Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Pediatr Res. 2024 Jan;95(1):213-222. doi: 10.1038/s41390-023-02763-3. Epub 2023 Aug 8.
Neonatal encephalopathy (NE) continues to be a significant risk for death and disability. To address this risk, regional guidelines were developed with the support of a malpractice insurance patient safety organization. A NE registry was also established to include 14 centers representing around 50% of deliveries in the state of Massachusetts. The aim of this study was to identify areas of variation in practice that could benefit from quality improvement projects.
This manuscript reports on the establishment of the registry and the primary findings to date.
From 2018 to 2020, 502 newborns with NE were evaluated for Therapeutic Hypothermia (TH), of which 246 (49%) received TH, representing a mean of 2.91 per 1000 live births. The study reports on prenatal characteristics, delivery room resuscitation, TH eligibility screening, and post-natal management of newborns with NE who did and did not receive TH.
The registry has allowed for the identification of areas of variation in clinical practices, which have guided ongoing quality improvement projects. The authors advocate for the establishment of local and regional registries to standardize and improve NE patient care. They have made the registry data collection tools freely available for other centers to replicate this work.
Malpractice insurance companies can take an active role in supporting clinicians in establishing clinical practice guidelines and regional registries. Establishing a collaborative regional neonatal encephalopathy (NE) registry is feasible. Data Collection tools for a NE registry have been made publicly available to be adopted and replicated by other groups. Establishing a regional NE registry allowed for the identification of gaps in knowledge, variations in practice, and the opportunity to advance care through quality improvement projects.
新生儿脑病（NE）仍然是导致死亡和残疾的重大风险。为了应对这一风险，在医疗事故保险患者安全组织的支持下制定了区域指南。还建立了一个 NE 登记处，包括代表马萨诸塞州约 50%分娩量的 14 个中心。本研究旨在确定可以通过质量改进项目受益的实践差异领域。
本手稿报告了登记处的建立情况和迄今为止的主要发现。
2018 年至 2020 年，对 502 名患有 NE 的新生儿进行了治疗性低温（TH）评估，其中 246 名（49%）接受了 TH，平均每 1000 例活产 2.91 例。本研究报告了未接受 TH 和接受 TH 的 NE 新生儿的产前特征、产房复苏、TH 资格筛查和产后管理情况。
该登记处允许确定临床实践中的差异领域，这些差异领域指导了正在进行的质量改进项目。作者主张建立本地和区域登记处，以规范和改善 NE 患者的护理。他们免费提供了登记处数据收集工具，供其他中心复制这项工作。
医疗事故保险公司可以在支持临床医生制定临床实践指南和区域登记处方面发挥积极作用。建立协作式区域新生儿脑病（NE）登记处是可行的。NE 登记处的数据收集工具已公开提供，以供其他团体采用和复制。建立区域 NE 登记处可以发现知识差距、实践差异，并通过质量改进项目提供改善护理的机会。
