H, Jones S. Surfactant and pulmonary blo- od flow distributions following treatment of premature lambs with natural surfactant. J Clin Invest 1984;73:848–56.
14. Brown MK, DiBiasi RM. Mechanical ventilation of the premature neonate. Respir Care 2011;56:1298–311.
15. Bry K. Newborn resuscitation and the lung. NeoReviews 2008;9:506– 11.3.
16. Leone TA, Finer NN. Neonatal resuscitation: beyond the basics. NeoRe- views 2005;6:177–83.
17. Schmo¨ lzer GM, Te Pas AB, Davis PG, Morley CJ. Reducing lung injury during neonatal resuscitation of preterm infants. J Pediatr 2008;153:741– 5.
18. Roehr CC, Morley CJ, Vento M. Improving neonatal transition by giving ventilatory support in the delivery room. Neoreviews 2012;13:343–52.
19. Tingay DG, Bhatia R, Schmo¨ lzer GM, Wallace MJ, Zahra VA, Davis PG. Effect of sustained inflation vs. stepwise PEEP strategy at birth on gas exchange and lung mechanics in preterm lambs. Pediatr Res 2013.
20. Mehler K, Grimme J, Abele J, Huenseler C, Roth B, Kribs A. Outcome of extremely low gestational age newborns after introduction of a revised protocol to assist preterm infants in their transition to extrauterine life. Acta Pædiatr 2012;101:1232–9.
21. Milner AD. Resuscitation of the newborn. Archives of Disease in Childho- od 1991;66:66–9.
22. Vyas H, Field D, Milner AD, Hopkin IE. Determinants of the first inspiratory volume and functional residual capacity at birth. Pediatric Pulmonology 1986;2:189–93.
23. Vyas H, Milner AD, Hopkin IE, Boon AW. Physiologic responses to pro- longed and slow-rise inflation in the resuscitation of the asphyxiated new- born infant. J Pediatr 1981;99:635–9.
24. Sobokta KS, Hooper SB, te PAS AB, Davis PG, Morley CJ, Moss TJ. An initial sustained inflation improves the respiratory and cardiovascular transition in preterm lambs. Pediatr Res 2011; 70:56–60.
25. Klingenberg C, Sobotka KS, Ong T, Allison BJ, Schmo¨ lzer GM, Moss TJ, et al. Effect of sustained inflation duration: resuscitation of near-term asphyxiated lambs. Arch Dis Child Fetal Neonatal Ed 2013;98:222–7.
26. Gerhardt T, Bancalari E. Chestwall compliance in full-term and premature infants. Acta Paediatr Scand 1980;69:359–64.
27. Heldt GP, Mc Ilroy MB. Dynamics of chest wall in preterm infants. J Appl Physiol 1987;62:170–4.
28. Te Pas AB, Walther FJ. A randomized, controlled trial of delivery-room res- pi-ratory management in very preterm infants. Pediatrics 2007;120:322– 9.
29. Fuchs H, Lindner W, Buschko A, Trischberger T, Schmid M, Hummler HD. Cerebral oxygenation in very low birth weight infants supported with sus-tained lung inflations after birth. Pediatr Res 2011;70:176–80.
30. Gao Y, Raj JU. Regulation of pulmonary circulation in the fetus and new- born. Physiol Rev 2010;90:1291–335.
31. Vento M, Teramo K. Evaluating the fetus at risk for cardiopulmonary com- pro-mise. Semin Fetal Neonatal Med 2013;18:324–9.
32. Schneider H. Oxygenation of the placental-fetal unit in humans. Respir Physiol Neurobiol 2011;178:51-8.
33. O’Donnell CP, Kamlin CO, Davis PG, Carlin JB, Morley CJ. Clinical as- sessment of infant colour at delivery. Arch Dis Child Fetal Neonatal Ed 2007;92:465–7.
34. Rabi Y, Dawson JA. Oxygen therapy and oximetry in the delivery room. Semin Fetal Neonatal Med 2013;18:330–5.
35. Finer N, Leone T. Oxygen saturation for the preterm infant: The evidence basis for current practice. Pediatr Res 2009;65:375–80.
36. O’Donnell CPF, Kamlin COF, Davis PG, Morley CJ. Feasibility of and de- lay in obtaining pulse oximetry during neonatal resuscitation. Pediatrics 2005;147: 698–9.
37. Vento M, Saugstad OD. Resuscitation of the term and preterm infant. Se- min Fetal Neonatal Med 2010;15:16–22.
38. Vento M, Aguar M, Leone TA, Finer NN, Gimeno A, Rich W, Saenz P, Esc- rig R, Brugada M. Using intensive care technology in the delivery room: a new concept for the resuscitation of extremely preterm neonates. Pediat- rics 2008;122:1113–6.
39. Dawson JA, Kamlin CO, Wong C, te Pas AB, Vento M, Cole TJ, Donath SM, Hooper SB, Davis PG, Morley CJ. Changes in heart rate in the first minutes after birth. Arch Dis Child Fetal Neonatal Ed 2010;95:177–81.
40. Vento M, Cubells E, Escobar JJ, Escrig R, Aguar M, Brugada M, Cernada M, Sae´nz P, Izquierdo I. Oxygen saturation after birth in preterm infants treated with continuous positive airway pressure and air: assessment of gender differences and comparison with a published nomogram. Arch Dis Child Fetal Neonatal Ed 2013;98:228–32.
41. Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J, Ha- zinski MF, Halamek LP, Kumar P, Little G, McGowan JE, Nightengale B, Ramirez MM, Ringer S, Simon WM, Weiner GM, Wyckoff M, Zaichkin J. Special Report Neonatal Resuscitation: 2010 American Heart Association for Cardiopulmo-nary Resuscitation and Emergency Cardiovascular Care Pediatrics 2010;122: 909–19.
42. Dawson JA, Vento M, Finer NN, Rich W, Saugstad OD, Morley CJ, Davis PG. Managing oxygen therapy during delivery room stabilization of pre- term infants. J Pediatr 2012;160:158–61.
43. Power G, Blood A. Fetal and Neonatal Physiology. In: Polin R, Fox W, Ab- man S, editors. Thermoregulation. Philadelpia: Elsiever; 2011: 615–24.
44. Laptook AR, Watkinson M. Temperature management in the delivery room. Semin Fetal Neonatal Med 2008;13:383–91.
45. McCall EM, Alderdice FA, Halliday HL, Jenkins JG, Vohra S. Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants. Cochrane Database Syst Rev 2010;(3):CD004210.
46. Trevisanuto D, Doglioni N, Cavallin F, Parotto M, Micaglio M, Zanardo V. Heat loss prevention in very preterm infants in the delivery room: a prospective, randomized, controlled trial of polyethylene caps. J Pediatr 2010;156:914-7.
47. Trevisanuto D, Coretti I, Doglioni N, Udilano A, Cavallin F, Zanardo V. Ef- fective temperature under radiant infant warmer: does the device make a difference? Resuscitation 2011;82:720–3.
48. Perlman JM, Kasdorf E. Hyperthermia, inflammation, and perinatal brain injury. Pediatr Neurol 2913; 49: 8–14.
49. Petrova A, Demissie K, Rhoads GG, Smulian JC, Marcella S, Ananth CV. Associ-ation of maternal fever during labor with neonatal an infant morbi- dity and mortality. Obstet Gynecol 2001;98:20–7.