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Erstversorgung von Neugeborenen

Kreißsaalausstattung und -management in Österreich

Delivery room resuscitation

Review of equipment and survey of practice in Austria

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Zusammenfassung

Beim Übergang vom intrauterinen zum neonatalen Leben müssen 3–6% aller Neugeborenen unterstützt werden. Damit stellt die neonatale Erstversorgung eine der häufigsten medizinischen Interventionen dar. Mittels eines Fragebogens wurden das verwendete Equipment und das dazugehörige Verwendungsprotokoll bei der Erstversorgung von Neugeborenen in Österreich erhoben und mit den im Jahr 2005 publizierten Richtlinien des European Resuscitation Council verglichen. Alle 20 kontaktierten Abteilungen beantworteten den Fragebogen. Erfragt wurden die Verwendung von Pulsoxymetrie, Beatmungsbeutel („self-inflating“/“flow-inflating“/“T-piece device“), CO2-Detektor zur Tubuslagekontrolle, Sauerstoffblender, Larynxmaske, oralem Airway, Klarsichtfolie zur Verhinderung des Wärmeverlusts bei der Erstversorgung von Frühgeborenen unter 28 Schwangerschaftswochen sowie die initiale Sauerstoffkonzentration bei der Erstversorgung von Reifgeborenen. Letztere variierte zwischen 21% und 100%. Bei 17 Abteilungen (85%) kamen Sauerstoffblender, bei den übrigen Flowmeter zur Anwendung. Alle 20 Abteilungen (100%) verwendeten Pulsoxymetrie, 9 (45%) „self-inflating-bags“, 9 (45%) „T-piece devices“ und 2 beide Beatmungshilfen. Einen oralen Airway bei schwieriger Maskenbeatmung nutzten 10 Abteilungen (50%), eine Larynxmaske als Alternative zur Intubation 8 (40%) und einen CO2-Detektor zur Tubuslagekontrolle 6 (30%). Klarsichtfolien zur Verhinderung des Wärmeverlusts wurden in 11 Abteilungen (55%) eingesetzt. Dem internationalen Trend entsprechend zeigte sich auch in Österreich eine große Variationsbreite des verwendeten Equipments. Dies reflektiert die allgemein ungenügende Datenlage zur Erstversorgung von Neugeborenen.

Abstract

Approximately 3%–6% of all newborn infants require some form of resuscitation at birth, making neonatal resuscitation one of the commonest medical interventions. An internationally agreed consensus statement and various guidelines advise how newborn infants should be resuscitated and suggest equipment to use. The aim of this study was to compare the current standard of neonatal resuscitation in Austria with the neonatal resuscitation guidelines published in 2005. A questionnaire was sent to Austrian neonatal units with delivery rooms. The questionnaire evaluated the use of positive pressure ventilation devices, pulse oximetry, laryngeal mask, oral (Guedel) airway, oxygen blenders, use of supplementary oxygen in term infants, CO2 detectors and polyethylene wrapping for infants ≤ 28 weeks. All 20 neonatal units contacted answered the questionnaire. The initial oxygen concentration during resuscitation of term infants ranged between 21% and 100%. A total of 17 (85%) departments used oxygen blenders, the others a flow meter. Pulse oximetry was used in 20 (100%) departments, nine (45%) used a self-inflating-bag and a T-piece device. Two departments used either the self-inflating or the T-piece device and none used the flow-inflating bag. An oral airway (Guedel) was used in 10 (50%) and a laryngeal mask in eight (40%) departments. CO2 detectors were in use in six (30%) and polyethylene wrapping in 11 (55%) departments. This survey shows that, in line with the international trend, a wide-ranging variety of equipment is used also in Austria, reflecting the lack of data on neonatal resuscitation.

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Abb. 1

Abbreviations

ERC:

European Resuscitation Council

ILCOR:

International Liaison Committee on Resuscitation

LMA:

Larynxmaske

NICN:

Neonatal Intermediate Care Nursery

SaO2 :

Sauerstoffsättigung des arteriellen Blutes

SSW:

Schwangerschaftswoche

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Danksagung

Wir danken allen teilnehmenden neonatologischen Abteilungen: Universitätskliniken für Kinder- und Jugendheilkunde Graz, Innsbruck und Wien, St. Johanns-Spital und Paracelsus-Privatuniversität Salzburg, Landesspitäler Bregenz, Dornbirn, Eisenstadt, Klagenfurt, Leoben, Linz, Oberwart und Villach, Krankenhaus St. Josef in Braunau, Krankenhaus der Barmherzigen Schwestern vom Heiligen Kreuz Wels, Thermenklinikum Mödling, Zentralklinikum St. Pölten, Krankenhaus der Staturstadt Wiener Neustadt, Gottfried von Preyer’sches Kinderspital Wien, Donauspital im Sozialmedizinischen Zentrum Ost der Stadt Wien sowie Kinderklinik Glanzing im Wilhelminenspital Wien.

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Authors and Affiliations

  1. Department of Newborn Research/Neonatal Services, The Royal Women’s Hospital, 20 Flemington Road, 3052, Victoria, Australien

    G.M. Schmölzer

  2. Klinische Abteilung für Neonatologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich

    G.M. Schmölzer, W. Raith, B. Resch, F. Reiterer, W. Müller & B. Urlesberger

  3. Murdoch Children Research Institute, Melbourne, Melbourne, Australien

    G.M. Schmölzer

  4. Department of Physiology, Monash University, Melbourne, Melbourne, Australien

    G.M. Schmölzer

  5. Department of Neonatology, The Royal Children’s Hospital, Melbourne, Melbourne, Australien

    M. Olischar

  6. Division of General Pediatrics and Neonatology, Department of Pediatrics and Adolescent Medicine, Universität Wien, Wien, Österreich

    M. Olischar

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  1. G.M. Schmölzer
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  2. M. Olischar
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  3. W. Raith
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  4. B. Resch
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  6. W. Müller
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  7. B. Urlesberger
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Corresponding author

Correspondence to G.M. Schmölzer.

Additional information

Dr. Schmölzer wird teilweise durch ein Royal Women’s Hospital Postgraduate Research Degree Scholarship, ein Monash International Postgraduate Research Scholarship sowie ein Research Grant von der Steirischen Landesregierung unterstützt.

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Schmölzer, G., Olischar, M., Raith, W. et al. Erstversorgung von Neugeborenen. Monatsschr Kinderheilkd 158, 471–476 (2010). https://doi.org/10.1007/s00112-010-2171-y

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