Binkhorst Mathijs, van de Wiel Irene, Draaisma Jos M T, van Heijst Arno F J, Antonius Tim, Hogeveen Marije
Department of Neonatology, Amalia Children's Hospital, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, the Netherlands.
Eur J Pediatr. 2020 Nov;179(11):1813-1822. doi: 10.1007/s00431-020-03693-6. Epub 2020 May 29.
We wanted to assess newborn life support (NLS) knowledge and guideline adherence, and provide strategies to improve (neonatal) resuscitation guideline adherence. Pediatricians completed 17 multiple-choice questions (MCQ). They performed a simulated NLS scenario, using a high-fidelity manikin. The literature was systematically searched for publications regarding guideline adherence. Forty-six pediatricians participated: 45 completed the MCQ, 34 performed the scenario. Seventy-one percent (median, IQR 56-82) of the MCQ were answered correctly. Fifty-six percent performed inflation breaths ≤ 60 s, 24% delivered inflation breaths of 2-3 s, and 85% used adequate inspiratory pressures. Airway patency was ensured 83% (IQR 76-92) of the time. Median events/min, compression rate, and percentage of effective compressions were 138/min (IQR 130-145), 120/min (IQR 114-120), and 38% (IQR 24-48), respectively. Other adherence percentages were temperature management 50%, auscultation of initial heart rate 100%, pulse oximeter use 94%, oxygen increase 74%, and correct epinephrine dose 82%. Ten publications were identified and used for our framework. The framework may inspire clinicians, educators, researchers, and guideline developers in their attempt to improve resuscitation guideline adherence. It contains many feasible strategies to enhance professionals' knowledge, skills, self-efficacy, and team performance, as well as recommendations regarding equipment, environment, and guideline development/dissemination.Conclusion: NLS guideline adherence among pediatricians needs improvement. Our framework is meant to promote resuscitation guideline adherence. What is Known: • Inadequate newborn life support (NLS) may contribute to (long-term) pulmonary and cerebral damage. • Video-based assessment of neonatal resuscitations has shown that deviations from the NLS guideline occur frequently; this assessment method has its audiovisual shortcomings. What is New: • The resuscitation quality metrics provided by our high-fidelity manikin suggest that the adherence of Dutch general pediatricians to the NLS guideline is suboptimal. • We constructed a comprehensive framework, containing multiple strategies to improve (neonatal) resuscitation guideline adherence.
我们旨在评估新生儿生命支持（NLS）知识及对指南的遵循情况，并提供提高（新生儿）复苏指南遵循率的策略。儿科医生完成了17道多项选择题（MCQ）。他们使用高仿真模拟人进行了一次模拟NLS场景操作。系统检索了关于指南遵循情况的文献。46名儿科医生参与其中：45人完成了多项选择题，34人进行了场景操作。多项选择题的正确率为71%（中位数，四分位间距56 - 82）。56%的人进行通气呼吸的时间≤60秒，24%的人进行2 - 3秒的通气呼吸，85%的人使用了适当的吸气压力。气道通畅率在83%（四分位间距76 - 92）的时间内得到保证。每分钟事件中位数、按压频率和有效按压百分比分别为138次/分钟（四分位间距130 - 145）、120次/分钟（四分位间距114 - 120）和38%（四分位间距24 - 48）。其他遵循率分别为体温管理50%、初始心率听诊100%、脉搏血氧仪使用94%、增加氧气74%以及正确的肾上腺素剂量82%。确定了10篇出版物并用于我们的框架构建。该框架可能会激励临床医生、教育工作者、研究人员和指南制定者努力提高复苏指南的遵循率。它包含许多可行的策略来提高专业人员的知识、技能、自我效能和团队表现，以及关于设备、环境和指南制定/传播的建议。结论：儿科医生对NLS指南的遵循情况需要改进。我们的框架旨在促进复苏指南的遵循。已知信息：• 新生儿生命支持（NLS）不足可能导致（长期）肺部和脑部损伤。• 基于视频的新生儿复苏评估表明，与NLS指南的偏差经常发生；这种评估方法存在视听方面的缺点。新发现：• 我们的高仿真模拟人提供的复苏质量指标表明，荷兰普通儿科医生对NLS指南的遵循情况不理想。• 我们构建了一个综合框架，包含多种提高（新生儿）复苏指南遵循率的策略。
