Tu Joanna H, Profit Jochen, Melsop Kathryn, Brown Taylor, Davis Alexis, Main Elliot, Lee Henry C
College of Physicians and Surgeons, Columbia University, New York, New York.
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California.
Am J Perinatol. 2017 Feb;34(3):259-263. doi: 10.1055/s-0036-1586505. Epub 2016 Aug 3.
The objective of this study was to assess utilization of specialist coverage and checklists in perinatal settings and to examine utilization by birth asphyxia rates. This is a survey study of California maternity hospitals concerning checklist use to prepare for delivery room resuscitation and 24-hour in-house specialist coverage (pediatrician/neonatologist, obstetrician, and obstetric anesthesiologist) and results linked to hospital birth asphyxia rates (preterm and low weight births were excluded). Of 253 maternity hospitals, 138 responded (55%); 59 (43%) indicated checklist use, and in-house specialist coverage ranged from 38% (pediatrician/neonatologist) to 54% (anesthesiology). In-house coverage was more common in urban versus rural hospitals for all specialties ( < 0.0001), but checklist use was not significantly different ( = 0.88). Higher birth volume hospitals had more specialist coverage ( < 0.0001), whereas checklist use did not differ ( = 0.3). In-house obstetric coverage was associated with lower asphyxia rates (odds ratio: 0.34; 95% confidence interval [CI]: 0.20, 0.58) in a regression model accounting for other providers. Checklist use was not associated with birth asphyxia (odds ratio: 1.12; 95% CI: 0.75, 1.68). Higher birth volume and urban hospitals demonstrated greater in-house specialist coverage, but checklist use was similar across all hospitals. Current data suggest that in-house obstetric coverage has greater impact on asphyxia than other specialist coverage or checklist use.
本研究的目的是评估围产期环境中专科医生覆盖情况和清单的使用情况，并按出生窒息率检查其使用情况。这是一项针对加利福尼亚州妇产医院的调查研究，涉及用于产房复苏准备的清单使用情况以及24小时内部专科医生覆盖情况（儿科医生/新生儿科医生、产科医生和产科麻醉医生），结果与医院出生窒息率相关（排除早产和低体重儿）。在253家妇产医院中，138家做出了回应（55%）；59家（43%）表示使用了清单，内部专科医生覆盖范围从38%（儿科医生/新生儿科医生）到54%（麻醉科）。所有专科的内部覆盖在城市医院比农村医院更常见（<0.0001），但清单使用情况无显著差异（=0.88）。出生量较高的医院有更多的专科医生覆盖（<0.0001），而清单使用情况无差异（=0.3）。在考虑其他医疗人员的回归模型中，内部产科覆盖与较低的窒息率相关（优势比：0.34；95%置信区间[CI]：0.20，0.58）。清单使用与出生窒息无关（优势比：1.12；95%CI：0.75，1.68）。出生量较高的医院和城市医院显示出更大的内部专科医生覆盖，但所有医院的清单使用情况相似。目前的数据表明，内部产科覆盖对窒息的影响比其他专科医生覆盖或清单使用更大。
