School of Health and Social Wellbeing, University of the West of England, Bristol, UK.
School of Health and Social Wellbeing, University of the West of England, Bristol, UK
BMJ Open. 2024 Apr 28;14(4):e081106. doi: 10.1136/bmjopen-2023-081106.
To examine inequalities in birth before arrival (BBA) at hospitals in South West England, understand which groups are most likely to experience BBA and how this relates to hypothermia and outcomes (phase A). To investigate opportunities to improve temperature management advice given by emergency medical services (EMS) call-handlers during emergency calls regarding BBA in the UK (phase B).
A two-phase multimethod study. Phase A analysed anonymised data from hospital neonatal records between January 2018 and January 2021. Phase B analysed anonymised EMS call transcripts, followed by focus groups with National Health Service (NHS) staff and patients.
Six Hospital Trusts in South West England and two EMS providers (ambulance services) in South West and North East England.
18 multidisciplinary NHS staff and 22 members of the public who had experienced BBA in the UK.
35% (64/184) of babies conveyed to hospital were hypothermic on arrival. When compared with national data on all births in the South West, we found higher percentages of women with documented safeguarding concerns at booking, previous live births and 'late bookers' (booking their pregnancy >13 weeks gestation). These women may, therefore, be more likely to experience BBA. Preterm babies, babies to first-time mothers and babies born to mothers with disability or safeguarding concerns at booking were more likely to be hypothermic following BBA. Five main themes emerged from qualitative data on call-handler advice: (1) importance placed on neonatal temperature; (2) advice on where the baby should be placed following birth; (3) advice on how to keep the baby warm; (4) timing of temperature management advice and (5) clarity and priority of instructions.
Findings identified factors associated with BBA and neonatal hypothermia following BBA. Improvements to EMS call-handler advice could reduce the number of babies arriving at hospital hypothermic.
考察英格兰西南部医院出生前抵达（BBA）的不平等现象，了解哪些群体最有可能经历 BBA，以及这与体温过低和结果有何关系（阶段 A）。调查在英国，改善紧急医疗服务（EMS）接线员在紧急电话中关于 BBA 的体温管理建议的机会（阶段 B）。
两阶段多方法研究。阶段 A 分析了 2018 年 1 月至 2021 年 1 月期间医院新生儿记录中的匿名数据。阶段 B 分析了匿名的 EMS 通话记录，然后对 NHS 工作人员和患者进行焦点小组讨论。
英格兰西南部的六家医院信托和英格兰西南部和东北部的两家 EMS 提供商（救护车服务）。
18 名多学科 NHS 工作人员和 22 名在英国经历过 BBA 的公众。
64/184（35%）被送往医院的婴儿到达时体温过低。与英格兰西南部所有出生的全国数据相比，我们发现有记录的在预约时存在保障问题、以前有过活产和“迟到预订者”（怀孕预约时间超过 13 周）的女性比例更高。因此，这些女性可能更有可能经历 BBA。早产儿、首次分娩的婴儿和母亲有残疾或在预约时存在保障问题的婴儿在 BBA 后更有可能体温过低。关于接线员建议的定性数据中出现了五个主要主题：（1）对新生儿体温的重视；（2）出生后婴儿应放置的位置的建议；（3）保持婴儿温暖的建议；（4）体温管理建议的时间；（5）指示的清晰度和优先级。
研究结果确定了与 BBA 和 BBA 后新生儿体温过低相关的因素。改善 EMS 接线员的建议可以减少到达医院时体温过低的婴儿数量。
