坦桑尼亚奔巴岛四家地区医院的新生儿死亡率和复苏情况的视频评估。
Neonatal mortality and video assessment of resuscitation in four district hospitals in Pemba, Tanzania.
机构信息
Global Health Unit, Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Neonatology, The Juliane Marie Centre for Children, Copenhagen University Hospital Rigshospitalet, København, Denmark.
出版信息
Pediatr Res. 2024 Feb;95(3):712-721. doi: 10.1038/s41390-023-02824-7. Epub 2023 Sep 28.
BACKGROUND
We aimed to assess risk factors for neonatal mortality, quality of neonatal resuscitation (NR) on videos and identify potential areas for improvement.
METHODS
This prospective cohort study included women in childbirth and their newborns at four district hospitals in Pemba, Tanzania. Videos were analysed for quality-of-care. Questionnaires on quality-of-care indicators were answered by health workers (HW) and women. Risk factors for neonatal mortality were analysed in a binomial logistic regression model.
RESULTS
1440 newborns were enrolled. 34 newborns died within the neonatal period (23.6 per 1000 live births). Ninety neonatal resuscitations were performed, 20 cases on video. Positive pressure ventilation (PPV) was inadequate in 15 cases (75%). Half (10/20) did not have PPV initiated within the first minute, and in one case (5.0%), no PPV was performed. PPV was not sustained in 16/20 (80%) newborns. Of the 20 videos analysed, death occurred in 10 newborns: 8 after resuscitation attempts and two within the first 24 h. Most of HW 49/56 (87.5%) had received training in NR.
CONCLUSIONS
Video analysis of NR revealed significant deviations from guidelines despite 87.5% of HW being trained in NR. Videos provided direct evidence of gaps in the quality of care and areas for future education, particularly effective PPV.
IMPACT
Neonatal mortality in Pemba is 23.6 per 1000 livebirths, with more than 90% occurring in the first 24 h of life. Video assessment of neonatal resuscitation revealed deviations from guidelines and can add to understanding challenges and aid intervention design. The present study using video assessment of neonatal resuscitation is the first one performed at secondary-level hospitals where many of the world's births are conducted. Almost 90% of the health workers had received training in neonatal resuscitation, and the paper can aid intervention design by understanding the actual challenges in neonatal resuscitation.
背景
我们旨在评估新生儿死亡率的风险因素、视频中新生儿复苏的质量，并确定潜在的改进领域。
方法
本前瞻性队列研究纳入了坦桑尼亚奔巴岛四家区医院分娩的妇女及其新生儿。对护理质量进行视频分析。卫生工作者（HW）和妇女回答了关于护理质量指标的问卷。使用二项逻辑回归模型分析了新生儿死亡的风险因素。
结果
共纳入 1440 名新生儿。34 名新生儿在新生儿期内死亡（每 1000 例活产 23.6 例）。共进行了 90 例新生儿复苏，其中 20 例进行了录像。15 例（75%）正压通气（PPV）不足。有一半（10/20）新生儿在第 1 分钟内未开始进行 PPV，有 1 例（5.0%）未进行 PPV。20 例新生儿中有 16 例（80%）未持续进行 PPV。在分析的 20 个视频中，有 10 例新生儿死亡：8 例复苏后死亡，2 例在出生后 24 小时内死亡。49/56（87.5%）HW 接受过 NR 培训。
结论
尽管 87.5%的 HW 接受过 NR 培训，但 NR 视频分析显示，尽管 87.5%的 HW 接受过 NR 培训，但仍存在与指南明显不符的情况。视频提供了护理质量差距和未来教育领域的直接证据，特别是有效的 PPV。
影响
奔巴岛的新生儿死亡率为每 1000 例活产 23.6 例，其中超过 90%发生在出生后 24 小时内。新生儿复苏的视频评估显示，与指南存在偏差，可以帮助了解挑战并辅助干预措施的设计。本研究使用新生儿复苏视频评估是在世界上大多数分娩都在二级医院进行的情况下首次进行的。近 90%的卫生工作者接受过新生儿复苏培训，本文通过了解新生儿复苏的实际挑战，可以帮助干预措施的设计。
Zotero 插件