Shahroor Maher, Whyte-Lewis Andrew, Mak Wendy, Liriano Bridget, Jasani Bonny, Lee Kyong-Soon
Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Paediatr Child Health. 2023 Jul 19;29(5):292-299. doi: 10.1093/pch/pxad052. eCollection 2024 Aug.
Preterm infants born at <32 weeks gestational age (GA) have increased morbidity if they are born outside tertiary centres (outborn). Stabilization and resuscitation after birth consistent with the neonatal Golden Hour practices (NGHP) are required to optimize outcomes.
To evaluate physiological outcomes of hypothermia and hypoglycaemia, and compliance with NGHP by neonatal transport team (NTT) compared with referral hospital team (RHT) during the stabilization of infants born at <32 weeks GA.
A retrospective case-control study of infants born at <32 weeks GA during 2016-2019 at non-tertiary perinatal centres where the NTT attended the delivery (cases) were matched to infants where the RHT team attended the delivery (controls).
During the 4-year period, NTT team received 437 requests to attend deliveries at <32 weeks GA and attended 76 (17%) prior to delivery. These cases were matched 1:1 with controls composed of deliveries attended by the RHT. The rate of hypothermia was 15% versus 29% in the NTT and RHT groups, respectively (P = 0.01). The rate of hypoglycaemia (<2.2 mmol/L) was 5% versus 12% in the NTT and RHT groups, respectively (P = 0.64). For compliance with the NGHP, use of fluid boluses was 8% versus 33%, use of thermoregulation practices, that is, plastic bag, was 76% versus 21%, and establishment of intravenous access was 20 min versus 47 min, in the NTT and RHT groups, respectively.
High-risk preterm deliveries attended by the NTT compared with the RHT had increased compliance and earlier implementation of the NGHP elements, associated with improved physiological stability and lower hypothermia rates. Outreach education for RHT should ensure that these key elements are included during the training in the stabilization of high-risk preterm deliveries.
孕周小于32周的早产儿若在三级中心以外出生（外出生），其发病率会增加。出生后需按照新生儿黄金一小时实践（NGHP）进行稳定和复苏，以优化结局。
评估体温过低和低血糖的生理结局，以及在孕周小于32周的婴儿稳定期，新生儿转运团队（NTT）与转诊医院团队（RHT）对NGHP的依从性。
一项回顾性病例对照研究，研究对象为2016 - 2019年在非三级围产期中心出生、孕周小于32周的婴儿，其中NTT参与分娩的婴儿（病例）与RHT团队参与分娩的婴儿（对照）进行匹配。
在这4年期间，NTT团队收到437次孕周小于32周的分娩出诊请求，其中76例（17%）在分娩前出诊。这些病例与由RHT参与分娩的对照进行1:1匹配。NTT组和RHT组体温过低发生率分别为15%和29%（P = 0.01）。低血糖（<2.2 mmol/L）发生率在NTT组和RHT组分别为5%和12%（P = 0.64）。在NGHP依从性方面，NTT组和RHT组使用液体推注的比例分别为8%和33%，使用体温调节措施（即塑料袋）的比例分别为76%和21%，建立静脉通路的时间分别为20分钟和47分钟。
与RHT相比，NTT参与的高危早产分娩对NGHP要素的依从性更高且实施更早，这与生理稳定性改善和体温过低发生率降低相关。应对RHT进行外展教育，确保在高危早产分娩稳定期培训中纳入这些关键要素。
