National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing 100089, China.
Chin Med J (Engl). 2012 Apr;125(8):1448-56.
Seventeen million births occur in China each year. Neonatal mortality is the leading cause of under 5-year-old child deaths, and intrapartum-related injury accounts for much of mental retardation in young children. The Chinese Ministry of Health sought to improve infant and child survival through a nationwide initiative to have at least one person trained in neonatal resuscitation at every birth. The aim of the current study was to evaluate the impact of China Neonatal Resuscitation Program (NRP) on policy and infrastructure changes and its effectiveness in decreasing the incidence of mortality among newborn infants.
The Chinese NRP incorporated policy change, professional education, and creation of a sustainable health system infrastructure for resuscitation. Multidisciplinary teams from all 31 provinces and municipal states disseminated NRP in a train-the-trainer cascade. The intervention targeted 20 provinces with high neonatal mortality and programs to reduce maternal mortality. Program evaluation data came from 322 representative hospitals in those provinces.
Changes in policy permitted midwives to initiate resuscitation and required resuscitation training for licensure. From 2004 through 2009 more than 110,659 professionals received NRP training in the 20 target provinces, with 94% of delivery facilities and 99% of counties reached. Intrapartum-related deaths in the delivery room decreased from 7.5 to 3.4 per 10,000 from 2003 to 2008, and the incidence of Apgar ≤ 7 at 1 minute decreased from 6.3% to 2.9%.
The Chinese NRP achieved policy changes promoting resuscitation, trained large numbers of professionals, and contributed to reduction in delivery room mortality. Improved adherence to the resuscitation algorithm, extension of training to the township level, and coverage of births now occurring outside health facilities can further increase the number of lives saved.
中国每年有 1700 万新生儿出生。新生儿死亡率是导致 5 岁以下儿童死亡的主要原因，而分娩相关损伤导致了许多幼儿的智力迟钝。中国卫生部通过一项全国性倡议，旨在使每一个分娩都至少有一个人接受新生儿复苏培训，以提高婴儿和儿童的生存率。本研究旨在评估中国新生儿复苏计划（NRP）对政策和基础设施变化的影响及其降低新生儿死亡率的效果。
中国 NRP 纳入了政策变革、专业教育和建立可持续复苏卫生系统基础设施。来自全国 31 个省、自治区和直辖市的多学科团队以培训师为核心开展 NRP 传播工作。该干预措施针对新生儿死亡率较高和降低孕产妇死亡率的 20 个省份。项目评估数据来自这些省份的 322 家代表性医院。
政策的改变允许助产士开始进行复苏，并要求获得复苏资格证。从 2004 年到 2009 年，20 个目标省份的 110659 名专业人员接受了 NRP 培训，94%的分娩机构和 99%的县都接受了培训。从 2003 年到 2008 年，产房内与分娩相关的死亡人数从每 10000 例 7.5 例降至 3.4 例，1 分钟时 Apgar 评分≤7 的发生率从 6.3%降至 2.9%。
中国 NRP 实现了促进复苏的政策变革，培训了大量专业人员，并为降低产房死亡率做出了贡献。进一步提高复苏算法的依从性，将培训扩展到乡镇一级，并覆盖现在在医疗机构外发生的分娩，可以进一步增加拯救的生命数量。
