Department of Paediatrics, Ashford and St Peters NHS Foundation Trust, Chertsey, Surrey, England, UK; Formerly, Senior Registrar in Paediatrics at Delta State University Teaching Hospital, Oghara, Delta State, Nigeria.
Department of Neonates, Women and Newborn, Princess Anne Hospital, Southampton, England, UK.
Niger J Clin Pract. 2022 May;25(5):612-620. doi: 10.4103/njcp.njcp_1560_21.
Preterm births constitute a major clinical problem associated with significant morbidity and mortality in the perinatal, neonatal, and childhood periods. Decisions around initiating and/or continuing resuscitation and treatment of preterm infants (PI) both at birth and afterwards need careful consideration. While the developed countries have published guidelines for the resuscitation and care of the PI, this is not the case in developing countries where availability of resources and the absence of a published guidelines impacts on practice. Our study was therefore carried out to access the practice and decision-making that surrounds the resuscitation of PIs by neonatologists and neonatal nurses working in neonatal intensive care units (NICU) across Nigeria.
We conducted an online national survey on neonatal care providers working in level 2 and level 3 neonatal units (NICU) across Nigeria. Around 190 participants were selected from the six geopolitical zones of the country and they were asked about current practices relating to resuscitation and stopping life-sustaining treatment as well as estimated survival rates at different gestational ages (GA).
In total, 138 clinicians responded to our survey. Of this, 73% completed the survey. Majority (83%) of the respondents worked in government-funded public hospitals while the remaining 17% worked in the private hospitals. 74% of the respondents' report having a guideline on the PI. Resuscitation practice varied amongst different neonatologists and neonatal nurses with 48% of the clinicians providing resuscitation at 23-26 weeks and the remainder providing resuscitation at a GA >26 weeks with a median GA threshold for initiating resuscitation at 27 weeks. From an institutional perspective, 75% of PIs <26 weeks were resuscitated in public hospitals while the remaining 25% were resuscitated in private hospital, however this is not statistically significant (P = 0.385). In situations when the GA is unknown, we found a median fetal weight of 700 g as the threshold for providing active treatment. We noticed wide variations in responses on the estimated survival rates of the PIs, however a common finding is the increased chances of survival with increasing GA. Also, PIs across all GAs had higher chances of survival in public hospitals than in private hospitals, however, this is not statistically significant (P = 0.385-0.956). The major factor influencing a clinicians' decision to limit resuscitation was the "risk of poor quality of life" (50%) and the prevalent way of palliating the newborn amongst respondents is by stopping life-sustaining treatment (34%).
Our survey revealed considerable variation in resuscitation practices amongst different neonatal care providers. Having a framework that will formulate and publish a national guideline based on factors like local survival rates, societal norms, and resources and ensuring that it is adopted by all NICUs will generate greater consistency of care.
早产是围产期、新生儿期和儿童期发生重大发病率和死亡率的主要临床问题。在出生时和之后，启动和/或继续对早产儿（PI）进行复苏和治疗的决策需要仔细考虑。虽然发达国家已经发布了 PI 复苏和护理指南，但在发展中国家并非如此，因为资源的可用性和缺乏已发布的指南会影响实践。因此，我们进行了这项研究，以了解在尼日利亚的新生儿重症监护病房（NICU）工作的新生儿科医生和新生儿护士在复苏 PI 方面的实践和决策。
我们对在尼日利亚 2 级和 3 级新生儿单位（NICU）工作的新生儿护理人员进行了一项在线全国性调查。从该国的六个地缘政治区中选择了约 190 名参与者，他们被问及与复苏和停止维持生命的治疗有关的当前做法，以及不同胎龄（GA）的估计生存率。
共有 138 名临床医生对我们的调查做出了回应。其中，73%的人完成了调查。大多数（83%）受访者在政府资助的公立医院工作，而其余 17%在私立医院工作。74%的受访者报告有 PI 指南。不同的新生儿科医生和新生儿护士的复苏实践存在差异，48%的临床医生在 23-26 周时进行复苏，其余的在 GA>26 周时进行复苏，启动复苏的中位数 GA 阈值为 27 周。从机构角度来看，<26 周的 PI 在公立医院中有 75%被复苏，而在私立医院中则有 25%被复苏，但这没有统计学意义（P=0.385）。在 GA 未知的情况下，我们发现 700 克的胎儿体重中位数作为提供积极治疗的阈值。我们发现对 PI 估计生存率的回答存在广泛差异，但一个共同的发现是 GA 越高，生存机会越大。此外，所有 GA 的 PI 在公立医院的生存机会都高于私立医院，但这没有统计学意义（P=0.385-0.956）。影响临床医生限制复苏决策的主要因素是“生活质量差的风险”（50%），受访者中缓解新生儿的主要方式是停止维持生命的治疗（34%）。
我们的调查显示，不同的新生儿护理提供者在复苏实践方面存在相当大的差异。制定一个框架，根据当地生存率、社会规范和资源等因素制定并发布国家指南，并确保所有 NICU 都采用该指南，将产生更大的护理一致性。
