Aziz Khalid, Ma Xiaolu, Lockyer Jocelyn, McMillan Douglas, Ye Xiang Y, Du Lizhong, Lee Shoo K, Singhal Nalini
Department of Paediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta.
Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.
Paediatr Child Health. 2019 Apr 24;25(6):351-357. doi: 10.1093/pch/pxz050. eCollection 2020 Oct.
The Acute Care of at-Risk Newborns (ACoRN) program was developed in Canada to train health care providers in the identification and management of newborns who are at-risk and/or become unwell after birth. The ACoRN process follows a stepwise framework that enables evaluation, decision, and action irrespective of caregiver experience. This study examined the hypothesis that the ACoRN educational program improved clinical practices and outcomes in China.
In a before-and-after study, ACoRN training was provided to physicians, neonatal nurses, and administrators in 16 county hospitals in Zhejiang, PRC. Demographic and clinical data were collected on babies admitted to neonatal units before (May 1, 2008 to March 31, 2009) and after (June 1, 2010 to April 30, 2012) training.
A total of 4,310 babies (1,865 pre- and 2,445 post-training) from 14 sites were included. There were more in-hospital births (97.8% versus 95.6%, P<0.01) in the post-training epoch, fewer babies needing resuscitation (12.7% versus 16.0%, P=0.02), and more babies finishing their care in hospital (67.4% versus 53.1%, P<0.0001). After training, significantly more babies were evaluated as having respiratory distress at admission (14.2% versus 9.4%, P<0.0001); more babies had saturation, glucose and temperature measured on admission and at discharge; and more babies received intravenous fluids (86.3% versus 72.8%, P<0.0001). No significant improvements were noted in mortality (0.49% [post] versus 0.8% [pre], P=0.19 and adjusted odds ratio 0.54, 95% confidence interval: 0.23 to 1.29).
ACoRN training significantly increased patient evaluations and changed clinical practices. However, we were unable to ascertain improvement in morbidity or mortality.
加拿大开发了高危新生儿急性护理（ACoRN）项目，旨在培训医疗保健人员识别和管理出生后有风险及/或身体不适的新生儿。ACoRN流程遵循一个逐步的框架，无论护理人员的经验如何，都能进行评估、决策和采取行动。本研究检验了ACoRN教育项目改善中国临床实践和结果的假设。
在一项前后对照研究中，为中国浙江省16家县级医院的医生、新生儿护士和管理人员提供了ACoRN培训。收集了培训前（2008年5月1日至2009年3月31日）和培训后（2010年6月1日至2012年4月30日）入住新生儿病房的婴儿的人口统计学和临床数据。
共纳入了来自14个地点的4310名婴儿（培训前1865名，培训后2445名）。培训后时期的院内分娩更多（97.8%对95.6%，P<0.01），需要复苏的婴儿更少（12.7%对16.0%，P=0.02），在医院完成护理的婴儿更多（67.4%对53.1%，P<0.0001）。培训后，入院时被评估为有呼吸窘迫的婴儿显著增多（14.2%对9.4%，P<0.0001）；更多婴儿在入院时和出院时进行了血氧饱和度、血糖和体温测量；更多婴儿接受了静脉输液（86.3%对72.8%，P<0.0001）。死亡率没有显著改善（培训后为0.49%，培训前为0.8%，P=0.19，调整后的优势比为0.54，95%置信区间：0.23至1.29）。
ACoRN培训显著增加了患者评估并改变了临床实践。然而，我们无法确定发病率或死亡率是否有所改善。
