新疆维吾尔自治区开展新生儿窒息复苏培训的现状及总结

据世界卫生组织2005年报道，每年400多万死亡新生儿中约有1／4死于新生儿窒息，100万以上婴儿在分娩窒息后出现脑瘫、学习障碍等后遗症。2005年我国妇幼卫生监测结果报道，5岁以下儿童因出生窒息死亡的比例为14．2％，为第2位死因。而大多数新生儿的窒息死亡和致残，可以通过出生后第一时间内的积极复苏抢救而得以控制。[第一段]     

中国新生儿窒息复苏培训项目中期效果评价

目的 评价中国新生儿窒息复苏培训项目的 中期效果.方法 20个项目省每省随机抽取4所不同级别的医院进行调查;每所医院随机抽取产科医生、儿科医生、助产士各1名进行问卷调查和操作考核,共抽取240名医务人员,实际参与调查238名.通过问卷、查阅医院记录、对医务人员进行模拟操作考核等评价医护人员受培训情况,分析新生儿窒息发生率及新生儿窒息死于分娩现场的发生率.结果 80所被调查医院中,97.0%的产科、儿科和助产士接受过新生儿窒息复苏培训,操作考核的总合格率为72.7%.2003年至2006年新生儿窒息发生率从3.83%下降到2.76%(χ2=236.132,P<0.01);新生儿窒息死于分娩现场的发生率从3.08/万下降到2.06/万,但差异无统计学意义(χ2=2.694,P=0.101).结论 新生儿窒息复苏培训项目的 实施促进了我国新生儿窒息复苏技术的推广,降低了新生儿窒息的发生率和死亡率.加强操作培训是今后新生儿窒息复苏培训的关键.     

新生儿复苏培训项目十年回顾

每年约2000万新生儿出生的中国，鼓励一对夫妻只生一个孩子，随着国民经济迅速发展，生活水平不断提高，每一个新生儿的健康都受到家庭及社会的高度关注。1991年中国要儿死亡率为50．2‰，1998年降至33．3‰，地区性差别很大，贫困地区最高可达56‰，一些条件较好的城市低至7．5‰。围产医学界公认围产窒息为要儿患病及死亡的首要原因，如合并早产、严重肺、脑疾病等后果更为严重。     

对新生儿窒息新法复苏实施强化培训效果的评价

目的 探讨理论与操作相结合的强化培训模式对落实新法窒息复苏规范操作、提高复苏质量、降低新生儿窒息发生率和病死率的影响。方法 采用理论与实践相结合、技术骨干“一对一”、“手把手”操作指导的培训模式进行窒息复苏方法培训，比较强化培训前后市、镇（区）医院ABCD复苏的规范操作、复苏用药及治疗转归情况。结果 （1）培训前新生儿窒息发生率为2．67％，培训后第1年窒息发生率为2．21％，比培训前明显下降，差异有统计学意义（χ^2=12．581，P〈0．01）；培训后第2、3年窒息发生率分别为2．44％和2．45％，虽比培训前下降，但差异无统计学意义。培训前规范复苏为51．3％，培训后第1年提高至75．7％，第2、3年分别降至62．7％和51．6％，差异均有统计学意义（P均〈0．01）；（2）培训前复苏中用药的患儿占63．8％，培训后第1、2和3年分别降至45．0％、50．0％和49．2％，差异有统计学意义（P〈0．01）；（3）市、镇（区）医院经初步复苏后需要继续复苏者分别为89．9％和85．7％，规范复苏分别为83．7％和48．6％，使用一种或多种药物复苏分别为42．2％和79．2％，其中不合理用药分别为15．3％和39．4％，差异均有统计学意义（P均〈0．01）；（4）培训前新生儿窒息病死率为9．05％，培训后降至5．08％，差异有统计学意义（P〈0．05）。市、镇（区）医院培训后治疗转归情况好于培训前，差异有统计学意义（P均〈0．05）。结论 在行政干预下，采用理论与实践相结合的重点培训模式可明显提高新生儿窒息复苏培训效果。但复苏技术仍存在误区和不规范操作，镇（区）医院仍是复训的重点，复训间隔时间不能超过两年。     

新生儿窒息复苏培训项目经验交流暨省级师资培训在西安举行

2006年9月21～22日，由卫生部妇幼保健与社区卫生司和强生儿科研究院主办的新生儿窒息复苏培训项目经验交流暨省级师资培训在西安举行。会上对中国新生儿窒息复苏项目开展以来各省的培训情况进行了评奖，同时对第五版窒息复苏更新部分进行了详细介绍和培训。会上，美国儿科学会的专家与来自全国各地的专家、学者交流了新生儿窒息复苏心得，分享和传递国际最新新生儿窒息复苏知识与急救技术，耐心回答他们的问题，并与国内的专家携手教授学员第5版窒息复苏教材的新内容，以保证我国医护人员的窒息复苏技术与国际接轨。强生儿科研究院国际医学项目总监卓玛女士在大会上表示，强生儿科研究院将一如既往地与中国卫生部密切合作，继续支持中国新生儿窒息复苏项目，为母婴的生存与健康贡献更多的力量。     

新生儿窒息复苏及其培训存在问题和防治对策

2000年全球＜5岁儿童死亡1080万，其中＜28d新生儿390万。42个发展中国家占全球＜5岁死亡数的90％，33％(29％～369／5)为新生儿，在经济欠发达国家中新生儿窒息为新生儿死亡第一位原因，占29％。目前新生儿窒息仍是我国围产儿死亡的主要原因，近年来由于产儿科进一步合作，产科     

新生儿窒息与复苏

新生儿窒息与复苏沈阳市第五人民医院（１１００２１）樊世荣胎儿娩出后１分钟，仅有心跳而无呼吸或未建立规则呼吸的缺氧状态，称为新生儿窒息。新生儿窒息的发生率约占分娩总数的１０％，是围产儿死亡的主要原因之一。１新生儿窒息的原因新生儿窒息常是胎儿窘迫的延续，...     

新生儿窒息复苏项目专家会议纪要

由卫生部基妇司、中华医学会围产医学分会、强生儿科研究院联合举办的“新生儿窒息复苏项目专家会议”于2003年7月24日在北京召开，卫生部基妇司张德英处长、中华医学会围产医学分会主任委员叶鸿瑁、强生儿科研究院的负责人Joy Marini，以及来自美国儿科学会和美国心脏协会的专家Errol Alden和William J．Keenan教授和来自国内的产科、新生儿科专家教授共12人参加了会议。     

12所医疗机构开展新生儿窒息复苏领导小组试点干预的效果评价

目的 评价在医疗机构开展新生儿窒息复苏领导小组试点干预的效果.方法 在江西、辽宁和湖南3个省每省选择省级医院1所、市级医院2所、县级医院1所进行干预,即建立院内新生儿窒息复苏领导小组,探索人员培训与复训的模式,促进和落实产、儿科合作制度的建立和运作,对新生儿窒息病例进行常规记录和病例讨论;对建立院内新生儿窒息复苏领导小组前后新生儿窒息抢救过程和新生儿窒息发生率的变化情况进行分析,评价干预效果.结果 (1)试点期间新生儿窒息的发生情况:试点期间共完整记录315例窒息病例,其中轻度窒息占89.5%(282例),重度窒息占10.5%(33例).1 min Apgar评分在县级医院最低,为(5.40±1.56)分,其次是省级医院和市级医院,分别为(5.63±1.67)分和(6.03±1.41)分.(2)不符合新生儿窒息复苏指南的操作比例:不符合复苏指南操作的病例数占全部窒息病例数的47.9%(151/315),其中不符合复苏指南正压通气操作的病例数占36.5%(115/315).(3)试点前后窒息发生率比较:省级医院和市级医院窒息发生率在试点后分别为2.66%和1.67%,比试点前(分别为4.23%和2.83%)有所下降(χ2=5.021和4.948,P＜0.05),重度窒息发生率也均有所下降,但差异没有统计学意义(χ2=3.001和0.966,P＞0.05).县级医院窒息发生率由2.48%下降为1.22%,但差异无统计学意义(χ2=2.989,P=0.084),重度窒息发生率由0.39%下降为0.00%,差异有统计学意义(χ2=2.567,P=0.035).结论 通过在医疗机构内建立新生儿窒息复苏领导小组,可加强院内新生儿窒息复苏培训,促进科室间协调,提高医疗机构新生儿窒息抢救技术水平,降低新生儿窒息发生率.

Abstract：

Objective To evaluate the effect of a pilot intervention on setting up a hospital-based neonatal resuscitation leading group in 12 hospitals. Methods One provincial-level, two prefecturelevel and one county-level hospitals in Jiangxi, Liaoning and Hunan province were selected to participate in the intervention. A neonatal resuscitation leading group was set up in each hospital to investigate the mode of resuscitation practice training and re-training, improve and carry on the cooperation between obstetricians and pediatricians, record the steps of neonatal resuscitation of asphyxia cases and lead the exploration of the problems occurred during the process in their own hospital. The changes of asphyxia incidence and neonatal resuscitation process were analyzed to evaluate the effect of the intervention. Results (1) Incidence of neonatal asphyxia during intervention period: 315 neonatal asphyxia cases were recorded, among which 89.5 % (n = 282) were mild and 10. 5% (n=33) cases were severe asphyxia. The mean one-minute Apgar score was the lowest in county-level hospitals (5. 40±1.56), followed by provincial-level hospitals (5.63 ±1.67)and prefecture-level hospitals (6.03 ± 1.41). (2) Resuscitation was not performed according to the guidelines in 47. 9% (151/315) of asphyxia cases. Bag and mask ventilation was not performed according to guideline in 36. 5% (115/315) of cases. (3) Changes of asphyxia incidence after the intervention: the incidence of asphyxia in provincial-level (4.23 % vs 2.66 %, χ2 = 5. 021, P＜0.05)and prefecture-level (2.83% vs 1.67%, χ2 = 4. 948, P＜0.05) hospitals decreased significantly after the intervention. The incidence of severe asphyxia in both provincial-level (χ2 =3. 001, P＞0.05) and prefecture-level (χ2= 0. 966, P＞ 0. 05) hospitals decreased with no statistical significance. The asphyxia incidence in county-level hospitals decreased from 2. 48% to 1. 22% (χ2 = 2. 989, P =0. 084). The incidence of severe asphyxia in county-level hospitals decreased from 0.39% to 0. 00%(χ2=2. 567, P= 0. 035). Conclusions Setting up a hospital-based neonatal resuscitation leading group is an effective method to strengthen resuscitation practice training, promote the cooperation between departments, improve the level of neonatal resuscitation practice and therefore decrease the incidence of neonatal asphyxia in the hospital.     

Evaluation of the effectiveness of the standardized neonatal resuscitation program.

OBJECTIVE: To determine if health care personnel trained in the Neonatal Resuscitation Program (NRP) used the NRP guidelines in the resuscitation of newborn babies. To determine differences between self-reporting and documentation of resuscitation in medical records. STUDY DESIGN: Using a validated questionnaire, individuals participating in resuscitation of newborns voluntarily phoned and answered questions on an Interactive Voice Response (IVR) system. The study was undertaken in level II hospitals in Southern Alberta with 7500 deliveries per year. RESULTS: Of the 5155 babies delivered during the study, 16% required resuscitation (bag and mask ventilation 10.6%, intubation for meconium or intermittent positive pressure ventilation, IPPV, 3.6%, cardiac massage, CM, 0.3%, epinephrine 0.1%, naloxone 6.9%). Of babies whose interventions could be assessed, bag and mask was correct in 99%, endotracheal intubation for IPPV in 100%, and CM in 100%. Only 75% of babies had meconium managed correctly and 92% had naloxone administered according to guidelines. There were more instances where IVR (48) reported a procedure, which was not charted versus charted and not reported by IVR (21). Educational needs identified by IVR included skills of resuscitation and NRP indications for management. CONCLUSION: Bag and mask ventilation and intubation for neonatal resuscitation are more common than previously reported. Management of the meconium-stained baby and use of naloxone require further education. Compared to charts, use of IVR system allows more complete documentation with rationale of interventions and identification of continuing educational needs.     

Determining the contribution of asphyxia to brain damage in the neonate

Studies in the research laboratory have demonstrated the complex relationship between fetal and newborn asphyxia and brain damage, a balance between the degree, duration and nature of the asphyxia and the quality of the cardiovascular compensatory response. Clinical studies would support the contention that the human fetus and newborn behave in a similar manner. An accurate diagnosis of asphyxia requires a blood gas and acid base assessment. The clinical classification of fetal asphyxia is based on a measure of metabolic acidosis to confirm that fetal asphyxia has occurred and the expression of neonatal encephalopathy and other organ system complications to express the severity of the asphyxia. The prevalence of fetal asphyxia at delivery is at term, 25 per 1000 live births of whom 15% are moderate or severe; and in the preterm, 73 per 1000 live births of whom 50% are moderate or severe. It remains to be determined how often the asphyxia recognized at delivery may have been present before the onset of labor. There is a growing body of indirect and direct evidence to support the contention that antepartum fetal asphyxia is important in the occurrence of brain damage. Although much of the brain damage observed in the newborn reflects events that occurred before delivery, newborn asphyxia and hypotension, particularly in the preterm newborn, may contribute to the brain damage accounting for deficits in surviving children.     

中国新生儿复苏指南(2021年修订)

新生儿复苏是帮助和保障新生儿出生时平稳过渡的重要生命支持技术。随着临床实践及科学研究的不断进展,一些复苏操作要点及证据在不断更新。中国新生儿复苏项目专家组联合中华医学会围产医学分会新生儿复苏学组,在2020年国际新生儿复苏指南基础上,结合中国国情,修订中国新生儿复苏指南,以规范新生儿复苏,降低新生儿窒息发生率和死亡率。     

Antenatal antecedents of moderate or severe neonatal encephalopathy in term infants--a regional review

BACKGROUND: Regional audits of term infants with neonatal encephalopathy (NE) provide an opportunity to examine issues related to causation and quality of care. AIM: To document antenatal and intrapartum antecedents in a contemporary cohort of term infants with moderate or severe neonatal encephalopathy. METHODS: Term infants admitted with moderate-severe neonatal encephalopathy over 4 years were identified. The clinical records were reviewed for information about the pregnancy and birth including interpretation of monitoring and subsequent management of the labour and delivery. RESULTS: Fifty-two maternal records were reviewed. No mothers were diabetic or had gestations > 42 weeks, but 17% of the babies were small for gestational age (SGA). The cohort had evidence of antenatal hypoxia in 15%, a sentinel event in 25% and suboptimal fetal monitoring practice in at least 42% of cases. CONCLUSIONS: Peripartum events were the major contributors to neurological damage in infants with neonatal encephalopathy. Suboptimal fetal monitoring practice and sentinel events remain the most common contributors. Ongoing education and training to address these issues should be available to all involved with intrapartum care in New Zealand.     

Demographic characteristics and clinical course in infants with moderate or severe neonatal encephalopathy

A chart review of 64 infants with moderate or severe neonatal encephalopathy showed that resuscitation was required for 61 (95%), respiratory support for 53 (83%) and anticonvulsants for 58 (91%). Death occurred in 2 (4%) infants with moderate encephalopathy and 12 (86%) with severe encephalopathy. In addition, subsequent neurodevelopment was abnormal in approximately a quarter of infants who survived after a moderate to severe encephalopathy.     

中国新生儿复苏指南循证依据及推荐建议的解读

中国新生儿复苏指南(2021年修订)中的推荐意见,既有更新,也有对原有推荐意见的证据更新或重申。本文就更新要点或重要证据的更新或重申做进一步说明,以期正确理解指南和指导培训,实施规范和高效的复苏技术和步骤,改善新生儿结局。     

新生儿败血症早期诊断方法探讨

目的 通过比较不同指标在新生儿败血症诊断中的价值,探讨临床医生如何综合利用临床及实验室资料,进行新生儿败血症的早期快速诊断.方法 对2007年9月至2008年2月间所有入住新生儿病房的患儿,常规监测临床表现和实验室指标,详细记录患儿围产期情况、感染发生时间、临床表现及实验室指标.根据诊断分为败血症组(13例)、非败血症感染组(12例)和非感染对照组(12例).资料统计整理后,对各组数据应用灵敏度、特异度、误诊率、漏诊率、正确率、正确诊断指数(Youden指数)、阳性预测值、阴性预测值及ROC曲线等指标进行综合评价. 结果对于新生儿败血症的诊断:(1)临床表现中反应异常诊断价值最佳,正确诊断指数67.9%.(2)SIRS标准特异性高达95.8%,对诊断有重要参考价值.(3)常规实验室检查白细胞(WBC)、血小板(PLT)、血糖(GLU),其敏感性和特异性均不理想;I/T比有较高的特异性,但存在相当大的观察者差异.(4)C反应蛋白(CPR)、降钙素原(PCT)诊断新生儿败血症的ROC曲线下面积分别为0.734、0.878,最佳临界值分别为15 mg/L、0.81 ng/ml,P值分别为0.020、0.000,有统计学意义;正确诊断指数分别为45.5%、75.0%.结论 对临床表现的细心观察和重视,可有效发现感染败血症的患儿.对有临床表现异常的患儿,尽快完善SIRS标准评估,特异性高.常规实验室指标WBC、I/T、PLT,可作为对高危患儿经济简便的监测指标.CRP、PCT对新生儿败血症诊断有显著意义.     

河北省儿童医院新生儿呼吸衰竭的临床流行病学特点

目的 探讨本院新生儿重症监护病房中新生儿呼吸衰竭(neonatal respiratory failure,NRF)的发生及治疗情况. 方法 对2008年1月1日至12月31日间本院NICU诊断的626例NRF患儿进行回顾性资料收集及统计分析,了解NRF的发生、救治状况、病死高危因素及疾病负担,并采用卡方检验与其他研究结果进行比较. 结果 在连续12个月间,NRF患儿626例,占本院同期新生儿重症监护病房收治患儿的38.9％(626/1608),总的院内病死率为22.5％(141/626),其中放弃治疗的比例占95.0％(134/141),病死率较2004年至2005年(37.2％,113/304)有所下降,且低于同期全国性研究(24.7％,1683/6864).肺炎/败血症(34.8％,218/626)、新生儿呼吸窘迫综合征(31.6％,198/626)、胎粪吸入综合征(10.7％,67/626)等是NRF的首要原发疾病,肺炎/败血症(5.4％,34/626)、颅内出血(4.6％,29/626)、持续性肺动脉高压(3.2％,20/626)等是主要院内并发症.本院NRF患儿的肺表面活性物质应用率显著提高,由2004年至2005年的14.1％(43/304)上升至23.6％(149/626),接近国内平均水平(26.8％,1840/6864).70.2％(139/198)的新生儿呼吸窘迫综合征患儿接受了肺表面活性物质治疗,12.1％(24/198)应用了气管插管-肺表面活性物质-拔管使用持续气道正压通气技术.2.7％(17/626)的患儿接受了一氧化氮吸入治疗.经鼻持续气道正压通气使用率由2004年至2005年的47.1％(143/304)上升至76.5％(479/626),常频通气由72.7％(221/304)下降至49.8％(312/626),高频通气由0.7％(2/304)上升至10.5％(66/626),各种辅助通气构成变化与全国性研究结果一致.治愈和好转出院的480例患儿中,住院总天数平均为(15.1±4.0)d,住院总费用为(12752±5148)元. 结论 本院NRF的治疗规模、技术水平及救治手段均有很大发展,肺表面活性物质、经鼻持续气道正压通气和高频通气的使用率均有明显提高.新生儿呼吸衰竭的疾病负担仍很重.     

原发免疫性血小板减少症孕妇新生儿发生血小板减少症相关因素分析#br#

Objective?To investigate the maternal and neonatal outcomes of pregnancies with primary immune thrombocytopenia (ITP) and also to identify risk factors that predicts neonatal-thrombocytopenia (NT). Methods?This retrospective study was performed in a single academic center from October 2015 to December 2020. Pregnant women with ITP and their babies were included. Medical records of 111 neonates born from 105 mothers were analyzed. Results?A total of 41 (36.9%) of neonates were thrombocytopenic (<150×109/L) and in 21 (51.2%) platelet count was below 50×109/L, but none of them presented with severe bleeding. The lowest platelet count before and during pregnancy in NT group was lower than control group. However, there was no significant difference in maternal platelet count at the time of delivery and ITP history. Previous delivery history of NT had high predictive value for the possible occurrence of NT in this pregnancy (OR=8.070, 95% CI: 1.686~38.633). Conclusion?Neonates born to mothers with ITP have an increased tendency to develop thrombocytopenia, but the incidence of poor neonatal outcomes is extremely low. The occurrence of NT may be associated with the lowest platelet count before and during pregnancy in ITP pregnant women. The presence of an older sibling with neonatal thrombocytopenia may be a risk factor for neonatal thrombocytopenia in subsequent pregnancies.