新生儿重症监护病房侵袭性霉菌感染的临床分析

目的分析新生儿重症监护病房(NICU)侵袭性霉菌感染的发生率、临床表现、治疗及预后,以及引起霉菌感染的危险因素。方法总结1995~2004年10年间我院NICU侵袭性霉菌感染病例,分析霉菌感染发生的危险因素及氟康唑的疗效。结果(1)同期NICU收治的1 854例患儿中32例发生霉菌感染,发生率为1.73%,死亡12例,病死率37.5%;(2)发生霉菌感染的时间平均为入院后(10.4±7.3)d,表现为霉菌性败血症、脑膜炎、腹膜炎、肺炎,症状包括发热(68.8%)、反应差(71.9%)、呼吸增快(81.3%)或呼吸暂停(46.9%)、腹胀(31.3%)、胃肠营养不耐受(25%)、休克(25%)、皮疹(18.8%)、外周血白细胞增高(65.6%);(3)霉菌感染的危险因素中,低出生体重和机械通气是发生霉菌感染的高危因素(χ2=10.68,P<0.005;χ2=36.2,P<0.005);(4)病原学检查结果以白色念珠菌为主,28例(87.5%);(5)接受氟康唑治疗患儿预后优于非氟康唑治疗者(χ2=7.03,P<0.05)。结论霉菌已成为NICU院内感染的一个重要的致病菌;白色念珠菌是主要的致病菌;引起霉菌感染的危险因素有早产、极低出生体重、机械通气;氟康唑是一种有效的抗霉菌药,适用于早产儿及新生儿。     

Neonatal follow-up programs and follow-up studies: Historical and current perspectives

The present report reviews some highlights in the history of neonatal intensive care and neonatal follow-up programs, particularly developments and reports that were based on experiences in Canada. Early outcomes reported from ‘preemie baby units’ were distressing, but attention has consistently been paid to preterm infant outcomes, even from the early days of neonatal intensive care units. Most current follow-up programs have goals related to ‘audit’ functions, education and clinical roles, but existing literature related to these functions is limited. Several reports have provided guidance in terms of neonatal follow-up research issues, and these strengthen the place of follow-up studies in outcomes research.     

现代化医院NICU的建设与管理

按现代化医院NICU建设与管理要求,对NICU的必备设施、人员配置和NICU的各要素进行管理,建立完善的NICU规章制度和岗位职责,做到有章可循,提高护理人员整体素质,加强职业道德教育,提高思想素质,加强专科培训提高知识与技能,培训护士的急救技术提高急救成功率.培养护士良好的心理素质与身体素质提高应急能力.妥善保管与使用仪器设备,建立登记清点制度实行班班交接实行"四定"管理,随时取用与补足,严格执行仪器操作规范,做好相关记录.做好医院内感染的控制,提高医护人员医院内感染的认识,控制医院内感染发生率,认真落实消毒隔离制度抓好消毒环节质量,定期进行消毒灭菌监测和效果评价,确保消毒质量达标.做好护理安全管理与质量控制,定期做好护理安全教育,预防护理差错,严格执行无菌技术操作,做好管道的护理,认真详细书写护理记录,抓好环节质量,加强沟通,减少医疗纠纷的发生,护理管理者不仅要加强护理队伍的建设,在护士人力资源管理上进行合理调配和科学管理,而且要在护理专业技术上给予重点扶持,有计划地制订对专科护理岗位和护理管理岗位的护士规范化培训,提高护士对差错及医疗纠纷的防范意识,提高护理管理的科学化、民主化、法制化水平,促进护理事业的发展.     

A review of breastfeeding training intervention studies that evaluate staff knowledge outcomes in NICU

BackgroundThe NICU environment presents many barriers for mothers to provide breast milk for their infants. In order to succeed, mothers require advice and assistance from healthcare staff, however some staff lack the necessary knowledge and skills to support them. This review evaluates studies of breastfeeding education interventions on staff knowledge outcomes.MethodsA systematic search of the literature was conducted. Research studies that measured NICU staff knowledge outcomes of training were included.ResultsFrom 94 studies identified, four were included, each demonstrated significant positive effects on staff knowledge outcomes following a breastfeeding educational intervention in NICU. There were no RCTs, three studies used a pre and post-test design, and one used a post-test only design. One study performed a time series analysis of knowledge, staff attitudes and beliefs and two studies conducted an audit of breastfeeding rates.ConclusionsThis review identified a lack of good quality evidence on the effectiveness of breastfeeding educational interventions for staff in NICU. Future research should address the breastfeeding education needs of multidisciplinary healthcare staff in NICU through large, well-conducted RCTs.     

Primary palliative care in neonatal intensive care

This article explores the 2014 Institute of Medicine׳s recommendation concerning primary palliative care as integral to all neonates and their families in the intensive care setting. We review trends in neonatology and barriers to implementing palliative care in intensive care settings. Neonatal primary palliative care education should address the unique needs of neonates and their families. The neonatal intensive care unit needs a mixed model of palliative care, where the neonatal team provides primary palliative care and the palliative subspecialist consults for more complex or refractory situations that exceed the primary team׳s skills or available time.