新生儿复苏培训对新生儿及围产期死亡率的影响：一项系统评价与荟萃分析
Impact of neonatal resuscitation trainings on neonatal and perinatal mortality: a systematic review and meta-analysis.
作者信息
Patel Archana, Khatib Mahalaqua Nazli, Kurhe Kunal, Bhargava Savita, Bang Akash
机构信息
Lata Medical Research Foundation, Nagpur, Maharashtra, India.
Division of Evidence Synthesis; School of Epidemiology and Public Health & Department of Physiology, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India.
出版信息
BMJ Paediatr Open. 2017 Nov 16;1(1):e000183. doi: 10.1136/bmjpo-2017-000183. eCollection 2017.
BACKGROUND
Training of birth attendants in neonatal resuscitation is likely to reduce birth asphyxia and neonatal mortality. We performed a systematic review and meta-analysis to assess the impact of neonatal resuscitation training (NRT) programme in reducing stillbirths, neonatal mortality, and perinatal mortality.
METHODS
We considered studies where any NRT was provided to healthcare personnel involved in delivery process and handling of newborns. We searched MEDLINE, CENTRAL, ERIC and other electronic databases. We also searched ongoing trials and bibliographies of the retrieved articles, and contacted experts for unpublished work. We undertook screening of studies and assessment of risk of bias in duplicates. We performed review according to Cochrane Handbook. We assessed the quality of evidence using the GRADE approach.
RESULTS
We included 20 trials with 1 653 805 births in this meta-analysis. The meta-analysis of NRT versus control shows that NRT decreases the risk of all stillbirths by 21% (RR 0.79, 95% CI 0.44 to 1.41), 7-day neonatal mortality by 47% (RR 0.53, 95% CI 0.38 to 0.73), 28-day neonatal mortality by 50% (RR 0.50, 95% CI 0.37 to 0.68) and perinatal mortality by 37% (RR 0.63, 95% CI 0.42 to 0.94). The meta-analysis of pre-NRT versus post-NRT showed that post-NRT decreased the risk of all stillbirths by 12% (RR 0.88, 95% CI 0.83 to 0.94), fresh stillbirths by 26% (RR 0.74, 95% CI 0.61 to 0.90), 1-day neonatal mortality by 42% (RR 0.58, 95% CI 0.42 to 0.82), 7-day neonatal mortality by 18% (RR 0.82, 95% CI 0.73 to 0.93), 28-day neonatal mortality by 14% (RR 0.86, 95% CI 0.65 to 1.13) and perinatal mortality by 18% (RR 0.82, 95% CI 0.74 to 0.91).
CONCLUSIONS
Findings of this review show that implementation of NRT improves neonatal and perinatal mortality. Further good quality randomised controlled trials addressing the role of NRT for improving neonatal and perinatal outcomes may be warranted.
TRIAL REGISTRATION NUMBER
PROSPERO 2016:CRD42016043668.
背景
对助产人员进行新生儿复苏培训可能会降低出生窒息和新生儿死亡率。我们进行了一项系统评价和荟萃分析，以评估新生儿复苏培训（NRT）计划对降低死产、新生儿死亡率和围产期死亡率的影响。
方法
我们纳入了向参与分娩过程和新生儿护理的医护人员提供任何NRT的研究。我们检索了MEDLINE、CENTRAL、ERIC和其他电子数据库。我们还检索了正在进行的试验和检索到的文章的参考文献，并联系专家获取未发表的研究成果。我们对研究进行了筛选，并对重复研究进行了偏倚风险评估。我们根据Cochrane手册进行综述。我们使用GRADE方法评估证据质量。
结果
本荟萃分析纳入了20项试验，涉及1653805例分娩。NRT与对照组的荟萃分析表明，NRT可使所有死产风险降低21%（RR 0.79，95%CI 0.44至1.41），7天新生儿死亡率降低47%（RR 0.53，95%CI 0.38至0.73），28天新生儿死亡率降低50%（RR 0.50，95%CI 0.37至0.68），围产期死亡率降低37%（RR 0.63，95%CI 0.42至0.94）。NRT前与NRT后的荟萃分析表明，NRT后可使所有死产风险降低12%（RR 0.88，95%CI 0.83至0.94），新鲜死产风险降低26%（RR 0.74，95%CI 0.61至0.90），1天新生儿死亡率降低42%（RR 0.58，95%CI 0.42至0.82），7天新生儿死亡率降低18%（RR 0.82，95%CI 0.73至0.93），28天新生儿死亡率降低14%（RR 0.86，95%CI 0.65至1.13），围产期死亡率降低18%（RR 0.82，95%CI 0.74至0.91）。
结论
本综述结果表明，实施NRT可改善新生儿和围产期死亡率。可能需要进一步开展高质量的随机对照试验，以探讨NRT在改善新生儿和围产期结局方面的作用。
试验注册号
PROSPERO 2016：CRD42016043668。
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