Rocha Gustavo, Saldanha Joana, Macedo Israel, Areias Augusta, Graça André, Tomé Teresa
Comissão de Investigação Científica, Secção de Neonatologia, Sociedade Portuguesa de Pediatria, Portugal.
Acta Med Port. 2011 Dec;24 Suppl 2:213-22; quiz 223-8. Epub 2011 Dec 31.
In Portugal, since 1989, the rates of maternal, perinatal and neonatal mortality present a significant decrease, after the implemented perinatal network. The continuous assessment of the existing conditions at the different levels of perinatal care is essential to identify deviations from normality and may allow the optimization of quality of care.
To obtain information on and to evaluate the conditions and practices of neonatal resuscitation at the Portuguese delivery rooms, in order to propose measures for improvement of neonatal care.
An electronic questionnaire was sent to 35 hospitals with maternity. The survey included questions regarding to human and material resources, characteristics of delivery room practices used in stabilization / resuscitation of the newborn, number of deliveries and number of newborns transferred after birth per year, as well as issues related with the collaboration of obstetric teams.
Thirty centres (86%) answered the questionnaire, 16 of the respondents were level III maternities/hospitals. In eight (27%) centres a paediatrician is present at all deliveries, whereas in the remaining centres a paediatrician is available only for risk situations. The material unavailable in some centres include cardio-respiratory monitoring equipment, support device with pressure controlled ventilation, oxygen blender, ventilator, CPAP (continuous positive airway pressure), neonatal transport incubators and equipments for thoracocentesis and paracentesis. The criteria used for prophylactic surfactant and oxygen use are very different among the various centres. All centres reported transferring newborns after birth, either because of lack of differentiation of care or vacant beds. The centres with perinatal support reported less cooperation of the obstetric teams.
The care of the newborn in the national delivery rooms can and should be improved. It is necessary to adapt the equipment and human resources to the needs of each centre. Protocols and practices such as oxygen and "prophylactic" surfactant must be updated, transport after birth must be reduced and the communication with the obstetric teams should be improved.
自1989年以来，葡萄牙实施围产期网络后，孕产妇、围产期和新生儿死亡率显著下降。持续评估围产期护理不同层面的现有状况对于识别与正常情况的偏差至关重要，并且可能有助于优化护理质量。
获取有关葡萄牙产房新生儿复苏的状况和做法的信息，并进行评估，以便提出改善新生儿护理的措施。
向35家设有产科的医院发送了电子问卷。调查内容包括人力和物力资源、用于新生儿稳定/复苏的产房操作特点、每年分娩数量和出生后转诊的新生儿数量，以及与产科团队协作相关的问题。
30个中心（86%）回复了问卷，其中16个回复者为三级产科/医院。在8个（27%）中心，每次分娩都有儿科医生在场，而在其余中心，仅在有风险情况时才有儿科医生。一些中心缺少的物资包括心肺监测设备、压力控制通气支持设备、氧气混合器、呼吸机、持续气道正压通气（CPAP）、新生儿转运暖箱以及胸腔穿刺和腹腔穿刺设备所需设备。各中心用于预防性使用表面活性剂和氧气的标准差异很大。所有中心都报告了出生后转诊新生儿的情况，原因要么是护理区分不足，要么是床位空缺。有围产期支持的中心报告产科团队的合作较少。
全国产房的新生儿护理可以而且应该得到改善。有必要使设备和人力资源适应每个中心的需求。必须更新氧气和“预防性”表面活性剂等方案和做法，减少出生后转运，并改善与产科团队的沟通。
