Bloomfield L, Rogers C, Townsend J, Wolke D, Quist-Therson E
Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
J Med Screen. 2003;10(4):176-80. doi: 10.1258/096914103771773267.
To evaluate the quality of the routine examination of the newborn as carried out by senior house officers (SHOs) and midwives.
Randomised controlled trial set in a district general hospital in Southeast England. Eligible babies were randomised to a midwife (11) or an SHO (8) who were then video recorded undertaking the routine newborn examination.
Quality of 62 observed technical and communication components of the newborn examination, as agreed between independent consultant paediatrician and senior midwife raters.
Major differences were found in the rated quality of examinations between midwives and SHOs for the examinations of the heart and lungs, for the overall quality of the examination, and in areas of communication skills. Quality of examination of the hips was assessed as poor for both professional groups. Where there were significant differences between examiners, the quality of the midwives' examinations was higher. Inter-rater agreement between the consultant paediatricians and senior midwives ranged from excellent to poor for different items of the examination with a mean kappa value of 0.42 across all items indicating moderate agreement.
The quality of midwife examinations exceeded that of SHOs. All midwives who examine receive formalized training in the examination of the newborn; SHOs may benefit from similar specific training. Training for both professional groups may need to be reviewed, particularly in relation to agreement on 'gold standards' for the screening of developmental dysplasia of the hip.
评估住院医师（SHOs）和助产士进行的新生儿常规检查质量。
在英格兰东南部一家地区综合医院开展的随机对照试验。符合条件的婴儿被随机分配给一名助产士（11名）或一名住院医师（8名），随后对他们进行新生儿常规检查的过程进行录像。
由独立的儿科顾问医生和资深助产士评估人员共同确定的新生儿检查中62项观察到的技术和沟通要素的质量。
在心脏和肺部检查、检查的整体质量以及沟通技能方面，助产士和住院医师的检查质量评分存在重大差异。两个专业组对髋关节检查质量的评估都较差。在检查人员之间存在显著差异的地方，助产士的检查质量更高。儿科顾问医生和资深助产士之间的评分者间一致性在检查的不同项目中从优秀到较差不等，所有项目的平均kappa值为0.42，表明一致性中等。
助产士的检查质量超过住院医师。所有进行检查的助产士都接受过新生儿检查的正规培训；住院医师可能会从类似的专项培训中受益。可能需要对两个专业组的培训进行审查，特别是在关于髋关节发育不良筛查的“金标准”达成一致方面。
