Fujian Key Laboratory of Neonatal Diseases, Xiamen Key Laboratory of Neonatal Diseases, Xiamen Children's Hospital (Children's Hospital of Fudan University at Xiamen), Xiamen, China; Children's Hospital of Fudan University, Shanghai, China.
Fujian Key Laboratory of Neonatal Diseases, Xiamen Key Laboratory of Neonatal Diseases, Xiamen Children's Hospital (Children's Hospital of Fudan University at Xiamen), Xiamen, China.
Int J Nurs Stud. 2024 Aug;156:104784. doi: 10.1016/j.ijnurstu.2024.104784. Epub 2024 May 5.
Despite previous studies suggesting that developmental care can provide benign stimulation to promote neural development of newborns, more evidence is needed regarding the other clinical benefits of developmental care.
To evaluate the effect of implementing developmental care on the length of hospital stay, the improvement of care practice in neonatal intensive care units, as well as the short-term outcome of very low birth weight infants.
Cluster-randomized controlled trial.
SETTING(S) AND PARTICIPANTS: From March 1, 2021 to March 1, 2022, 1400 very low birth weight infants were recruited from 14 tertiary neonatal intensive care units in China.
We assigned 14 neonatal intensive care units to either developmental care or standard care. The length of hospital stay of the infants was the primary outcome analyzed at the individual level. Secondary outcomes were family centered care practice including parental involvement, the skin to skin care, exclusive breast milk, oral immune therapy and breastfeeding. The environmental management (noise and light) and the short-term outcomes were also evaluated.
The length of hospital stay for the developmental care group was 65 % as long as that for the control group (HR: 0.65, 95 % CI, 0.451-0936, p = 0.021). After controlling the covariables, the adjusted HR = 0.755 (95 % CI, 0.515 to 1.107, p = 0.150). When compared to the control group, the developmental care group had greater access to SSC, with 22 infants (3.8 %) in the developmental care group compared to 13 infants (1.7 %) in the standard care group (p = 0.013). A greater proportion of infants in the developmental care group were fed at the breast, than those in the standard care group (136 [23.6 %] vs 9 [1.1 %]; p = 0.029). Compared to the control group, exclusively breast milk was significantly more favorable in the developmental care group (435 [75.6 %] vs 114 [15.0 %]; p = 0.001). The difference remained significant even after adjusting for covariates. However, the rate of oral immune therapy and parental involvement was similar in the two groups. The average noise and light levels in the developmental care group were significantly lower than those in the standard care group. After adjusting for confounders, the difference remained significant. There were no significant differences among groups in the mortality and major morbidity.
Developmental care might have developed an accumulated effect over time on the length of hospital stay among very low birth weight infants. The implementation of developmental care can greatly improve family centered care practices and the neonatal intensive care unit environment.
ClinicalTrials.govNCT05166720. Registration date: 1 March, 2021.
尽管先前的研究表明，发展护理可以提供良性刺激，促进新生儿的神经发育，但仍需要更多证据来证明发展护理的其他临床益处。
评估实施发展护理对极低出生体重儿住院时间、新生儿重症监护病房护理实践改善以及短期结局的影响。
整群随机对照试验。
2021 年 3 月 1 日至 2022 年 3 月 1 日，从中国 14 家三级新生儿重症监护病房招募了 1400 名极低出生体重儿。
我们将 14 家新生儿重症监护病房分配到发展护理或标准护理组。婴儿的住院时间是个体水平的主要分析结果。次要结局是包括父母参与、皮肤接触、纯母乳喂养、口服免疫治疗和母乳喂养在内的以家庭为中心的护理实践。还评估了环境管理（噪声和光照）和短期结局。
发展护理组的住院时间比对照组短 65%（HR：0.65，95%CI，0.451-0936，p=0.021）。在控制了协变量后，调整后的 HR=0.755（95%CI，0.515-1.107，p=0.150）。与对照组相比，发展护理组接受 SSC 的比例更高，发展护理组有 22 名婴儿（3.8%），而标准护理组有 13 名婴儿（1.7%）（p=0.013）。发展护理组以母乳喂养的婴儿比例高于标准护理组（136[23.6%]比 9[1.1%]；p=0.029）。与对照组相比，发展护理组中纯母乳喂养的比例明显更高（435[75.6%]比 114[15.0%]；p=0.001）。即使在调整了协变量后，这一差异仍然显著。然而，两组之间口服免疫治疗和父母参与的比例相似。发展护理组的平均噪声和光照水平明显低于标准护理组。在调整了混杂因素后，差异仍然显著。两组间死亡率和主要发病率无显著差异。
发展护理可能对极低出生体重儿的住院时间产生了累积效应。实施发展护理可以极大地改善以家庭为中心的护理实践和新生儿重症监护病房环境。
ClinicalTrials.govNCT05166720。注册日期：2021 年 3 月 1 日。
