Horbar J D, Lucey J F
Department of Pediatrics, College of Medicine, University of Vermont, USA.
Future Child. 1995 Spring;5(1):139-61.
The development and dissemination of neonatal intensive care technology has been associated with improved survival for critically ill newborn infants, particularly those with birth weights of less than 1,500 grams (3 pounds, 5 ounces). Despite these advances, there are concerns about the long-term health status of surviving infants and the costs of their initial and subsequent care. In this article, the authors review current evidence for the effectiveness of neonatal intensive care and discuss several approaches to evaluating neonatal intensive care technology. They discuss a four-step process originally proposed by Roper for assessing and improving neonatal intensive care practices which includes (1) monitoring of practices, outcomes, and costs; (2) analysis of variation in practices, outcomes, and costs; (3) assessment of the efficacy of individual interventions, and (4) feedback and education to alter clinical behavior. The authors conclude that organized networks of neonatal intensive care units can play a crucial role in this process.
新生儿重症监护技术的发展与传播，已使危重新生儿的存活率得到提高，尤其是那些出生体重不足1500克（3磅5盎司）的婴儿。尽管有这些进展，但对于存活婴儿的长期健康状况以及他们初始和后续护理的成本仍存在担忧。在本文中，作者回顾了关于新生儿重症监护有效性的当前证据，并讨论了评估新生儿重症监护技术的几种方法。他们讨论了罗珀最初提出的用于评估和改进新生儿重症监护实践的四步流程，其中包括：（1）监测实践、结果和成本；（2）分析实践、结果和成本的差异；（3）评估个体干预措施的疗效；以及（4）反馈和教育以改变临床行为。作者得出结论，新生儿重症监护病房的有组织网络可以在这一过程中发挥关键作用。
