每个婴儿的基本护理：提高尼加拉瓜农村新生儿护理实践的依从性。
Essential Care for Every Baby: improving compliance with newborn care practices in rural Nicaragua.
机构信息
Division of Neonatal-Perinatal Medicine, Department of Pediatrics University of Washington, 1959 NE Pacific Street, Box 356320, Seattle, WA, 98195, USA.
Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
出版信息
BMC Pregnancy Childbirth. 2018 Sep 12;18(1):371. doi: 10.1186/s12884-018-2003-y.
BACKGROUND
Neonatal mortality comprises an increasing proportion of childhood deaths in the developing world. Essential newborn care practices as recommended by the WHO may improve neonatal outcomes in resource limited settings. Our objective was to pilot a Helping Babies Breathe and Essential Care for Every Baby (HBB and ECEB) implementation package using HBB-ECEB training combined with supportive supervision in rural Nicaragua.
METHODS
We employed an HBB-ECEB implementation package in El Ayote and Santo Domingo, two rural municipalities in Nicaragua and used a pre- and post- data collection design for comparison. Following a period of pre-intervention data collection (June-August 2015), care providers were trained in HBB and ECEB using a train-the- trainer model. An external supportive supervisor monitored processes of care and collected data. Data on newborn care processes and short-term outcomes such as hypothermia were collected from facility medical records and analyzed using standard run charts. Home visits were used to determine breastfeeding rates at 7, 30 and 60 days.
RESULTS
There were 480 institutional births during the study period (June 2015-June 2016). Following the HBB-ECEB implementation package, cord care improved (pre-intervention median 66%; post-intervention shift to ≥85%) and early skin-to-skin care improved (pre-intervention median 0%; post-intervention shift to ≥56%, with a high of 92% in June 2016). Rates of administration of ophthalmic ointment and vitamin K were high pre-intervention (median 97%) and remained high. Early initiation of breastfeeding increased with a pre-intervention median of 25% and post-intervention shift to ≥28%, with a peak of 81% in June 2016. Exclusive breastfeeding rates increased short-term but were not significantly different by 60-days of life (9% pre-intervention versus 21% post-intervention).
CONCLUSIONS
The implementation of the HBB-ECEB programs combined with supportive supervision improved the quality of care for newborns in terms of cord care, early skin-to-skin care and early initiation of breastfeeding. The rates of administration of ophthalmic ointment and vitamin K were high pre- intervention and remained high afterwards. These findings show that HBB-ECEB programs implemented with supportive supervision can improve quality of care for newborns.
背景
在发展中国家，新生儿死亡在儿童死亡中所占比例不断上升。世界卫生组织（WHO）推荐的基本新生儿护理措施可改善资源有限环境下的新生儿结局。我们的目的是在尼加拉瓜农村地区试用一种基于《帮助新生儿呼吸》（HBB）和《每个婴儿基本护理》（ECEB）培训的实施包，该实施包结合了支持性监督。
方法
我们在尼加拉瓜的两个农村市——El Ayote 和 Santo Domingo 采用 HBB-ECEB 实施包，并采用预干预和后干预数据收集设计进行比较。在预干预数据收集（2015 年 6 月至 8 月）之后，通过培训员培训模式对 HBB 和 ECEB 进行培训。一名外部支持性监督者监测护理过程并收集数据。从医疗机构病历中收集关于新生儿护理过程和短期结局（如低体温）的数据，并使用标准运行图进行分析。家访用于确定出生后 7、30 和 60 天的母乳喂养率。
结果
在研究期间（2015 年 6 月至 2016 年 6 月），共有 480 例机构分娩。在实施 HBB-ECEB 实施包后，脐带护理有所改善（干预前中位数 66%；干预后转为≥85%），早期皮肤接触也有所改善（干预前中位数 0%；干预后转为≥56%，2016 年 6 月最高达 92%）。眼药膏和维生素 K 的使用率在干预前很高（中位数 97%），且一直保持高位。早期母乳喂养的启动率有所增加，干预前中位数为 25%，干预后转为≥28%，2016 年 6 月最高达 81%。母乳喂养的纯母乳喂养率短期增加，但到 60 天时无显著差异（干预前 9%，干预后 21%）。
结论
HBB-ECEB 项目的实施与支持性监督相结合，提高了新生儿脐带护理、早期皮肤接触和早期母乳喂养启动的护理质量。眼药膏和维生素 K 的使用率在干预前较高，此后仍保持高位。这些发现表明，在支持性监督下实施 HBB-ECEB 项目可改善新生儿的护理质量。
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