WHO Representative's Office in the Philippines, Manila, Philippines.
Acta Paediatr. 2011 Aug;100(8):1127-33. doi: 10.1111/j.1651-2227.2011.02215.x. Epub 2011 Mar 7.
A deadly nosocomial outbreak in a Philippine hospital drew nationwide attention to neonatal sepsis. Together with specific infection control measures, interventions that protect newborns against infection-related mortality include drying, skin-to-skin contact, delayed cord clamping, breastfeeding initiation and delayed bathing. This evaluation characterized hospital care in the first hours of life with the intent to drive policy change, strategic planning and hospital reform.
Trained physicians observed 481 consecutive deliveries in 51 hospitals using a standardized tool to record practices and timing of immediate newborn care procedures.
Drying, weighing, eye care and vitamin K injections were performed in more than 90% of newborns. Only 9.6% were allowed skin-to-skin contact. Interventions were inappropriately sequenced, e.g. immediate cord clamping (median 12 sec), delayed drying (96.5%) and early bathing (90.0%). While 68.2% were put to the breast, they were separated two minutes later. Unnecessary suctioning was performed in 94.9%. Doctors trained in neonatal resuscitation were 2.5 (1.1-5.7) times more likely to unnecessarily suction vigorous newborns. Two per cent died and 5.7% developed sepsis/pneumonia.
This minute-by-minute observational assessment revealed that performance and timing of immediate newborn care interventions are below WHO standards and deprive newborns of basic protections against infection and death.
菲律宾一家医院发生的致命医院感染暴发事件引起了全国对新生儿败血症的关注。除了具体的感染控制措施外，保护新生儿免受感染相关死亡的干预措施还包括干燥、皮肤接触、延迟脐带结扎、开始母乳喂养和延迟沐浴。这项评估旨在推动政策变革、战略规划和医院改革，以描述生命最初数小时内的医院护理情况。
经过培训的医生使用标准化工具观察了 51 家医院的 481 例连续分娩，以记录新生儿护理程序的实践和时间安排。
在 90%以上的新生儿中进行了干燥、称重、眼部护理和维生素 K 注射。只有 9.6%的新生儿被允许进行皮肤接触。干预措施的顺序不当，例如立即进行脐带结扎（中位数为 12 秒）、延迟干燥（96.5%）和早期沐浴（90.0%）。尽管 68.2%的新生儿被放在母亲的胸前，但两分钟后就被分开了。94.9%的新生儿进行了不必要的抽吸。接受新生儿复苏培训的医生对活力较强的新生儿进行不必要抽吸的可能性是未接受培训医生的 2.5 倍（1.1-5.7）。有 2%的新生儿死亡，5.7%的新生儿发生败血症/肺炎。
这项逐分钟的观察评估显示，新生儿护理干预措施的执行情况和时机均低于世卫组织标准，使新生儿无法获得预防感染和死亡的基本保护。
