深圳市24家医院极/超早产儿产房过渡期管理的横断面调查

A cross-sectional survey of delivery room transitional care management for very/extremely preterm infants in 24 hospitals in Shenzhen City

摘要:

目的 了解深圳市极/超早产儿产房过渡期管理实施现状。方法 2022年11月对深圳新生儿数据协作网的24家三级医院的极/超早产儿产房过渡期管理实施情况进行横断面调查，调查内容包括产前准备、产房复苏实施和新生儿重症监护室复苏后管理。根据胎龄将所纳入早产儿分为4组：<26周、26~28⁺⁶周、29~30⁺⁶周和31~31⁺⁶周组，对结果进行描述性分析。结果 共纳入140例极/超早产儿，其中<26周组10例，26~28⁺⁶周组45例，29~30⁺⁶周组49例，31~31⁺⁶周组36例。140例极/超早产儿中，99例（70.7%）接受了产前咨询，提供产前咨询的人员以产科医生为主，占比为79.8%；产时参与复苏的人员主要为助产士（96.4%）和新生儿科住院医师（62.1%）；52例（37.1%）实施了延迟脐带结扎，平均延迟时间为（45±17）s；137例（97.9%）生后采用了预热辐射台保暖；110例（78.6%）需要正压通气，其中67例（60.9%）采用T组合复苏器，42例（38.2%）应用了空氧混合仪；119例（85.0%）复苏中进行了血氧饱和度监测；完成过渡期各项措施至关闭温箱门时间的中位数为87 min。结论 在深圳新生儿数据协作网医院中，极/超早产儿的产房过渡期管理实施与我国相应专家共识的要求存在不同程度的差异，需要通过多中心协作的持续质量改进缩小差距，从而改善极/超早产儿产房过渡期管理的质量和结局。

Abstract:

Objective To investigate the current status of delivery room transitional care management for very/extremely preterm infants in Shenzhen City.Methods A cross-sectional survey was conducted in November 2022, involving 24 tertiary hospitals participating in the Shenzhen Neonatal Data Network. The survey assessed the implementation of transitional care management in the delivery room, including prenatal preparation, delivery room resuscitation, and post-resuscitation management in the neonatal intensive care unit. Very/extremely preterm infants were divided into four groups based on gestational age: <26 weeks, 26-28⁺⁶ weeks, 29-30⁺⁶ weeks, and 31-31⁺⁶ weeks. Descriptive analysis was performed on the results.Results A total of 140 very/extremely preterm infants were included, with 10 cases in the <26 weeks group, 45 cases in the 26-28⁺⁶ weeks group, 49 cases in the 29-30⁺⁶ weeks group, and 36 cases in the 31-31⁺⁶ weeks group. Among these infants, 99 (70.7%) received prenatal counseling, predominantly provided by obstetricians (79.8%). The main personnel involved in resuscitation during delivery were midwives (96.4%) and neonatal resident physicians (62.1%). Delayed cord clamping was performed in 52 cases (37.1%), with an average delay time of (45±17) seconds. Postnatal radiant warmer was used in 137 cases (97.9%) for thermoregulation. Positive pressure ventilation was required in 110 cases (78.6%), with 67 cases (60.9%) using T-piece resuscitators and 42 cases (38.2%) using a blended oxygen device. Blood oxygen saturation was monitored during resuscitation in 119 cases (85.0%). The median time from initiating transitional care measures to closing the incubator door was 87 minutes.Conclusions The implementation of delivery room transitional care management for very/extremely preterm infants in the hospitals participating in the Shenzhen Neonatal Data Network shows varying degrees of deviation from the corresponding expert consensus in China. It is necessary to bridge the gap through continuous quality improvement and multicenter collaboration to improve the quality of the transitional care management and outcomes in very/extremely preterm infants.