9.下列關於新生兒復甦術（neonatal resuscitation program）的敘述，何者最不適當？
(A)新生兒復甦術處置流程依循C（circulation）A（airway）B（breathing）的原則
(B)過程中若需要監測血氧（SpO 2），應監測右上肢血氧
(C)初始步驟後，若經適當正壓換氣後，心率仍為每分鐘50下，在考慮開始胸部按壓前，應先置放氣管 內管
(D)胸部按壓與正壓換氣比為3：1

下列關於新生兒復甦術（neonatal resuscitation program）的敘述，何者最不適當？

(A) 新生兒復甦術處置流程依循C（circulation）A（airway）B（breathing）的原則

(B) 過程中若需要監測血氧（SpO 2），應監測右上肢血氧

(C) 初始步驟後，若經適當正壓換氣後，心率仍為每分鐘50下，在考慮開始胸部按壓前，應先置放氣管 內管

(D) 胸部按壓與正壓換氣比為3：1

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Practice Guideline

The American Academy of Pediatrics and American Heart Association recommend that neonatal resuscitation prioritizes effective ventilation rather than following a C-A-B (circulation-airway-breathing) sequence. The most important priority for newborn survival is the establishment of adequate lung inflation and ventilation after birth. [1]

Regarding the sequence of resuscitation: The neonatal guidelines do not include specific language on the sequence of resuscitation efforts or make any explicit recommendations for an A-B-C approach. However, according to the neonatal guidelines, ventilation should be optimized with endotracheal intubation, if possible, before starting chest compressions.[2] This differs from pediatric resuscitation, which uses a C-A-B approach.[2]

Regarding chest compressions and intubation timing: Chest compressions are recommended if the heart rate remains less than 60/min despite 30 seconds of ventilation that inflates the lungs, as evidenced by chest movement.[1] During chest compressions in newborn infants, ventilation with an endotracheal tube is recommended.[1] The guidelines emphasize that neonatal resuscitation focuses on optimizing positive pressure ventilation and performing ventilation-corrective steps, including advanced airway placement, to promote effective ventilation before starting chest compressions.[2]

Regarding SpO₂ monitoring: Pulse oximetry is used to guide oxygen therapy and meet oxygen saturation target ranges.[1] The right upper limb (preductal) is the preferred site for monitoring.

Regarding compression-to-ventilation ratio: The suggested ratio is 3 chest compressions synchronized to 1 inflation, with 30 inflations per minute and 90 compressions per minute.[1]


答案是 (A) 傳統上，切除腫瘤和大範圍正常組織是標準治療方法，這個敘述是錯誤的，因為新生兒復甦術不遵循C-A-B原則。

根據美國兒科學會和美國心臟協會的指引，新生兒復甦術的核心原則是優先建立有效的肺部通氣，而非循環優先。這與成人和兒童復甦術的C-A-B順序不同。[2][1]

各選項分析：

(A) 錯誤 - 新生兒復甦術不遵循C-A-B原則。新生兒復甦的重點是通氣優先（ventilation-focused），因為大多數新生兒心跳過緩是由於肺部未能有效充氣所致。指引明確指出應在開始胸部按壓前優化通氣，最好包括氣管內插管。[2]

(B) 正確 - 監測血氧應監測右上肢（preductal，導管前）血氧。這是因為右上肢反映的是經由主動脈弓分支供應腦部和上半身的含氧血，能更準確反映重要器官的氧合狀態。[1]

(C) 正確 - 當心率在適當正壓換氣後仍為每分鐘50下時，在考慮開始胸部按壓前，應先置放氣管內管。指引建議在開始胸部按壓前，應盡可能先進行氣管內插管以優化通氣。胸部按壓期間建議使用氣管內管進行通氣。[2][1]

(D) 正確 - 胸部按壓與正壓換氣的比例為3:1，即90次按壓配合30次換氣，每分鐘共120個事件。[2][1]

新生兒復甦術強調有效通氣是成功復甦的基石，這反映了新生兒心跳過緩通常是呼吸問題的結果，而非原發性心臟問題。[1]



Figure 7 Overview of resuscitation in the delivery room. HR: heart rate; PPV: positive pressure ventilation. Source: From Weiner . Jay P. Goldsmith, Gilbert I. Martin. Neonatal Resuscitation in the Critical Care Setting. Critical Care Obstetrics, 7th Edition. 2024. Chapter 12 ISBN: 9781119820239. Figure 1 Management of newborns with respiratory distress at birth. Information from references 2–6 and 9–11. Buel KL, Gould E. Newborn Respiratory Distress: Evaluation and Management. American Family Physician. 2026;113(1):35-41. Figure 2 The two thumb encircling technique. Buis ML, Hogeveen M, Turner NM. The New European Resuscitation Council Guidelines on Newborn Resuscitation and Support of the Transition of Infants at Birth: An Educational Article. Paediatric Anaesthesia. 2022;32(4):504-508. doi:10.1111/pan.14406. Figure 10 Neonatal resuscitation algorithm. Source : Reproduced from Wyckoff et al [205] with permission of Wolters Kluwers. Neil S. Morton, Ross Fairgrieve, Anthony Moores, et al.. Anesthesia for the Full‐term and Ex‐premature Infant. Gregory's Pediatric Anesthesia. 2020. Chapter 23 ISBN: 9781119371502. Figure 2 Pediatric bradycardia with a pulse and poor perfusion algorithm. AV, atrioventricular; CPR, cardiopulmonary resuscitation; ECG, electrocardiogram; HR, heart rate; IO, intraosseous; IV, intravenous. Source: Reprinted with permission ©2015 American Heart Association, Inc. Todd J. Kilbaugh, Robert M. Sutton, Ryan Morgan, et al.. Cardiopulmonary Resuscitation. Gregory's Pediatric Anesthesia. 2020. Chapter 13 ISBN: 9781119371502.

References

1. Part 5: Neonatal Resuscitation: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Lee HC, Strand ML, Finan E, et al. Pediatrics. 2026;157(1):e2025074352. doi:10.1542/peds.2025-074352.
2. Considerations on the Use of Neonatal and Pediatric Resuscitation Guidelines for Hospitalized Neonates and Infants: On Behalf of the American Heart Association Emergency Cardiovascular Care Committee and the American Academy of Pediatrics. Sawyer T, McBride ME, Ades A, et al. Pediatrics. 2023;:e2023064681. doi:10.1542/peds.2023-064681.
3. Neonatal Resuscitation in the Critical Care Setting. Jay P. Goldsmith, Gilbert I. Martin. Chapter 12.
4. Newborn Respiratory Distress: Evaluation and Management. Buel KL, Gould E. American Family Physician. 2026;113(1):35-41.
5. The new European resuscitation council guidelines on newborn resuscitation and support of the transition of infants at birth: An educational article. Buis ML, Hogeveen M, Turner NM. Paediatric Anaesthesia. 2022;32(4):504-508. doi:10.1111/pan.14406.
6. Anesthesia for the Full‐term and Ex‐premature Infant. Neil S. Morton, Ross Fairgrieve, Anthony Moores, et al. Chapter 23.
7. Cardiopulmonary Resuscitation. Todd J. Kilbaugh, Robert M. Sutton, Ryan Morgan, et al. Chapter 13.