Neonatology
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Historical Article
History of neonatal resuscitation. Part 2: oxygen and other drugs.
Oxygen was used in neonatal resuscitation from 1780, within 5 years of its detection. It rapidly gained general acceptance and infiltrated delivery rooms and, a century later, neonatal special care units. ⋯ Continuous distending airway pressure for oxygen administration was available at the beginning of the 20th century, but was not widely accepted. Alkali and analeptic drugs gained widespread but short-lived use after the Second World War.
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Historical Article
History of neonatal resuscitation - part 3: endotracheal intubation.
Endotracheal intubation to resuscitate neonates was used by Scheel in 1798. A century before endotracheal anesthesia was developed, inventive obstetricians constructed devices for endotracheal intubation of infants and mastered their insertion, localization, and airtight sealing. Fell's laryngoscope, Magill's intubation forceps and tissue-friendly materials were significant contributions of the 20th century to endotracheal intubation of the newborn. The striking absence of scientific studies on the most efficient resuscitation techniques for neonates can be explained by the difficulty to adjust for the personal skills of the resuscitator.
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Respiratory distress syndrome (RDS) is the most common cause of respiratory insufficiency in preterm infants, especially those born at <30 weeks of gestation. Continuous positive airway pressure has been used since the 1970s as a primary mode of treatment for RDS. Surfactant therapy became available in the 1980s and has become the standard care for infants with or at risk for RDS. ⋯ Of the eight prospective, randomized controlled trials and two retrospective studies involving the natural surfactant preparations, treatment with poractant alpha resulted in a significantly decreased mortality, decreased need for additional doses, faster weaning of oxygen and reduced hospital costs when compared to treatment with beractant or calfactant. These differences in outcome may be due to differences in phospholipid and SP-B content, amount of antioxidant phospholipids, plasmalogens, anti-inflammatory properties and viscosity among these three surfactants. Additional studies of administering surfactant non-invasively via laryngeal mask airway in preterm infants weighing >1,200 g and as an aerosol preparation are currently in progress.
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An increasing body of evidence has revealed that interventions performed during resuscitation of extremely-low-gestational-age neonates (ELGANs) may have a direct influence on the immediate survival and also on long-term morbidity. It has been proposed that interventions in the delivery room and/or hypothermia could trigger changes constitutive of chronic lung disease. ⋯ The first minutes of life are a valuable window for intervention. However, whilst these practice changes make sense and there are emerging data to support them, further evidence including long-term follow up is needed to definitively change resuscitation procedures in ELGANs.
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Low-birth-weight (LBW) infants have a significantly greater mortality than other babies, not only within the neonatal period but also in infancy and early childhood. Babies are LBW either because they are preterm or they have experienced intrauterine growth retardation. Reducing the prevalence of LBW babies is important in reducing child and infant mortality. ⋯ Key features of the Cuban healthcare system are that it is both free and universal, and additionally there is a strong emphasis on primary healthcare. It is likely that a similar approach in both developing countries and disadvantaged communities in developed countries would reduce the prevalence of LBW babies. This would have a major impact in relation to reducing infant mortality rates.