Service de Réanimation Pédiatrique et Médecine Néonatale, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud (APHP) et Centre de simulation LabForSIMS, Université Paris Saclay, Le Kremlin-Bicêtre, France.
Service de Réanimation Néonatale, Centre Hospitalier Sud Francilien, Corbeil, France.
BMC Pediatr. 2020 Jul 3;20(1):331. doi: 10.1186/s12887-020-02217-3.
Roughly 10% of newborns need help to complete the transition of birth. For these infants, international guidelines recommend supporting them using a 4-step procedure (A to D). Step A is an assessment time, which includes eight tasks and finishes by starting the positive pressure ventilation (PPV), if necessary (step B). The guidelines changed in 2015 and the allotted time was raised from 30 to 60 seconds for step A completion. This study aimed to assess if the reduced time constraint in step A could have an impact on 1st-year pediatric residents' performance to complete step A and if could lead to later initiation of step A.
Using video recordings of standardized neonatal scenarios over 6 years (3 before the change and 3 after), we assessed the ability of 1st-year pediatric residents of the Paris region to complete step A and initiate PPV in the allotted time in each period. Among the sessions, including at least five scenarios we evaluated all the PPV required scenarios executed for the first time by a dyad of 1st-year pediatric residents.
Among 52 sessions, we included 104 scenarios (25 sessions and 50 scenarios before the change and 27 sessions and 54 scenarios after). PPV started roughly at 1-minute resuscitation in both periods, but completion of the tasks before PPV-start was significant. Only 12% of the dyad of residents executed the eight tasks before PPV initiation in the first period versus 54% in the second period (p < 0.0001). Additionally, the completion of the eight tasks of step A was significantly better during the second period (6 [6-7] vs. 8 [7-8] p < 0.001).
These results could suggest that a reduced time constraint for step A imposed by the new Guidelines was associated with better performance.
大约 10%的新生儿在出生时需要帮助才能完成过渡。对于这些婴儿，国际指南建议采用四步程序（A 至 D）对其进行支持。步骤 A 是评估时间，包括八项任务，必要时开始正压通气（PPV）（步骤 B）。指南于 2015 年更新，完成步骤 A 的时间从 30 秒增加到 60 秒。本研究旨在评估步骤 A 中减少的时间限制是否会对第一年儿科住院医师完成步骤 A 的能力产生影响，以及是否会导致步骤 A 的启动延迟。
使用六年来标准化新生儿场景的视频记录（更改前 3 年和更改后 3 年），评估巴黎地区第一年儿科住院医师在每个时期内是否能够在规定时间内完成步骤 A 并启动 PPV。在包括至少五个场景的课程中，我们评估了第一组第一年儿科住院医师首次执行的所有需要进行 PPV 的场景。
在 52 次课程中，我们纳入了 104 个场景（25 次课程和 50 个场景在更改前，27 次课程和 54 个场景在更改后）。在两个时期，PPV 大约在复苏 1 分钟时开始，但在开始 PPV 之前完成任务是很重要的。在第一个时期，只有 12%的住院医师二人组在开始 PPV 之前完成了前八项任务，而在第二个时期则有 54%（p<0.0001）。此外，第二个时期步骤 A 的八项任务完成情况明显更好（6 [6-7] 与 8 [7-8]，p<0.001）。
这些结果表明，新指南对步骤 A 施加的时间限制减少与更好的表现相关。
