Duran Ridvan, Aladağ Nükhet, Vatansever Ulfet, Süt Necdet, Acunaş Betül
Department of Pediatrics, Trakya University School of Medicine, Edirne, Turkey.
Brain Dev. 2008 Jan;30(1):43-6. doi: 10.1016/j.braindev.2007.05.009. Epub 2007 Jun 18.
Neonatal care provided within the first few minutes of life plays a major role in the reduction of neonatal morbidity and mortality. Neonatal Resuscitation Program (NRP) courses had been held since 1996. The aim of this study was to evaluate the impact of the NRP on morbidity and mortality of newborn infants with perinatal asphyxia.
This retrospective study comprised newborn infants who were born in hospitals at Trakya region of Turkey during the last 3 years and were diagnosed as perinatal asphyxia and were referred to our Neonatal Unit. Those patients who were referred before NRP course (pretraining period) were designated as Group 1, those who were referred after the first NRP course (transition period) as Group 2, and those who were referred after the second NRP course (post-training period) as Group 3. Chart review was performed with regard to gestational age, birth weight, Apgar scores, resuscitation type, stage of hypoxic ischemic encephalopathy (HIE), existence of meconium aspiration syndrome (MAS), progress of the disease, duration of hospitalization.
The study comprised 66 patients; 35 in Group 1, 18 in Group 2 and 13 in Group 3. The number of cases who had not been resuscitated was 10 in the pretraining period, 3 in the transition period and 1 in the post-training period which decreased significantly. The first minute Apgar scores in three groups were as follows; 2.08+/-1.2, 2.2+/-1.1 and 3.7+/-1.4, and this increase was statistically significant. The fifth minute Apgar scores also increased from 5.43+/-1.5 in the pretraining period to 6.5+/-1.9 in the post-training period, but this increase was not statistically significant. The number of patients with Stage 1 and 2 HIE decreased more in Group 3 (n=11 in Stage 1 HIE, n=17 in Stage 2 HIE) compared to those in Group 1 (n=7 in Stage 1 HIE, n=5 in Stage 2 HIE) but the difference was not statistically significant. The duration of hospitalization decreased in post-training period (15.1+/-10.3 days in pretraining period, 12.0+/-8.9 days in transition period, 6.1+/-1.2 days in post-training period).
After NRP courses, the number of patients with perinatal asphyxia and with no resuscitation and also the duration of hospitalization decreased significantly, whereas the first minute Apgar scores increased significantly.
出生后最初几分钟内提供的新生儿护理在降低新生儿发病率和死亡率方面起着重要作用。自1996年以来一直举办新生儿复苏项目（NRP）课程。本研究的目的是评估NRP对围产期窒息新生儿发病率和死亡率的影响。
这项回顾性研究纳入了过去3年在土耳其特拉凯地区医院出生、被诊断为围产期窒息并转诊至我们新生儿科的新生儿。那些在NRP课程之前转诊的患者（培训前期）被指定为第1组，在第一次NRP课程之后转诊的患者（过渡期）为第2组，在第二次NRP课程之后转诊的患者（培训后期）为第3组。对孕周、出生体重、阿氏评分、复苏类型、缺氧缺血性脑病（HIE）阶段、胎粪吸入综合征（MAS）的存在情况、疾病进展、住院时间进行病历审查。
该研究包括66例患者；第1组35例，第2组18例，第3组13例。未进行复苏的病例数在培训前期为10例，过渡期为3例，培训后期为1例，显著减少。三组的第1分钟阿氏评分如下：2.08±1.2、2.2±1.1和3.7±1.4，这种增加具有统计学意义。第5分钟阿氏评分也从培训前期的5.43±1.5增加到培训后期的6.5±1.9，但这种增加无统计学意义。与第1组（1期HIE为7例，2期HIE为5例）相比，第3组（1期HIE为11例，2期HIE为17例）中1期和2期HIE患者数量减少更多，但差异无统计学意义。培训后期住院时间缩短（培训前期为15.1±10.3天，过渡期为12.0±8.9天，培训后期为6.1±1.2天）。
NRP课程后，围产期窒息且未进行复苏的患者数量以及住院时间显著减少，而第1分钟阿氏评分显著增加。
