Dempsey Eugene, Pammi Mohan, Ryan Anthony C, Barrington Keith J
Neonatology, Cork University Maternity Hospital, Wilton, Ireland.
Cochrane Database Syst Rev. 2015 Sep 4;2015(9):CD009106. doi: 10.1002/14651858.CD009106.pub2.
Approximately 10% of all newborns require resuscitation at birth. Training healthcare providers in standardised formal neonatal resuscitation training (SFNRT) programmes may improve neonatal outcomes. Substantial healthcare resources are expended on SFNRT.
To determine whether SFNRT programmes reduce neonatal mortality and morbidity, improve acquisition and retention of knowledge and skills, or change teamwork and resuscitation behaviour.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PREMEDLINE, EMBASE, CINAHL, Web of Science and the Oxford Database of Perinatal Trials, ongoing trials and conference proceedings in April 2014 and updated in March 2015.
Randomised or quasi-randomised trials including cluster-randomised trials, comparing a SFNRT with no SFNRT, additions to SFNRT or types of SFNRT, and reporting at least one of our specified outcomes.
Two authors extracted data independently and performed statistical analyses including typical risk ratio (RR), risk difference (RD), mean difference (MD), and number needed to treat for an additional beneficial outcome (NNTB) or an additional harmful outcome (NNTH) (all with 95% confidence intervals (CI)). We analysed cluster-randomised trials using the generic inverse variance and the approximate analysis methods.
We identified two community-based and three manikin-based trials that assessed the effect of SFNRT compared with no SFNRT. Very low quality evidence from one study suggested improvement in acquisition of knowledge (RR 5.96, 95% CI 3.60 to 9.87) and skills (RR 170, 95% CI 10.8 to 2711) and retention of knowledge (RR 3.60, 95% CI 2.43 to 5.35) and the other study suggested improvement in resuscitation and behavioural scores.We identified three community-based cluster-randomised trials in developing countries comparing SFNRT with basic resuscitation training (Early Newborn Care). In this setting, there was moderate quality evidence that SFNRT decreased early neonatal mortality (typical RR 0.88, 95% CI 0.78 to 1.00; 3 studies, 66,162 neonates) and when analysed by the approximate analysis method (typical RR 0.85, 95% CI 0.75 to 0.96; RD -0.0044, 95% CI -0.0082 to -0.0006; NNTB 227, 95% CI 122 to 1667). Low quality evidence from one trial showed that SFNRT may decrease 28-day mortality (typical RR 0.55, 95% CI 0.33 to 0.91) but the effect on late neonatal mortality was more uncertain (typical RR 0.47, 95% CI 0.20 to 1.11). None of our a priori defined neonatal morbidities were reported. We did not identify any randomised studies in the developed world.We identified two trials that compared SFNRT with team training to SFNRT. Teamwork training of physician trainees with simulation may increase any teamwork behaviour (assessed by frequency) (MD 2.41, 95% CI 1.72 to 3.11) and decrease resuscitation duration (MD -149.54, 95% CI -214.73 to -84.34) but may lead to little or no difference in Neonatal Resuscitation Program (NRP) scores (MD 1.40, 95% CI -2.02 to 4.82; 98 participants, low quality evidence).We identified two trials that compared SFNRT with booster courses to SFNRT. It is uncertain whether booster courses improve retention of resuscitation knowledge (84 participants, very low quality evidence) but may improve procedural and behavioural skills (40 participants, very low quality evidence).We identified two trials on decision support tools, one on a cognitive aid that did not change resuscitation scores and the other on an electronic decision support tool that improved the frequency of correct decision making on positive pressure ventilation, cardiac compressions and frequency of fraction of inspired oxygen (FiO2) adjustments (97 participants, very low quality evidence).
AUTHORS' CONCLUSIONS: SFNRT compared to basic newborn care or basic newborn resuscitation, in developing countries, results in a reduction of early neonatal and 28-day mortality. Randomised trials of SFNRT should report on neonatal morbidity including hypoxic ischaemic encephalopathy and neurodevelopmental outcomes. Innovative educational methods that enhance knowledge and skills and teamwork behaviour should be evaluated.
所有新生儿中约10%在出生时需要进行复苏。对医疗保健人员进行标准化正规新生儿复苏培训（SFNRT）项目可能会改善新生儿结局。SFNRT消耗了大量医疗资源。
确定SFNRT项目是否能降低新生儿死亡率和发病率，提高知识和技能的获得与保留率，或改变团队协作及复苏行为。
我们检索了Cochrane对照试验中心注册库（CENTRAL）、MEDLINE、PREMEDLINE、EMBASE、CINAHL、科学引文索引、牛津围产期试验数据库、正在进行的试验以及2014年4月的会议论文集，并于2015年3月进行了更新。
随机或半随机试验，包括整群随机试验，比较SFNRT与无SFNRT、SFNRT的附加内容或SFNRT的类型，并报告至少一项我们指定的结局。
两位作者独立提取数据并进行统计分析，包括典型风险比（RR）、风险差（RD）、平均差（MD）以及为获得额外有益结局（NNTB）或额外有害结局（NNTH）所需治疗的人数（均带有95%置信区间（CI））。我们使用通用逆方差法和近似分析法对整群随机试验进行分析。
我们确定了两项基于社区的试验和三项基于人体模型的试验，这些试验评估了SFNRT与无SFNRT相比的效果。一项研究的极低质量证据表明，在知识获得（RR 5.96，95% CI 3.60至9.87）、技能获得（RR 170，95% CI 10.8至2711）、知识保留（RR 3.60，95% CI 2.43至5.35）方面有所改善，另一项研究表明复苏和行为评分有所改善。我们确定了三项发展中国家基于社区的整群随机试验，比较了SFNRT与基本复苏培训（早期新生儿护理）。在这种情况下，有中等质量证据表明SFNRT降低了早期新生儿死亡率（典型RR 0.88，95% CI 0.78至1.00；3项研究，66162名新生儿），通过近似分析法分析时（典型RR 0.85，95% CI 0.75至0.96；RD -0.0044，95% CI -0.0082至-0.0006；NNTB 227，95% CI 122至1667）。一项试验的低质量证据表明，SFNRT可能降低28天死亡率（典型RR 0.55，95% CI 0.33至0.91），但对晚期新生儿死亡率的影响更不确定（典型RR 0.47，95% CI 0.20至1.11）。我们预先定义的新生儿疾病均未被报告。我们未在发达国家找到任何随机研究。我们确定了两项比较SFNRT与SFNRT团队培训的试验。对医师学员进行模拟团队协作培训可能会增加任何团队协作行为（按频率评估）（MD 2.41，95% CI 1.72至3.11）并缩短复苏持续时间（MD -149.54，95% CI -214.73至-84.34），但可能导致新生儿复苏项目（NRP）评分几乎没有差异或无差异（MD 1.40，95% CI -2.02至4.82；98名参与者，低质量证据）。我们确定了两项比较SFNRT与SFNRT强化课程的试验。强化课程是否能提高复苏知识的保留率尚不确定（84名参与者，极低质量证据），但可能会提高操作和行为技能（40名参与者，极低质量证据）。我们确定了两项关于决策支持工具的试验，一项关于认知辅助工具，其未改变复苏评分，另一项关于电子决策支持工具，其提高了在正压通气、心脏按压及吸入氧分数（FiO2）调整频率方面正确决策的频率（97名参与者，极低质量证据）。
在发展中国家，与基本新生儿护理或基本新生儿复苏相比，SFNRT可降低早期新生儿和28天死亡率。SFNRT的随机试验应报告包括缺氧缺血性脑病和神经发育结局在内的新生儿疾病。应评估能增强知识和技能以及团队协作行为的创新教育方法。
