Van Reempts Patrick, Gortner Ludwig, Milligan David, Cuttini Marina, Petrou Stavros, Agostino Rocco, Field David, den Ouden Lya, Børch Klaus, Mazela Jan, Carrapato Manuel, Zeitlin Jennifer
Department of Neonatology, Antwerp University Hospital, University of Antwerp and Study Centre for Perinatal Epidemiology, Flanders, Belgium.
Pediatrics. 2007 Oct;120(4):e815-25. doi: 10.1542/peds.2006-3122.
We sought to compare guidelines for level III units in 10 European regions and analyze the characteristics of neonatal units that care for very preterm infants.
The MOSAIC (Models of Organising Access to Intensive Care for Very Preterm Births) project combined a prospective cohort study on all births between 22 and 31 completed weeks of gestation in 10 European regions and a survey of neonatal unit characteristics. Units that admitted > or = 5 infants at < 32 weeks of gestation were included in the analysis (N = 111). Place of hospitalization of infants who were admitted to neonatal care was analyzed by using the cohort data (N = 4947). National or regional guidelines for level III units were reviewed.
Six of 9 guidelines for level III units included minimum size criteria, based on number of intensive care beds (6 guidelines), neonatal admissions (2), ventilated patients (1), obstetric intensive care beds (1), and deliveries (2). The characteristics of level III units varied, and many were small or unspecialized by recommended criteria: 36% had fewer than 50 very preterm annual admissions, 22% ventilated fewer than 50 infants annually, and 28% had fewer than 6 intensive care beds. Level II units were less specialized, but some provided mechanical ventilation (57%) or high-frequency ventilation (20%) or had neonatal surgery facilities (17%). Sixty-nine percent of level III and 36% of level I or II units had continuous medical coverage by a qualified pediatrician. Twenty-two percent of infants who were < 28 weeks of gestation were treated in units that admitted fewer than 50 very preterm infants annually (range: 2%-54% across the study regions).
No consensus exists in Europe about size or other criteria for NICUs. A better understanding of the characteristics associated with high-quality neonatal care is needed, given the high proportion of very preterm infants who are cared for in units that are considered small or less specialized by many recommendations.
我们试图比较欧洲10个地区三级新生儿重症监护病房（NICU）的指南，并分析照顾极早产儿的新生儿重症监护病房的特点。
MOSAIC（极早产重症监护组织模式）项目结合了一项对欧洲10个地区妊娠22至31足周所有出生婴儿的前瞻性队列研究以及对新生儿重症监护病房特点的调查。纳入分析的是那些在妊娠32周前收治≥5名婴儿的病房（N = 111）。利用队列数据（N = 4947）分析入住新生儿重症监护病房婴儿的住院地点。对国家或地区的三级新生儿重症监护病房指南进行了审查。
9项三级新生儿重症监护病房指南中有6项包含了最小规模标准，这些标准基于重症监护病床数量（6项指南）、新生儿入院人数（2项）、接受机械通气的患者人数（1项）、产科重症监护病床数量（1项）以及分娩数量（2项）。三级新生儿重症监护病房的特点各不相同，按照推荐标准，许多病房规模较小或不够专业化：36%的病房每年收治的极早产儿少于50例，22%的病房每年为少于50名婴儿提供机械通气，28%的病房重症监护病床少于6张。二级新生儿重症监护病房的专业化程度较低，但有些提供机械通气（57%）或高频通气（20%），或者具备新生儿外科设施（17%）。69%的三级新生儿重症监护病房以及36%的一级或二级新生儿重症监护病房有合格儿科医生进行连续医疗覆盖。22%的妊娠28周前出生的婴儿在每年收治少于50例极早产儿的病房接受治疗（研究地区范围内的比例为2% - 54%）。
欧洲对于新生儿重症监护病房的规模或其他标准尚未达成共识。鉴于有很大比例的极早产儿在许多建议认为规模较小或专业化程度较低的病房接受护理，因此需要更好地了解与高质量新生儿护理相关的特点。
Zotero 插件