Duke University, Durham, North Carolina, and Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee (Dr Nation); Division of Neonatology, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee (Dr Sanlorenzo); Women's and Children's Service Line, Philadelphia, Pennsylvania (Dr Lebar); and Duke University School of Nursing, Durham, North Carolina (Dr Brandon).
J Perinat Neonatal Nurs. 2021;35(3):247-257. doi: 10.1097/JPN.0000000000000556.
Benefits of skin-to-skin contact (SSC) are documented but often delayed in the extremely preterm population due to medical complexity and staff misconceptions about safety. This quality improvement initiative was designed to increase SSC utilization among infants born before 29 weeks' gestation regardless of respiratory support by addressing nursing barriers inhibiting SSC. A pre-/postsurvey evaluated comfort level performing and perceived barriers to SSC utilization. Implementation consisted of an updated unit-specific SSC protocol and tailored education specific to identified barriers. Evaluation included SSC rates and maternal human milk usage in the first 30 days of life. In total, 81 patients (22-28 weeks, 370-1410 g) were included. SSC rates ranged from 3.3% to 17.7% at baseline and increased to 33.2% to 39.1% postintervention. Maternal human milk utilization increased above target (≥75%) postintervention for days 7 and 14, but declined towards baseline on days 21 and 30. A statistically significant increase was observed in nursing comfort level when performing SSC for intubated infants as well as infants with a peripherally inserted central catheter or umbilical venous catheter. SSC rates increased with infants younger than 29 weeks requiring intubation and central line management, possibly as a result of greater nursing comfort surrounding with SSC.
皮肤接触（SSC）的益处已有相关记载，但由于早产儿病情复杂且医护人员对安全性存在误解，这一益处往往难以在极早产儿群体中实现。本质量改进项目旨在解决阻碍 SSC 的护理障碍，以提高 29 周以下出生的婴儿的 SSC 利用率，无论其是否需要呼吸支持。在实施前后，通过调查评估护理人员进行 SSC 的舒适度以及对 SSC 利用的感知障碍。实施内容包括更新特定单位的 SSC 方案和针对已识别障碍的量身定制教育。评估包括 SSC 率和母亲在生命最初 30 天内的人乳使用量。共有 81 名患者（22-28 周，370-1410 克）入组。SSC 率从基线的 3.3%至 17.7%增加到干预后的 33.2%至 39.1%。人乳使用率在干预后第 7 天和第 14 天超过目标（≥75%），但在第 21 天和第 30 天又降至基线。在对插管婴儿和外周置入中心静脉导管或脐静脉导管婴儿进行 SSC 时，护理人员在进行 SSC 时的舒适度显著提高。对于需要插管和中央导管管理的小于 29 周的婴儿，SSC 率有所增加，这可能是由于 SSC 周围的护理舒适度更高所致。
