Monatsschrift Kinderheilkunde

, Volume 164, Issue 8, pp 652–659 | Cite as

Erstversorgung von Früh- und Termingeborenen

Leitthema

Zusammenfassung

Die perinatale Adaptation ist ein komplexer Prozess, in dessen Mittelpunkt das Einsetzen der Atmung mit der damit verbundenen Entfernung von Flüssigkeit aus den Atemwegen und die Umstellung des fetalen Kreislaufs stehen. Unmittelbar nach der Geburt ergibt sich selten der Bedarf einer Wiederbelebung (Reanimation); vielmehr machen Störungen der Adaptation häufiger eine medizinische Unterstützung (Animation) unterschiedlichen Ausmaßes erforderlich. Ziel der vorliegenden Arbeit ist ein Überblick über aktuelle Empfehlungen, wie potenzielle Probleme der postnatalen Adaptation vermieden und klinische Symptome der gestörten Adaptation erkannt bzw. behandelt werden können. Dabei wird auch auf Besonderheiten der aktuellen Empfehlungen des European Resuscitation Council (ERC) eingegangen.

Schlüsselwörter

Adaptation Anpassungsstörung Apgar-Score Sectio caesarea ERC-Richtlinie 

Support for perinatal transition of term and preterm infants

Abstract

Perinatal transition represents a complex process, including onset of breathing which is associated with a clearance of lung fluid and the hemodynamic changes from fetal circulation. Whereas disturbances in postnatal adaptation with a subsequent need for medical support of varying intensity are relatively frequent immediately after parturition, only few infants actually require resuscitation. This article gives an overview of current recommendations on how to prevent problems in adaptation and how to diagnose and treat symptoms of disturbed adaptation. It also covers some special aspects of the current guidelines of the European Resuscitation Council (ERC).

Keywords

Adaptation Adaptation disorder Apgar score Cesarean section ERC guidelines 

Literatur

  1. 1.
    Al-Wassia H, Shah PS (2015) Efficacy and safety of umbilical cord milking at birth: a systematic review and meta-analysis. JAMA Pediatr 169:18–25. doi:10.1001/jamapediatrics.2014.1906CrossRefPubMedGoogle Scholar
  2. 2.
    Apgar V (1953) A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg 32:260–267CrossRefPubMedGoogle Scholar
  3. 3.
    Bradshaw LE, Pushpa-Rajah A, Dorling J et al (2015) Cord pilot trial: update to randomised trial protocol. Trials 16:1–3. doi:10.1186/s13063-015-0936-2CrossRefGoogle Scholar
  4. 4.
    Chaillet N, Dumont A, Abrahamowicz M et al (2015) A cluster-randomized trial to reduce cesarean delivery rates in quebec. N Engl J Med 372:1710–1721. doi:10.1056/NEJMoa1407120CrossRefPubMedGoogle Scholar
  5. 5.
    Dalili H, Nili F, Sheikh M et al (2015) Comparison of the four proposed Apgar scoring systems in the assessment of birth asphyxia and adverse early neurologic outcomes. PLoS ONE doi:10.1371/journal.pone.0122116PubMedPubMedCentralGoogle Scholar
  6. 6.
    Dalili H, Sheikh M, Hardani AK et al (2016) Comparison of the combined versus conventional Apgar scores in predicting adverse neonatal outcomes. PLoS ONE 11:e0149464 doi:10.1371/journal.pone.0149464CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    a DJ, Kamlin COF, Vento M et al (2010) Defining the reference range for oxygen saturation for infants after birth. Pediatrics 125:e1340–e1347. doi:10.1542/peds.2009–1510CrossRefGoogle Scholar
  8. 8.
    Feldman R, Weller A, Sirota L, Eidelman AI (2002) Skin-to-skin contact (kangaroo care) promotes self-regulation in premature infants: sleep-wake cyclicity, arousal modulation, and sustained exploration. Dev Psychol 38:194–207. doi:10.1037/0012-1649.38.2.194CrossRefPubMedGoogle Scholar
  9. 9.
    Gyamfi-Bannerman C, Thom EA, Blackwell SC et al (2016) Antenatal betamethasone for women at risk for late preterm delivery. N Engl J Med 374. doi:10.1056/NEJMoa1516783PubMedGoogle Scholar
  10. 10.
    Hooper SB, Pas AB te, Lang J et al (2015) Cardiovascular transition at birth: a physiological sequence. Pediatr Res 77:608–614. doi:10.1038/pr.2015.21PubMedGoogle Scholar
  11. 11.
    Kennell J, McGrath S (2005) Starting the process of mother-infant bonding. Acta Paediatr 94:775–777. doi:10.1080/08035250510035634CrossRefPubMedGoogle Scholar
  12. 12.
    Mehler K, Wendrich D, Kissgen R et al (2011) Mothers seeing their VLBW infants within 3 h after birth are more likely to establish a secure attachment behavior: evidence of a sensitive period with preterm infants? J Perinatol 31:404–410. doi:10.1038/jp.2010.139CrossRefPubMedGoogle Scholar
  13. 13.
    Mikiel-Kostyra K, Mazur J, Boltruszko I (2007) Effect of early skin-to-skin contact after delivery on duration of breastfeeding: a prospective cohort study. Acta Paediatr 91:1301–1306. doi:10.1111/j.1651-2227.2002.tb02824.xCrossRefGoogle Scholar
  14. 14.
    Miserocchi G, Haxhiu B, Fabbro M del (1994) Pulmonary interstitial newborn rabbits pressure in anesthetized paralyzed. J Appl Physiol 77:2260–2268PubMedGoogle Scholar
  15. 15.
    Phillipos E, Solevåg AL, Pichler G et al (2015) Heart rate assessment immediately after birth. Neonatology 9:130–138. doi:10.1159/000441940CrossRefGoogle Scholar
  16. 16.
    Pinheiro JM (2009) The Apgar cycle: a new view of a familiar scoring system. Arch Dis Child Fetal Neonatal Ed 94:F70–F72. doi:10.1136/adc.2008.145037CrossRefPubMedGoogle Scholar
  17. 17.
    Rabe H, Diaz-Rossello JL, Duley L, Dowswell T (2012) Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 8:CD003248. doi:10.1002/14651858.CD003248.pub3PubMedGoogle Scholar
  18. 18.
    Rüdiger M, Braun N, Aranda J et al (2015) Neonatal assessment in the delivery room – trial to evaluate a specified type of Apgar (TEST-Apgar). BMC Pediatr 15:18. doi:10.1186/s12887-015-0334-7CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Rüdiger M, Wauer RR, Schmidt K, Küster H (2006) The Apgar score. Pediatrics 118:1314–1315 (author reply 1315–1316). doi:10.1542/peds.2006–1254CrossRefPubMedGoogle Scholar
  20. 20.
    Schmid MB, Reister F, Mayer B et al (2013) Prospective risk factor monitoring reduces intracranial hemorrhage rates in preterm infants. Dtsch Arztebl Int 110:489–496. doi:10.3238/arztebl.2013.0489PubMedPubMedCentralGoogle Scholar
  21. 21.
    Smit M, Dawson JA, Ganzeboom A et al (2014) Pulse oximetry in newborns with delayed cord clamping and immediate skin-to-skin contact. Arch Dis Child Fetal Neonatal Ed 99:F309–F314. doi:10.1136/archdischild-2013-305484CrossRefPubMedGoogle Scholar
  22. 22.
    Statement P (2006) The Apgar score. Pediatrics 117:1444–1447. doi:10.1542/peds.2006-0325CrossRefGoogle Scholar
  23. 23.
    Stutchfield P, Whitaker R, Russell I (2005) Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomised trial. BMJ 331:660–662. doi:10.1136/bmj.38547.416493.06Google Scholar
  24. 24.
    Stutchfield PR, Whitaker R, Gliddon AE et al (2013) Behavioural, educational and respiratory outcomes of antenatal betamethasone for term caesarean section (ASTECS trial). Arch Dis Child Fetal Neonatal Ed 98:F195–F200. doi:10.1136/archdischild-2012-303157CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Wyllie J, Bruinenberg J, Roehr CC et al (2015) European resuscitation council guidelines for resuscitation 2015. Resuscitation 95:249–263. doi:10.1016/j.resuscitation.2015.07.029CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Fachbereich Neonatologie und Pädiatrische IntensivmedizinKlinik für Kinderheilkunde und JugendmedizinDresdenDeutschland

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