PDF(Pubmed)
Abstract：
A shift in the Neonatal Resuscitation Program (NRP) guidelines occurred in 2015 from routine intubation and endotracheal suctioning of all meconium-stained non-vigorous infants towards less aggressive interventions based on response to initial resuscitation. This study aims to examine the impact of this change on outcomes of non-vigorous infants born through meconium-stained amniotic fluid at a level III academic NICU encompassing years before and after the change in guideline. This single-center retrospective study compared NICU therapies and clinical outcomes of 117 non-vigorous newborns pre-guideline implementation to 106 non-vigorous newborns post-guideline implementation. Nearly two thirds of infants in the pre-guideline cohort received endotracheal suctioning with recovery of meconium compared to less than a third of infants in the post-guideline cohort (p<0.01). Though a higher proportion of the pre-guideline cohort were admitted to the NICU for respiratory issues compared to the post-guideline cohort, the two groups did not differ significantly with regard to morbidity and therapies. Despite a marked reduction in rates of intubation and endotracheal suctioning, there is no difference in outcomes between pre-guideline implementation vs post-guideline implementation in non-vigorous meconium-stained infants, supporting the recent NRP guideline change and highlighting the benefit of expectant management.
摘要：
2015年，新生儿复苏计划（NRP）指南发生了转变，从所有胎粪染色的非精力充沛婴儿的常规插管和气管内抽吸，转向基于对初始复苏的反应的较不积极的干预措施。这项研究旨在研究这种变化对在III级学术NICU中通过胎粪染色的羊水出生的非精力充沛婴儿的结局的影响，该结果涵盖了指南更改前后的数年。这项单中心回顾性研究比较了NICU治疗方法和指南实施前117例非健壮新生儿与指南实施后106例非健壮新生儿的临床结果。指南前队列中将近三分之二的婴儿接受了气管内吸引并恢复了胎粪，而指南后队列中不到三分之一的婴儿（p<0.01）。尽管与指南后队列相比，指南前队列因呼吸系统问题进入NICU的比例更高，两组在发病率和治疗方面没有显著差异.尽管插管率和气管内吸引率显着降低，在非剧烈胎粪污染的婴儿中，指南前实施与指南后实施之间的结果没有差异，支持最近的NRP指南变更，并强调预期管理的好处。
