神经保护护理包的实施以减少早产儿急性脑损伤。
Neuroprotection Care Bundle Implementation to Decrease Acute Brain Injury in Preterm Infants.
机构信息
Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
Division of Neuroradiology, Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada.
出版信息
Pediatr Neurol. 2020 Sep;110:42-48. doi: 10.1016/j.pediatrneurol.2020.04.016. Epub 2020 May 1.
BACKGROUND
We assessed the impact of an evidence-based neuroprotection care bundle on the risk of brain injury in extremely preterm infants.
METHODS
We implemented a neuroprotection care bundle consisting of a combination of neuroprotection interventions such as minimal handling, midline head position, deferred cord clamping, and protocolization of hemodynamic and respiratory managements. These interventions targeted risk factors for acute brain injury in extremely preterm infants (born at gestational age less than 29 weeks) during the first three days of birth. Implementation occurred in a stepwise manner, including care bundle development by a multidisciplinary care team based on previous evidence and experience, standardization of outcome assessment tools, and education. We compared the incidence of the composite outcome of acute preterm brain injury or death preimplementation and postimplementation.
RESULTS
Neuroprotection care bundle implementation associated with a significant reduction in acute brain injury risk factors such as the use of inotropes (24% before, 7% after, P value < 0.001) and fluid boluses (37% before, 19% after, P value < 0.001), pneumothorax (5% before, 2% after, P value = 0.002), and opioid use (19% before, 7% after, P value < 0.001). Adjusting for confounding factors, the neuroprotection care bundle significantly reduced death or severe brain injury (adjusted odds ratio, 0.34; 95% confidence interval, 0.20 to 0.59; P value < 0.001) and severe brain injury (adjusted odds ratio, 0.31; 95% confidence interval, 0.17 to 0.58; P < 0.001).
CONCLUSIONS
Implementation of neuroprotection care bundle targeting predefined risk factors is feasible and effective in reducing acute brain injury in extremely preterm infants.
背景
我们评估了基于证据的神经保护护理包对极早产儿脑损伤风险的影响。
方法
我们实施了神经保护护理包，其中包括最小化处理、中线头部位置、延迟脐带夹闭以及对血流动力学和呼吸管理进行方案化等神经保护干预措施。这些干预措施针对极早产儿（出生胎龄小于 29 周）出生后前三天急性脑损伤的危险因素。实施是逐步进行的，包括多学科护理团队基于先前的证据和经验制定护理包、标准化结局评估工具以及教育。我们比较了实施前后急性早产儿脑损伤或死亡的复合结局发生率。
结果
神经保护护理包的实施与急性脑损伤危险因素的显著减少相关，如使用正性肌力药（实施前为 24%，实施后为 7%，P 值<0.001）和液体冲击（实施前为 37%，实施后为 19%，P 值<0.001）、气胸（实施前为 5%，实施后为 2%，P 值=0.002）和阿片类药物使用（实施前为 19%，实施后为 7%，P 值<0.001）。调整混杂因素后，神经保护护理包显著降低了死亡或严重脑损伤（调整后的优势比，0.34；95%置信区间，0.20 至 0.59；P 值<0.001）和严重脑损伤（调整后的优势比，0.31；95%置信区间，0.17 至 0.58；P<0.001）的发生率。
结论
针对既定危险因素实施神经保护护理包是可行且有效的，可以降低极早产儿的急性脑损伤。
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