The University of Queensland, Australia; The Royal Brisbane and Women's Hospital, Queensland, Australia.
The University of Queensland, Australia; The Royal Brisbane and Women's Hospital, Queensland, Australia.
Int J Nurs Stud. 2018 Jan;77:81-90. doi: 10.1016/j.ijnurstu.2017.10.004. Epub 2017 Oct 9.
The birth process and the moments thereafter are a crucial time for newborns as they adapt to extra uterine life. The adaptive process begins immediately and can take a number of days to complete. The process involves initiating and maintaining respirations, thermoregulation, and the change from foetal circulation to newborn circulation. The majority of newborns successfully adapt to extra uterine life, some experience difficulty. Early warning tools may assist clinicians identify early signs of failure to adapt and/or deterioration but these are dependent on 'Normal' vital sign reference ranges for triggering an escalation of care. Age-matched early warning tools may improve the sensitivity of tools.
To identify physiological vital sign reference ranges for newborns ≥34 weeks gestation from two hours of age.
Systematic Review.
Between August 2016 and January 2017, PubMed, CINAHL, Embase, The Cochrane Library databases, and conference abstracts were searched for primary studies published between 1946 and 2017. Reference lists of retrieved articles were reviewed for potential studies.
Primary studies published in English that reported physiological vital sign reference ranges pertaining to well newborns born from 34 weeks gestation were selected. Two authors independently assessed eligibility of studies for inclusion. Titles and abstracts were matched with the inclusion criteria: studies investigating heart or respiratory rate, temperature, blood pressure and oxygen saturations in well newborns greater than 34 weeks gestational age. Assessment of quality and grading of level of evidence were assessed using National Health and Medical Research Council level of Evidence Hierarchy Table and the Quality Assessment Tool for Quantitative Studies. Any disagreements were resolved by consensus. Data were extracted by two reviewers.
A total of 1497 primary studies were retrieved. Following screening and removal of duplicates and screening, 10 primary studies investigating heart rate (n=1), respiratory rate (n=1), temperature (n=1), blood pressure (n=4) and oxygen saturations (n=3) were eligible for inclusion in this review. The populations studied included term (n=6) or both preterm and term newborns (n=4). No reference ranges for any vital sign measurements could be identified from the included literature. In addition, inconsistencies between vital sign parameters of newborns were identified between the studies.
There is paucity of normal vital sign data in the late preterm >34 weeks and post term gestational age cohorts despite literature suggesting differences in physiological maturity between these cohorts.
新生儿在出生过程中和出生后不久是一个关键时期，因为他们需要适应子宫外的生活。适应过程立即开始，可能需要数天才能完成。这个过程包括开始和维持呼吸、体温调节以及从胎儿循环到新生儿循环的转变。大多数新生儿成功适应了子宫外的生活，但有些新生儿会遇到困难。早期预警工具可以帮助临床医生识别适应不良和/或恶化的早期迹象，但这些都依赖于“正常”生命体征参考范围来触发护理升级。与年龄匹配的早期预警工具可以提高工具的灵敏度。
确定胎龄≥34 周的新生儿从出生后两小时开始的生理生命体征参考范围。
系统综述。
2016 年 8 月至 2017 年 1 月期间，检索了 1946 年至 2017 年期间发表的原始研究的 PubMed、CINAHL、Embase、Cochrane 图书馆数据库和会议摘要。对检索到的文章的参考文献进行了审查，以寻找可能的研究。
选择了以胎龄≥34 周的健康新生儿的心率、呼吸率、体温、血压和血氧饱和度为研究对象的英文原始研究。两名作者独立评估研究纳入的资格。标题和摘要与纳入标准相匹配：研究对象为胎龄大于 34 周的健康新生儿，研究内容为心率或呼吸率、体温、血压和血氧饱和度。使用国家卫生和医学研究委员会证据层次表和定量研究质量评估工具评估质量和证据水平分级。任何分歧都通过共识解决。两名审查员提取数据。
共检索到 1497 篇原始研究。经过筛选和重复去除以及筛选后，有 10 项原始研究符合纳入标准，研究内容包括心率（n=1）、呼吸率（n=1）、体温（n=1）、血压（n=4）和血氧饱和度（n=3）。研究人群包括足月（n=6）或早产儿和足月新生儿（n=4）。无法从纳入的文献中确定任何生命体征测量的参考范围。此外，研究之间还发现了新生儿生命体征参数之间的不一致。
尽管文献表明这些队列之间存在生理成熟度的差异，但在晚期早产儿（胎龄>34 周）和晚期足月队列中，正常生命体征数据仍然很少。
