Role of Sustained Inflation and Delayed Cord Clamping in Resuscitation after Asphyxia

持续充气和延迟脐带结扎在窒息后复苏中的作用

• 批准号: 9312133
• 负责人: Jayasree Nair
• 金额: $ 7.98万
• 依托单位: STATE UNIVERSITY OF NEW YORK AT BUFFALO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-07 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9312133
• 关键词: Address; Air; Albumins; Asphyxia; Asphyxia Neonatorum; Birth; Blood Circulation; Blood Pressure; Blood flow; Brain; Breathing; Cardiac Output; Cerebrovascular Circulation; Cerebrum; Cessation of life; Clinical; Closure by clamp; Consent; Economic Inflation; Environmental air flow; Equipment; Ethics; European; Excision; Fetus; Functional Residual Capacity; Future; Guidelines; Heart Rate; Hematocrit procedure; Hour; Human; Human Resources; Infant; Inflammation; Injury; Interleukin-6; Intervention; Left; Liquid substance; Lung; Lung Compliance; Lung Inflammation; Measures; Metabolic acidosis; Modeling; Neonatal Mortality; Newborn Infant; Organ; Oryctolagus cuniculus; Output; Oxygen; Oxygen saturation measurement; Perfusion; Peripheral Resistance; Physiological; Placenta; Placental Circulation; Population; Positive-Pressure Respiration; Premature Infant; Pulmonary Vascular Resistance; Pulmonary Ventilation; Randomized Clinical Trials; Randomized Controlled Trials; Recommendation; Recovery; Resources; Resuscitation; Risk; Role; Source; Speed; Structure of ductus venosus; Structure of parenchyma of lung; Syndrome; Techniques; Time; Training; Transfusion; Umbilical cord structure; Venous; Ventilatory Depression; Ventricular; World Health Organization; early onset; foramen ovale; hemodynamics; improved; insight; lung injury; neonatal morbidity; neonatal resuscitation; neonate; phase change; pressure; prevent; temporal measurement; translational clinical trial; translational study

Birth asphyxia, according to the World Health Organization (WHO), accounts for an estimated 900 000 deaths each year and is one of the primary causes of early neonatal morbidity and mortality. Ventilation constitutes the critical step in resuscitation of asphyxiated newborns. Current neonatal resuscitation guidelines recommend initiating ventilation if required after 30 sec of initial steps. Early onset of ventilation may have beneficial effects. A sustained inflation breath may help in establishing adequate functional residual capacity and may improve physiological parameters quickly during resuscitation. Delaying cord clamping is now recommended for all preterm infants. WHO also supports delayed cord clamping in normal term infants, however its role in birth asphyxia has not been well studied. The need for resuscitation often prevents the practitioner from delaying cord clamping in this population. Establishing ventilation with an intact cord, prior to clamping, helps to stabilize cerebral and pulmonary blood flows in preterm lambs. Improving cerebral blood flow may be critical in asphyxia. In this proposal, we plan to study initiation of ventilation with an intact cord and delayed cord clamping together, in near term lambs asphyxiated by cord occlusion. It would theoretically combine the advantages of placental transfusion and prompt resuscitation. A randomized controlled trial evaluating SI or PPV prior to delayed cord clamping in asphyxiated human infants is ideal. However, ethical concerns about proper consent, and feasibility of real time measurements of cerebral oximetry, flow and pressure limit the ability to perform such a study. Relevance to current practice in neonatal resuscitation: Sustained Inflation and Positive Pressure Ventilation prior to delayed cord clamping is a simple intervention that does not require sophisticated equipment or training and could be performed by personnel in low resource settings as well. This study will provide critical insight into the optimal approach to cord management and ventilation and influence future recommendations for management of the asphyxiated human neonate at delivery.

据世界卫生组织 (WHO) 称，出生窒息估计导致 90 万人死亡 每年都会发生，是早期新生儿发病和死亡的主要原因之一。通风构成 窒息新生儿复苏的关键步骤。现行新生儿复苏指南 如果需要，建议在初始步骤 30 秒后启动通气。早期开始通气可能会导致 有益的影响。持续的充气呼吸可能有助于建立足够的功能剩余能力 并可在复苏过程中快速改善生理参数。 现在建议所有早产儿延迟脐带结扎。世卫组织也支持脐带延迟 正常足月婴儿的夹紧，但其在出生窒息中的作用尚未得到充分研究。需要 在这一人群中，复苏通常会阻止医生推迟脐带结扎。 在夹闭之前用完整的脐带建立通气有助于稳定脑血和肺血 流于早产羔羊。改善脑血流量对于窒息可能至关重要。 在本提案中，我们计划研究在完整脐带和延迟脐带夹紧的情况下启动通气 在一起，近期羔羊因脐带阻塞而窒息。理论上它会结合以下优点 胎盘输血和及时复苏。一项评估 SI 或 PPV 之前的随机对照试验 对于窒息的人类婴儿，延迟断脐是理想的选择。然而，出于对适当同意的道德担忧， 实时测量脑血氧饱和度、流量和压力的可行性限制了执行能力 这样的研究。 与当前新生儿复苏实践的相关性： 延迟断脐之前持续充气和正压通气是一种简单的干预措施 不需要复杂的设备或培训，并且可以由资源匮乏的人员来执行 设置也是如此。这项研究将为电源线管理和优化的最佳方法提供重要的见解。 通气并影响未来窒息新生儿管理的建议 送货。

项目成果

Current and Emerging Therapies in the Management of Hypoxic Ischemic Encephalopathy in Neonates.

新生儿缺氧缺血性脑病治疗的当前和新兴疗法。

• 发表时间: 2018-07-19
• 作者: Nair, Jayasree;Kumar, Vasantha H S
• 通讯作者: Kumar, Vasantha H S

Oxygenation and Hemodynamics during Chest Compressions in a Lamb Model of Perinatal Asphyxia Induced Cardiac Arrest.

围产期窒息引起心脏骤停的羔羊模型胸外按压期间的氧合和血流动力学。

• 发表时间: 2019-04-03
• 作者: Rawat, Munmun;Chandrasekharan, Praveen;Gugino, Sylvia;Koenigsknecht, Carmon;Helman, Justin;Alsaleem, Mahdi;Mathew, Bobby;Nair, Jayasree;Berkelhamer, Sara;Vali, Payam;Lakshminrusimha, Satyan
• 通讯作者: Lakshminrusimha, Satyan

Term Neonate with Respiratory Distress.

患有呼吸窘迫的足月新生儿。

• 发表时间: 2017-10
• 作者: Dumpa, Vikramaditya;Gupta, Puneet;Iqbal, Vaseem;Nair, Jayasree
• 通讯作者: Nair, Jayasree