National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Reproductive, Maternal, Newborn, Child and Adolescent Health, Division of Noncommunicable Diseases and Health through Life-Course, World Health Organization, Regional Office for the Western Pacific, Manila, Philippines.
Glob Health Sci Pract. 2018 Oct 4;6(3):565-573. doi: 10.9745/GHSP-D-18-00017. Print 2018 Oct 3.
As a part of the process of implementing Early Essential Newborn Care (EENC) in China, which are evidence-based interventions recommended by the World Health Organization (WHO), we sought to understand whether current hospital policies are consistent with WHO-recommended standards and what factors influence their use. Data from the study will help inform policy changes needed to support the introduction of evidence-based childbirth and early newborn care practices effectively and to inform further scale up of EENC nationwide.
Ten randomly selected hospitals in 4 early-introducing provinces participated in the study. We collected data from 20 simulated delivery scenario observations and focus group discussions and individual interviews with 10 hospital management staff. Policies, protocols, and guidelines related to childbirth and newborn care practice were also collected and reviewed at each hospital. Additionally, a survey was emailed to 15 childbirth and newborn experts from the 4 selected provinces and completed by 13. Data were compared with WHO EENC evidence-based standards to calculate the agreement rates. Barriers to introducing evidence-based guidelines were identified in focus groups and key informant interviews, then combined into common categories.
Hospital policies were not consistent with WHO recommendations in 10 (59%) of the 17 delivery and early newborn care practices. Delayed cord clamping was recommended by 30% of hospital protocols and prolonged skin-to-skin contact by 13%, neither of which were observed in the delivery simulations. Kangaroo mother care (KMC) for stable preterm babies was required in only 17% of the hospitals; no preterm babies had KMC initiated, with all immediately separated from their mothers and admitted to neonatal intensive care units. Newborn resuscitation equipment was required to be placed within 2 meters of the delivery bed in 84% of hospital protocols, but was prepared in only 40% of cases. Immediate drying after birth was required in 48% of hospital protocols, but was initiated in only 20% of observed cases.
Current childbirth and early newborn care policy and practice in China is not aligned with WHO recommendations for some major interventions. To make it easier and safer for hospital workers to practice EENC, expert working groups and national policies must be established to address inconsistencies and cultural beliefs and provide a strong, evidence-based set of guidelines for hospitals and health workers to follow.
作为在中国实施早期基本新生儿护理（EENC）的一部分，EENC 是世界卫生组织（WHO）推荐的基于证据的干预措施，我们旨在了解当前的医院政策是否与 WHO 推荐的标准一致，以及哪些因素影响了这些政策的使用。本研究的数据将有助于为支持有效引入基于证据的分娩和新生儿护理实践以及进一步在全国范围内扩大 EENC 提供所需的政策变革提供信息。
在四个早期引入的省份中，随机选择了十家医院参与了这项研究。我们从 20 个模拟分娩场景观察、焦点小组讨论以及与 10 名医院管理人员的个人访谈中收集了数据。还在每家医院收集了与分娩和新生儿护理实践相关的政策、协议和指南，并进行了审查。此外，我们还向四个选定省份的 15 名分娩和新生儿专家发送了电子邮件调查，并由 13 名专家完成。将数据与 WHO EENC 基于证据的标准进行比较，以计算一致性率。在焦点小组和关键知情者访谈中确定了引入基于证据的指南的障碍，然后将这些障碍归入常见类别。
在 17 项分娩和早期新生儿护理实践中，有 10 项（59%）医院政策与 WHO 建议不一致。30%的医院方案建议延迟脐带夹闭，13%的医院方案建议延长皮肤接触时间，但在分娩模拟中均未观察到这两种情况。只有 17%的医院要求对稳定的早产儿进行袋鼠式母亲护理（KMC）；没有早产儿开始进行 KMC，所有早产儿都立即与母亲分开并被送入新生儿重症监护病房。84%的医院方案要求新生儿复苏设备必须放置在离分娩床 2 米以内，但只有 40%的情况下准备了设备。48%的医院方案要求在出生后立即擦干，但只有 20%的观察案例中实施了这一操作。
中国目前的分娩和新生儿护理政策和实践与 WHO 推荐的一些主要干预措施不一致。为了使医院工作人员更容易和更安全地实施 EENC，必须成立专家工作组和国家政策，以解决不一致和文化信仰问题，并为医院和卫生工作者提供一套强有力的、基于证据的指南。
