Mihalik Heather, Young Smith Hyo, Mullen Chanda, George Estee, Cottrell Constance, Markovich Renee, Savitski Jennifer
J Obstet Gynecol Neonatal Nurs. 2021 Nov;50(6):724-731. doi: 10.1016/j.jogn.2021.09.001. Epub 2021 Sep 21.
To compare the incidence of transient tachypnea of the newborn (TTN) before and after the implementation of a Baby-Friendly protocol and to determine changes in the rates of TTN symptoms, interventions, completion of skin-to-skin contact.
Retrospective cohort study using data in the electronic medical record.
Community-based tertiary obstetric facility.
We reviewed 934 charts of neonates born at or greater than 34 weeks gestation to women ages 18 years or older and included 790 neonates: 491 in the preimplementation group and 299 in the postimplementation group. Group assignment was based on time of Baby-Friendly protocol implementation. The preimplementation group included neonates born in April, August, and December of 2014, and the postimplementation group included neonates born during these months in 2018.
The primary outcome was incidence of TTN. Secondary outcomes were rates of the following: tachypnea symptoms, hypoglycemia, antibiotic administration, and completion of skin-to-skin contact.
The incidence of TTN was 2% (n = 8/491) in the preimplementation group and 1% (n = 4/299) in the postimplementation group (p = 1.000). The rate of tachypnea symptoms decreased from 5% (n = 25/491) to 1% (n = 3/299, p = .003), the rate of hypoglycemia decreased from 11% (n = 54/491) to 3% (n = 10/299, p < .001), and the rate of antibiotic administration decreased from 13% (n = 66/491) to 4% (n = 11/299, p < .001). The skin-to-skin completion rate increased from 16% (n = 79/491) to 61% (n = 183/299, p < .001).
Although skin-to-skin contact facilitates physiologic transition to extrauterine life, incidence of TTN was not significantly reduced after the implementation of the Baby-Friendly protocol. However, increased practice of skin-to-skin contact was an improvement in care with implications for the transition to extrauterine life.
比较实施爱婴医院协议前后新生儿暂时性呼吸急促（TTN）的发生率，并确定TTN症状发生率、干预措施、皮肤接触完成率的变化。
利用电子病历中的数据进行回顾性队列研究。
社区三级产科机构。
我们回顾了934例妊娠34周及以上、母亲年龄在18岁及以上的新生儿病历，纳入790例新生儿：实施前组491例，实施后组299例。分组基于爱婴医院协议实施时间。实施前组包括2014年4月、8月和12月出生的新生儿，实施后组包括2018年这些月份出生的新生儿。
主要结局是TTN的发生率。次要结局是以下各项的发生率：呼吸急促症状、低血糖、抗生素使用以及皮肤接触的完成情况。
实施前组TTN的发生率为2%（n = 8/491），实施后组为1%（n = 4/299）（p = 1.000）。呼吸急促症状的发生率从5%（n = 25/491）降至1%（n = 3/299，p = .003），低血糖的发生率从11%（n = 54/491）降至3%（n = 10/299，p < .001），抗生素使用的发生率从13%（n = 66/491）降至4%（n = 11/299，p < .001）。皮肤接触完成率从16%（n = 79/491）升至61%（n = 183/299，p < .001）。
尽管皮肤接触有助于向宫外生活的生理过渡，但实施爱婴医院协议后TTN的发生率并未显著降低。然而，增加皮肤接触的做法是护理方面的一项改进，对向宫外生活的过渡具有重要意义。
