MSCE, The Children's Hospital of Philadelphia, 2nd Floor Main Building, Division of Neonatology, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104.
Pediatrics. 2013 Oct;132(4):e1018-25. doi: 10.1542/peds.2013-0686. Epub 2013 Sep 16.
Events in the delivery room significantly impact the outcomes of preterm infants. We developed evidence-based guidelines to prevent heat loss, reduce exposure to supplemental oxygen, and increase use of noninvasive respiratory support to improve the care and outcomes of infants with birth weight ≤1250 g at our institution.
The guidelines were implemented through multidisciplinary conferences, routine use of a checklist, appointment of a dedicated resuscitation nurse, and frequent feedback to clinicians. This cohort study compares a historical group (n = 80) to a prospective group (n = 80, after guidelines were implemented). Primary outcome was axillary temperature at admission to the intensive care nursery. Secondary outcomes measured adherence to the guidelines and changes in clinically relevant patient outcomes.
Baseline characteristics of the groups were similar. After introduction of the guidelines, average admission temperatures increased (36.4°C vs 36.7°C, P < .001) and the proportion of infants admitted with moderate/severe hypothermia fell (14% vs 1%, P = .003). Infants were exposed to less oxygen during the first 10 minutes (P < .001), with similar oxygen saturations. Although more patients were tried on continuous positive airway pressure (40% vs 61%, P = .007), the intubation rate was not significantly different (64% vs 54%, P = .20). Median durations of invasive ventilation and hospitalization decreased after the quality initiative (5 vs 1 days [P = .008] and 80 vs 60 days [P = .02], respectively).
We have demonstrated significantly improved quality of delivery room care for very preterm infants after introduction of evidence-based delivery room guidelines. Multidisciplinary involvement and continuous education and reinforcement of the guidelines permitted sustained change.
分娩室中的事件会显著影响早产儿的结局。我们制定了循证指南，以防止热量流失、减少补充氧气的暴露，并增加非侵入性呼吸支持的使用，以改善我们机构中出生体重≤1250 克的婴儿的护理和结局。
通过多学科会议、常规使用检查表、指定专门的复苏护士以及向临床医生提供频繁反馈，实施了这些指南。这项队列研究将历史组（n=80）与前瞻性组（n=80，在指南实施后）进行了比较。主要结局是进入重症监护病房时的腋温。次要结局是评估对指南的依从性和与患者相关的临床结局变化。
两组的基线特征相似。在指南实施后，平均入院温度升高（36.4°C 与 36.7°C，P<.001），中度/重度低体温的婴儿比例下降（14%与 1%，P=.003）。在最初的 10 分钟内，婴儿暴露于较少的氧气中（P<.001），但氧饱和度相似。尽管更多的患者尝试持续气道正压通气（40%与 61%，P=.007），但插管率并无显著差异（64%与 54%，P=.20）。质量倡议后，有创通气和住院的中位时间均缩短（5 天与 1 天[P=.008]和 80 天与 60 天[P=.02]）。
在引入基于证据的分娩室指南后，我们已经证明了为非常早产儿提供的分娩室护理质量有了显著改善。多学科参与以及对指南的持续教育和强化，使这种改变得以持续。
