Department of Obstetrics and Gynecology, Division of Obstetrics and Fetal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
J Adv Nurs. 2022 Mar;78(3):739-749. doi: 10.1111/jan.15003. Epub 2021 Sep 30.
This study aims to evaluate the effectiveness of an innovative postnatal risk assessment (the postnatal Rotterdam Reproductive Risk Reduction checklist: R4U) and corresponding care pathways in Preventive Child Healthcare (PCHC), along with PCHC professional satisfaction.
Four PCHC organizations located in three municipalities with a higher adverse perinatal outcome than the national average were selected for participation. The study concerns a historically controlled study design.
The study enrolled participants from September 2016 until December 2017. The historical cohort existed of children born in previous years from 2008 until 2016. The outcome measure was defined as catch-up growth: more than 0.67 standard deviation score weight for height increase in the first 6 months of life. PCHC professional opinion was assessed with a digital survey.
After the inclusion period, 1,953 children were included in the intervention cohort and 7,436 children in the historical cohort. Catch-up growth was significantly less common in the intervention cohort; 14.9% versus 19.5% in the historical cohort (p < 0.001). A regression sensitivity analysis, using matching, showed an odds ratio of 0.957 (95% CI 0.938-0.976) for the intervention cohort. In the survey, 74 PCHC physicians and nurses participated; most of them were neutral concerning the benefits of the postnatal R4U.
This study shows that the implementation of a novel postnatal risk assessment including in PCHC is feasible and effective. Final efforts to ensure a widespread implementation should be taken.
PCHC offers a unique opportunity to recognize and address risk factors for growth and development in children and to implement care pathways. Effective and widely implemented risk assessments in antenatal and PCHC are scarce. To our knowledge, this kind of evidence-based postnatal risk assessment has not been implemented in PCHC before and seizes the opportunity to prevent catch-up growth and its long-term effects.
本研究旨在评估一种创新的产后风险评估（产后鹿特丹生殖风险降低清单：R4U）及其在预防儿童保健（PCHC）中的相应护理路径的有效性，以及 PCHC 专业人员的满意度。
选择了三个市的四个 PCHC 组织参与研究，这些组织的围产期不良结局高于全国平均水平。本研究采用历史性对照研究设计。
研究于 2016 年 9 月至 2017 年 12 月期间招募参与者。历史队列由 2008 年至 2016 年期间出生的前几年的儿童组成。主要结局定义为追赶生长：出生后前 6 个月体重身高增加超过 0.67 个标准差评分。通过数字调查评估 PCHC 专业人员的意见。
纳入期结束后，干预组纳入了 1953 名儿童，历史组纳入了 7436 名儿童。干预组的追赶生长明显较少，为 14.9%，而历史组为 19.5%（p<0.001）。使用匹配的回归敏感性分析显示，干预组的优势比为 0.957（95%置信区间 0.938-0.976）。在调查中，74 名 PCHC 医生和护士参与其中；他们大多数对产后 R4U 的益处持中立态度。
本研究表明，在 PCHC 中实施一种新的产后风险评估是可行且有效的。应最终努力确保广泛实施。
PCHC 提供了一个独特的机会，可以识别和解决儿童生长发育的风险因素，并实施护理路径。有效的、广泛实施的产前和 PCHC 风险评估很少。据我们所知，这种基于证据的产后风险评估以前没有在 PCHC 中实施过，抓住了预防追赶生长及其长期影响的机会。
