手卫生干预措施提高新生儿重症监护室手消毒依从性的观察与效果

目的研究提高新生儿重症监护室的手消毒依从性。方法建立手卫生干预措施,并用视频监测手段观察干预前后共13个月的各类接触。结果实施手卫生干预措施后手消毒依从性从25．15％上升为88．20％;培训后护理员的手消毒依从性较医生和护士低,夜间护士和护理员的手消毒依从性低于白班（P〈0．01）。结论手卫生干预措施能有效提高手消毒的依从性。     

表格式出院指导在NICU的应用

目的：探讨表格式出院指导在早产新生儿监护（ NICU）的应用效果。方法针对NICU特点,制定表格式出院指导。使用前加强护士培训,完善规章制度和工作流程,比较使用口头式出院指导（n＝560）和表格式出院指导（n＝500）患儿家长对护理工作的满意度、对出院指导的依从性的差异。结果使用表格式出院指导后,患儿家属对服务可及性、健康教育、人文关怀满意度得分别为（4．13±0.27）,（4．52±0．33）,（4．56±0．34）分,均高于实施前,差异有统计学意义（t值分别为47．30,27．53,41.74;P＜0．01）。使用表格式出院指导后患儿各项复查率均高于使用前,差异有统计学意义（ P＜0.01）。结论 NICU使用表格式出院指导,可以提高家属对健康教育的满意度,提高对健康教育的依从性。     

新生儿重症监护病房医院感染的因素探讨及防控对策

目的探讨新生儿重症监护病房医院感染的原因及对策。方法采用回顾性调查研究的方法,对2007年1月至2008年12月我院新生儿重症监护病房收治的981例患儿的病例资料进行统计学分析。结果发生医院感染23例,感染率2.33%,感染部位以胃肠道为主,其次为呼吸道、皮肤黏膜、口腔、其他等,病原体以肺炎克雷伯菌、表皮葡萄球菌、金黄色葡萄球菌为主。结论采取严格的消毒隔离制度,合理使用抗生素,尽量缩短住院时间等相应措施可有效减少新生儿医院感染的发生。     

集束照护策略对提高NICU医护人员手卫生依从性的作用

目的 探讨集束照护策略对提高新生儿重症监护病房(NICU)医护人员手卫生依从性的作用.方法 通过开展品质罔活动,实施医护人员手卫生的集束照护策略(care bundle),即:(1)加强培训和管理,增强手卫牛意识,强化手卫牛观念;(2)进行环境改造和流程再造,创建手卫生的氛围和方便的洗手设施;(3)加强监督,医护人员共同参与,保证洗手的正确性.对实施集束照护策略前后NICU医护人员入室及接触患儿前手卫生的落实情况进行比较分析. 结果NICU医护人员入室、接触患儿前手卫生实施率分别由集束照护策略实施前的32.1%、92.0%上升至实施后的97.4%、99.3%;新生儿院内感染的发生率由实施前的2.22%下降到实施后的1.38%.结论 集束照护策略能有效提高医护人员手卫生的依从性,预防医院内感染发生.     

Nurses' expectations of using music for premature infants in neonatal intensive care unit

This study aimed to describe nurses' expectations of using music for premature infants in the neonatal intensive care unit (NICU) and to find out about the related background factors. The subjects consisted of 210 Finnish nurses who were recruited from the country's five university hospitals providing premature infant care in NICU. The data were collected by validated questionnaire, and the response rate was 82%. Most nurses preferred recorded music to live music in the NICU. They expected that music would have positive effects on premature infants, parents, and staff. Few demographic and many background factors of the respondents' music-related experiences correlated significantly with the expectations concerning their preference. In conclusion, the nurses' expectations were positive regarding the use of music in the NICU, which supports evidence regarding the efficacy of music therapy for premature infants.     

循征医学在新生儿重症监护病房感染控制中的应用

目的 应用循征医学的方法建立新生儿重症监护病房（NICU）感染控制流程.方法 通过对NICU感染控制相关资料的调查,确定存在的问题,利用医学文献数据库（Medline）等相关医学网站检索相关文献,进行评价整合证据,以系统科学的方法建立NICU感染控制流程.结果 对照组和观察组对比：奶瓶奶嘴清洁消毒合格率,空气、物体表面、保温箱湿化水监测以及两组医护人员洗手依从性,各项监测指标差异均具有统计学意义（P＜0.05或P＜0.01）.结论 应用循征医学的方法建立NICU感染控制流程,是科学、有效的方法.     

Kangaroo mother care: A literature review of barriers and facilitators to implementation in the neonatal intensive care unit

Kangaroo mother care (KMC) is a cost-effective, natural, safe, and evidence-based intervention that improves maternal-infant bonding, increases breastfeeding rates, and decreases the risk of mortality and morbidity in preterm infants. Although KMC is recommended to be the standard of care for preterm infants, there are significant implementation barriers. This literature review critically analyzes the barriers and facilitators to implementation from three health care system components: (1) health care facilities, (2) health care providers, and (3) parents. One independent author included 17 research-based articles from 2014 to 2021. Overarching themes identified were: availability of protocols, policies, and guidelines; access to training and support; access to resources; buy-in; and medical concerns. Recommendations to overcome barriers and increase uptake are: develop and disseminate KMC protocols, policies, and guidelines; provide quality training and support to health care providers; provide quality education and socio-cultural support to parents; and allocate resources to support KMC.     

新生儿重症监护室噪音对新生儿影响的研究进展

新生儿重症监护病房(neonatal intensive care unit,NICU)是治疗危重新生儿的重要场所,是一个对危重新生儿的病情进行持续不断的监护、及时有效的治疗和护理的集中病室。国内外的医学和护理文献中大量记载着关于新生儿重症监护病房声音水平标准研究的报道,然而大多数新生儿重症监护病房因其人员密度大, 操作抢救频率高, 高精密仪器聚集,使其存在着声音水平远远高于国际规定水平的隐患[1]。大量文献研究中显示,新生儿重症监护病房的噪音会对新生儿的听力系统、生理和行为、中枢神经系统等造成一系列的危害,从而影响新生儿的生长发育以及康复[2-4]。本文就新生儿重症监护病房噪音的水平、来源、对新生儿的影响,以及降低噪音的措施进行综述。     

Risk factors for ventilator-associated pneumonia in neonatal intensive care unit patients

Ventilator-associated pneumonia (VAP) is a serious complication in neonatal patients on mechanical ventilation. The objective of this study was to examine the incidence and risk factors associated with VAP, particularly in every 7-day versus every 14-day ventilator circuit changes, in a neonatal intensive care unit (NICU). Seventy-one neonates hospitalized in the NICU were enrolled. First, the neonates were divided into groups with and without VAP. On univariate logistic regression analyses, prolonged mechanical ventilation, frequent re-intubation, low gestational age, and low birth weight (BW) were significant risk factors for VAP development. After adjustments for other variables, only BW <626 g was a significant independent predictor for VAP in NICU infants. Second, to examine the effect of the frequency of changing ventilator circuits on the incidence of VAP, circuit changes were compared between the every 7-day group and the every 14-day group. The incidence of VAP per 1000 ventilator days was 9.66 for the every 7-day group and 8.08 for the every 14-day group, and there was no significant difference between the 2 groups. BW <626 g was a significant independent predictor of VAP, and decreasing the frequency of ventilator circuit changes from every 7 days to 14 days had no adverse effect on the VAP rate in the NICU.     

新生儿重症监护病房护士职业倦怠特征分析

目的了解新生儿重症监护病房护士职业倦怠的情况。方法整群抽样抽取浙江大学医学院附属儿童医院、浙江大学医学院附属妇产科医院、浙江省中医院三家医院重症监护病房的护士65人,通过发放护士工作压力源表、中文版M氏职业倦怠量表及一般情况调查表收集资料。结果65位护士的工作压力平均值85.43分,属中度压力水平;职业倦怠检出率为81.54%,护士轻、中、重度倦怠分别为9.23%、43.08%、29.23%,与杭州市医院护士群体职业倦怠相比有显著差异,与杭州市医院急诊科护士群体相比有显著差异。结论新生儿重症监护病房护士工作压力较大,是倦怠的高发人群。     

Implementation of a simulation-based education for mothers in managing respiratory emergencies in the neonatal intensive care unit

Neonatal Intensive Care Unit (NICU) discharge often causes concern for mothers since they are solely responsible for the care and safety of their infants. This study assesses the feasibility of simulation-based education on managing respiratory emergencies for mothers and investigates changes in mothers' confidence. It used a pilot one-group pre- and post-test design in an NICU. The general estimation equation was used to analyze the effects of simulation-based education and factors affecting mothers' confidence. The simulation-based education increased mothers' confidence in managing respiratory emergencies, and these effects continuedeven after discharge. Mothers with multiple pregnancies and mothers of infants with low birth weight, long gestation, and NICU stays showed increased confidence compared to their counterparts. Teaching using a simulation approach is feasible and significantly improves mothers' confidence in infants’ respiratory emergency management. The findings demonstrate the feasibility of simulation-based education in terms of clinical education for improving infant health outcomes.     

袋鼠式护理对新生儿重症监护室早产儿操作性疼痛的影响

目的:探讨新生儿重症监护室(NICU)早产儿执行疼痛性操作时应用袋鼠式护理对改善操作性疼痛的效果.方法:将本院N IC U收治的90例早产儿按入科顺序分为对照组和观察组.对照组45例早产儿接受N IC U常规护理,观察组45例早产儿接受常规护理和袋鼠式护理.比较两组早产儿操作性疼痛评分及血氧饱和度(SPO2)、心率(H...     

Parental stress in the neonatology unit - The influence of hospital stay length and neonatal unit differentiation

AimTo analyze the influence of neonatal unit differentiation and hospital stay length on parental stress.BackgroundParents choose to deliver in a private or public hospital. These hospitals differ in the specialization in perinatal care and the support offered by the neonatal units.MethodsIt was a methodological study. Data were collected using the Neonatal Unit Parental Stress Scale - Portuguese version that was given to parents on day 2, and day 14 of hospitalization after the child's birth.ResultsIn the Parent Relationship with Infant and Parental Role and Physical Environment and Sounds dimensions, there was an increase in parental stress in differentiated neonatal intensive units and a decrease in stress in specialized and special neonatal units.ConclusionParents should be integrated into activities that promote their parental role, and actions should be implemented to reduce stressors in the neonatal unit environment.     

新生儿监护室患儿家属的压力源干预研究

目的 通过对新生儿监护室患儿家属的压力源进行的分析,给予实施干预。方法 选择2013年6月~2014年6月我科住院的患儿家属300名为研究对象。心理因素用焦虑自评量表（SAS）和抑郁自评量表（SDS）进行分析。针对压力源实施干预,干预前为对照组,干预后为实验组。干预后300例家属再进行前后的心理因素对比。结果通过对患儿家属进行心理压力干预,增加患儿家属对疾病知识的认识,对新生儿监护病房环境和对我们医务人员工作的了解。使抑郁、焦虑等负性情绪均低于干预前,比较差异有统计学意义（P<0.05）。结论了解和识别家属的压力源,减少其压力应激,实施护理干预及情感支持有利于满足家属需求,优化服务,减少医患纠纷,和谐医患关系,提高了患儿家属的满意度。     

Excellence reporting in a neonatal intensive care unit during COVID-19 era

We are reporting our engagement with the ‘Learning from Excellence’ initiative in the neonatal intensive care unit during the covid era, with enhanced professional and personal stresses in the workforce. It highlights the positive experiences around technical management of sick neonates and human factors, like team working, leadership and communication.     

新生儿重症监护病房多重耐药菌筛查及耐药性分析

目的分析新生儿重症监护病房（NICU）住院患儿多重耐药菌的定植状况以及耐药特点,为预防和控制多重耐药菌在院内的传播及临床合理用药提供科学依据。 方法对2018年5月1日至10月31日期间在广西壮族自治区妇幼保健院NICU住院患儿176例,入院1 h内采集肛拭子进行定植菌筛查。筛查阳性者,进行耐药性分析,了解NICU住院患儿细菌定植及耐药情况。采用χ²检验比较不同分娩方式患儿中细菌培养结果及不同日龄患儿细菌分离率的差异。 结果在23例患儿标本中检测出多重耐药菌,多重耐药菌定植率13.1%（23/176）,日龄<3 d新生儿多重耐药菌筛查阳性率低于日龄3~28 d的新生儿,差异具有统计学意义（χ²=4.099,P=0.043）。其中23株多重耐药细菌包括：11株产超广谱β-内酰胺酶（ESBLs）肠杆菌,10株耐万古霉素肠球菌（VRE）,2株耐甲氧西林金黄色葡萄球菌（MRSA）。11株产ESBLs肠杆菌对氨苄西林、哌拉西林、头孢唑啉、头孢呋辛、头孢曲松、庆大霉素耐药率达100%;10株VRE对万古霉素、青霉素、氨苄西林耐药率达100%,对替考拉宁和利奈唑胺完全敏感。2株MRSA除对万古霉素、替考拉宁和利奈唑胺完全敏感,对青霉素类、头孢菌素类、红霉素完全耐药。 结论NICU住院患儿肠道多重耐药菌定植情况比较严重,以产ESBLs肠杆菌、VRE为主,耐药现象严重。应重视日龄≥3 d新生儿肛拭子多重耐药菌的筛查,加强监测,避免多重耐药菌在医院内暴发流行。     

220例经大隐静脉置入PICC导管术在新生儿监护病房中的应用

[目的]探讨经大隐静脉置入中心静脉导管（PICC）导管在新生儿监护病房中（NICU）的应用效果。[方法]对住NICU的220例患儿经大隐静脉置入PICC导管,并对其临床资料进行总结、分析。[结果j220例患儿中成功置管于下腔静脉217例,3例因导管末端异位于腹壁下静脉拔管;一次穿刺成功196例,成功率89．1％;留置时间4d～98d（23．94d±13．73d）;置管期间导管堵塞13例次,发生静脉炎19例次,导管因渗液脱出l例,导管体外断裂1例;206例拔管后行导管末端培养,结果导管末端细菌培养阳性2例。[结论]经大隐静脉置入PICC导管技术一次穿刺成功率高、异位率低、并发症少。