Versorgung und Reanimation des reifen Neugeborenen nach der Geburt

Die volle Reanimation eines Neugeborenen mit Beatmungen, Thoraxkompressionen und der Gabe von Medikamenten ist ein äußerst seltenes Ereignis, das selbst neonatologische Teams immer wieder vor Herausforderungen stellt. Gerade in diesen seltenen und häufig dramatischen Situationen ist schnelles und umsichtiges Handeln im Team gefragt. Dabei ist die effektivste und meist einzig notwendige Maßnahme für die erfolgreiche Versorgung eines nicht spontan atmenden Neugeborenen eine suffiziente Maskenbeatmung. Wird diese effektiv durchgeführt, sind beim Neugeborenen in den seltensten Fällen tatsächlich Thoraxkompressionen notwendig. Im März 2021 wurde vom European Resuscitation Council (ERC) die neue Leitlinie zur Reanimation von Neugeborenen publiziert. Auf Basis dieser Leitlinie beschreibt der vorliegende Beitrag detailliert den im Algorithmus der Versorgung und Reanimation von reifen Neugeborenen dargestellten Handlungsablauf. Er richtet sich damit einerseits insbesondere an NichtneonatologInnen, die für die Versorgung v. a. von reifen Neugeborenen nach der Geburt verantwortlich sind. Andererseits soll er auch jenen zur Unterstützung dienen, die medizinisches Personal in der Versorgung von lebensbedrohten Neugeborenen trainieren und den Algorithmus der Neugeborenenreanimation als didaktisches Konzept vermitteln.

Evaluation of a novel flow-controlled syringe infusion pump for precise and continuous drug delivery at low flow rates: a laboratory study

Syringe infusion pumps are used for the administration of short-acting drugs in anaesthesia and critical care medicine, but are prone to flow irregularities at low flow rates. A flow-controlled syringe infusion pump using an integrated flow sensor for feedback control represents a new approach to overcoming these limitations. This study compares the performance of a prototype flow-controlled syringe pump both at start-up, and during vertical displacement manoeuvres, with that of a standard infusion syringe pump. The novel pump almost completely eliminated delays at start-up and flow irregularities during hydrostatic pressure changes. Related fluctuations in plasma drug concentration were minimised and the known disadvantages of standard syringe infusion pumps currently used in clinical practice were reduced. Besides providing fast start-up to steady-state flow and precise continuous drug delivery at low flow rates during hydrostatic pressure changes, the new pump offers the potential for the development of target-controlled infusion algorithms for short-acting cardiovascular and other drugs.

Association of perinatal risk factors with neurological outcome in neonates with hypoxic ischemic encephalopathy

OBJECTIVE

Neonates exposed to perinatal insults typically present with hypoxic ischemic encephalopathy (HIE). The aim of our study was to analyze the association between known risk factors for HIE and the severity of encephalopathy after birth and neurological outcome in neonates during the first 4 d of life.

METHODS

Retrospective cohort study including 174 neonates registered between 2011 and 2013 in the National Asphyxia and Cooling Register of Switzerland.

RESULTS

None of the studied perinatal risk factors is associated with the severity of encephalopathy after birth. Fetal distress during labor (OR, 2.06; 95% CI, 1.02-4.25, p = .049) and neonatal head circumference (HC) above 10th percentile (p10) at birth (OR, 1.33; 95% CI, 1.05-1.69, p = .02) were associated with neurological benefit in the univariate analysis. Fetal distress on maternal admission for delivery was the only risk factor for neurological harm in the univariate (OR, 0.26; 95% CI, 0.12-0.57, p < .01) and the multivariate analysis (OR, 0.15; 95% CI, 0.04-0.67, p = .013). We identified two different patient scenarios: the probability for neurological benefit during the first 4 d of life was only 20% in neonates with the combination of all the following risk factors (gestational age >41 weeks, chorioamnionitis, fetal distress on maternal admission for delivery, fetal distress during labor, sentinel events during labor, HC below 10th percentile), whereas in the absence of these risk factors the probability for neurological benefit increased to 80%.

CONCLUSIONS

We identified a constellation of risk factors that influence neurological outcome in neonates with HIE during the first 4 d of life. These findings may help clinicians to counsel parents during the early neonatal period. (ClinicalTrials.gov NCT02800018).

In-line filter included into the syringe infusion pump assembly reduces flow irregularities

PURPOSE

To evaluate whether an in-line filter inserted in the syringe pump infusion line assembly influences start-up times and flow irregularities during vertical pump displacement at low infusion rates.

METHODS

Fluid delivery after syringe pump start-up and after vertical displacement of the syringe pump by -50 cm was determined gravimetrically at flow rates of 0.5, 1.0 and 2.0 ml h(-1). Measurements were repeated for each flow rate four times with two different syringe pumps with and without an in-line filter incorporated. Data are shown as median and range.

RESULTS

Start-up times were reduced by an in-line filter at 0.5 ml h(-1) flow rate from 355.5 s (0-660) to 115 s (0-320), whereas the effect was attenuated at higher flow rates. Pooling of fluid into the infusion system after lowering the infusion syringe pump was halved in all flow rates tested. Amount of infusion bolus after elevating the syringe pump by 50 cm was not affected by an in-line filter.

CONCLUSION

In the evaluated model in-line filters help to reduce flow irregularities and delay in drug delivery of syringe pumps at low flow rates and represent an option to optimize continuous administration of highly concentrated short-acting drugs at very small infusion rates.

Comparison of different conductivity detector geometries on an isotachophoresis PMMA-microchip

Conductivity detection is one of the most often employed means of detection in isotachophoresis. In microanalytical devices, thin-film platinum electrodes can be used for conductivity detection and for other electrochemical methods of detection. The design and the performance of different electrode geometries for on-column contact conductivity detection with thin-film platinum electrodes integrated on an isotachophoresis PMMA-microchip is described. Three different electrode geometries for direct conductivity detection were used for the investigation of isotachophoretic separations. The influence of the width of the electrodes and their positioning relative to the separation channel was investigated. The performance of the different detectors is compared for the analysis of organic carboxylic acid anions.