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Reanimation des Neugeborenen

Resuscitation of newborn infants

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Zusammenfassung

Obwohl rund 10% aller Neugeborenen nach ihrer Geburt einfache respiratorische Unterstützung benötigen, sind weiterführende Reanimationsmaßnahmen nur bei etwa 1% der Neugeborenen notwendig. Da diese relativ seltenen Situationen nicht immer antizipiert werden können, sind Pädiater oder Neonatologen oft nicht verfügbar, und die Reanimation wird von den Geburtshelfern an die Anästhesisten delegiert. In den letzten Jahren wurden die internationalen Empfehlungen zur Neugeborenenreanimation vom International Liaison Committee on Resuscitation (ILCOR), der American Academy of Pediatrics (AAP) und der American Heart Association (AHA) sowie vom European Resuscitation Council (ERC) aktualisiert. Die revidierten Empfehlungen beschreiben einen vereinfachten Reanimationsalgorithmus, in dem die zentrale Rolle der Beatmung hervorgehoben und das Ansteigen der Herzfrequenz als bester Hinweis auf eine effektive Beatmung gewertet werden. Bei mekoniumhaltigem Fruchtwasser soll der Oropharynx nach Geburt des Kopfes nicht mehr abgesaugt werden, und ein intratracheales Absaugen erfolgt nur noch bei schwerer deprimierten Neugeborenen. Die Publikationen erwähnen den Einsatz von Larynxmaske und Kohlendioxid- (CO2)-Detektoren, ohne jedoch konkrete Empfehlungen abzugeben. Zunehmend wird die Frage kontrovers diskutiert, mit welcher Sauerstoffkonzentration initial reanimiert werden soll (FIO2 21–100%). In den seltenen Fällen, in denen die Herzfrequenz unter 60/min abfällt, kommen weiterführende Maßnahmen (Herzmassage mit der Zweidaumentechnik, Adrenalin 10–30 μg/kgKG i.v.) zum Einsatz. Schließlich wird der mögliche neuroprotektive Effekt einer therapeutischen Hypothermie nach Asphyxie erwähnt, letztlich aber nur darauf hingewiesen, dass eine Hyperthermie vermieden werden soll.

Abstract

Although almost 10% of all newborn infants need some form of respiratory assistance after birth, only 1% will require more advanced forms of resuscitation. Because these rare events cannot always be anticipated, pediatricians and neonatologists may not be readily available and resuscitation will have to be performed by anesthesiologists. In recent years, international guidelines for neonatal resuscitation have been revised by the International Liaison Committee on Resuscitation (ILCOR), the American Academy of Pediatrics (AAP) and the American Heart Association (AHA), as well as the European Resuscitation Council (ERC). The revised guidelines describe a simplified resuscitation algorithm which emphasizes the central role of respiratory support and an increase in heart rate is judged to be the best marker for successful ventilation. In deliveries complicated by meconium-stained amniotic fluid, intrapartum suctioning of the oropharynx is no longer recommended and endotracheal suctioning is restricted to severely depressed babies. The new guidelines mention the use of the laryngeal mask airway (LMA) and CO2 detectors without, however, making firm recommendations. The use of 100% oxygen in neonatal resuscitation is increasingly being challenged. In the rare event of a newborn whose heart rate drops below 60 beats/min, more advanced resuscitation (chest compressions using the 2-thumb-encircling-hands technique, epinephrine 10–30 μg/kgBW i.v.) will be required. Finally, the guidelines mention the possible neuroprotective effect of therapeutic hypothermia after asphyxia, but finally only recommend that hyperthermia should be avoided.

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  1. Neonatologische und pädiatrische Intensivpflegestation, Kinderspital Luzern, 6000, Luzern, Schweiz

    T.M. Berger & S. Pilgrim

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Correspondence to T.M. Berger.

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Berger, T., Pilgrim, S. Reanimation des Neugeborenen. Anaesthesist 58, 39–50 (2009). https://doi.org/10.1007/s00101-008-1439-2

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