摘要
Aim: To characterize the development of clinically relevant variables the firs t minutes after birth and identify early prognostic markers in newborn infants r equiring resuscitation. Methods: A database of 591 infants resuscitated with eit her 21%or 100%oxygen was analysed. Time to first breath, development in heart rate, Apgar scores, arterial oxygen saturation (SaO2), and base deficit (BD) are described in relation to different degrees of birth depression and outcomes. Re sults: Heart rate and Apgar scores increased quickly even in the most depressed infants but were significantly lower in those having a poor outcome. By contrast , BD normalized at the same rate, 6-7 mmol/l/h, in the first hour of life regar dless of the degree of birth depression and outcome. SaO2 values increased as qu ickly in room air as in 100%-oxygen-resuscitated infants. Time to first breat h was prolonged threefold, from 1 to 3 min, in the most depressed (1-min Apgar score < 4) compared with the less depressed infants. Highest odds ratio (OR) for death in the first week of life or for development of hypoxic-ischaemic enceph alopathy (HIE) stage 2 and 3 was a 5-min heart rate ≤60 bpm (OR 16.5 for both death and HIE) and Apgar <4 (OR 14 and 18.8). Neonatal survival for HIE stage 1, 2, and 3 was 93%, 63%, and 11%, respectively. OR for early neonatal death, i f SaO2 ≤60%at 1 min, was 8.6 (sensitivity 0.82 and specificity 0.65). Conclusi on: Apgar scores, heart rate, SaO2, and time to first breath in newly born infan ts in need of resuscitation may be used for early identification of infants with a poor prognosis. These data may be helpful in describing the severity of depre ssion in single infants and to select infants in need of interventional therapy.
Aim: To characterize the development of clinically relevant variables the firs t minutes after birth and identify early prognostic markers in newborn infants r equiring resuscitation. Methods: A database of 591 infants resuscitated with eit her 21%or 100%oxygen was analysed. Time to first breath, development in heart rate, Apgar scores, arterial oxygen saturation (SaO2), and base deficit (BD) are described in relation to different degrees of birth depression and outcomes. Re sults: Heart rate and Apgar scores increased quickly even in the most depressed infants but were significantly lower in those having a poor outcome. By contrast , BD normalized at the same rate, 6-7 mmol/l/h, in the first hour of life regar dless of the degree of birth depression and outcome. SaO2 values increased as qu ickly in room air as in 100%-oxygen-resuscitated infants. Time to first breat h was prolonged threefold, from 1 to 3 min, in the most depressed (1-min Apgar score < 4) compared with the less depressed infants. Highest odds ratio (OR) for death in the first week of life or for development of hypoxic-ischaemic enceph alopathy (HIE) stage 2 and 3 was a 5-min heart rate ≤60 bpm (OR 16.5 for both death and HIE) and Apgar <4 (OR 14 and 18.8). Neonatal survival for HIE stage 1, 2, and 3 was 93%, 63%, and 11%, respectively. OR for early neonatal death, i f SaO2 ≤60%at 1 min, was 8.6 (sensitivity 0.82 and specificity 0.65). Conclusi on: Apgar scores, heart rate, SaO2, and time to first breath in newly born infan ts in need of resuscitation may be used for early identification of infants with a poor prognosis. These data may be helpful in describing the severity of depre ssion in single infants and to select infants in need of interventional therapy.
