加拿大三级医疗中心新生儿的临终关怀

当今新生儿的存活率在不断提高,危重症的诊断准确性也较以往有明显改善。但当新生儿基本或完全治疗无望时,其诊疗重心应由积极监护治疗转为临终关怀舒缓治疗。医疗团队需尽早与家长进行多方面沟通,以便对临终关怀达成共识。在某些情况下,一味地延长生命反而会增加患儿的痛苦,并导致家长怀有不切实际的期望。目前国际上临终关怀的相关指南存在一些漏洞且较为空泛,缺乏可操作性,不同医院的实践之间也存在很大差异。很多研究指出新生儿临终关怀实践中,患儿家属、医疗团队、社工以及医院伦理委员会的参与度不足,对多方的意见不够重视,较难在很多问题上达成共识。未来的新生儿临终关怀应当更加注重多方共同决策,尤其提高患儿家长的参与度,并且避免简单地根据胎龄而做出是否临终关怀的决定。本研究由加拿大萨斯喀彻温大学伦理委员会审核批准,对萨斯喀彻温大学医学院儿科学系新生儿重症监护病房2008~2012年5年时间内接受临终关怀并最终离世的新生儿的相关病历资料进行了回顾分析,也纳入同时期内围产期死亡及婴儿期死亡的临终关怀病例。萨斯喀彻温大学皇家大学医院新生儿科的临终关怀指南在上世纪90年代初制定,并在2000年修订,主要包括以下内容:(1)客观评估并确认患儿的诊断,判断其疾患是否属于基本或完全治疗无望(如Ⅳ级脑室内出血、不可逆的多器官功能衰竭、极难存活的极早早产儿、严重且不可逆的脑损伤、多发的严重先天畸形、罕见的遗传代谢疾病以及染色体疾病等)。(2)高年资新生儿科医师审核诊断,并评估临终关怀是否恰当。(3)在确认后,第一时间与患儿家属沟通临终关怀的相关情况。(4)患儿的主治医生与床旁护士一同正式地与家属交流讨论,并解释病情。第一次交流主要侧重于患儿当前的情况,强调目前的重症监护并未对患儿有任何帮助,并告诉家属他们可能的选择有哪些。在第一次交流时,与家属预约好第二次交流的时间。(5)及时开具医嘱并记录病程。(6)邀请新生儿父母或长辈所信仰宗教的高级神职人员参与讨论。在患儿离世后8~12周内,邀请患儿家属回医院参加半结构式访谈,由新生儿科医师解答家属的疑惑和问题。并在访谈结束时,询问家属对医院相关工作是否有意见或建议。一名临终关怀专职联络护士将跟进安排后续的回访会议,并提供丧葬服务帮助。其他服务还包括一个回访电话和一次家访,如有需要还可帮助预约医院教堂及祷告仪式。如果患儿的母亲是单亲妈妈,如果妈妈愿意,祖父母也会被邀请。联络护士会全程记录下相关的交流会议、回访及反馈的情况,并与新生儿科医师共享这些信息。共40名婴儿纳入本研究,其中30名符合入组条件(男性16名,女性14名),胎龄最小的为22周,最大的为41周。结果80%纳入本研究的病例,临终关怀是由医疗团队在与家属的沟通中主动提出。此外由医患双方共同考虑并提出的占17%,仅1位患儿(3%)的临终关怀是由家属提出。本研究观察到整个临终关怀的过程中,需要医患双方的沟通会议从1次到30次不等,平均每个病例需要7次沟通。排除一个需要30次沟通的特殊案例,每个病例临终关怀的平均沟通会议次数为4次。这个数据此前并未有报道过,有重要的参考意义,可以指导未来的人力资源配置以及新指南的编写。总的来说,单亲、原住民以及天主教家长所需要的沟通次数是其他家长的两倍左右。不同种族和宗教信仰的家庭,在处理临终关怀上也不尽相同。这显示了种族、民族以及宗教信仰在临终关怀问题上的敏感性,需要谨慎处理。在未来临终关怀的教育中,应当设立针对不同文化背景的特殊培训。本研究中大部分接受临终关怀的新生儿患有多发的先天畸形或罕见的遗传代谢疾病。由于出色的产前筛查系统,会诊咨询团队很多时候在产前就已经与家属开始交流沟通了。这样的咨询团队由新生儿科医师、遗传学医师、临终关怀专家、小儿心脏内科医师以及社工等多专业背景的优秀成员共同组成。在常规的会诊制度外,有针对性的继续教育培训,并开展常规的围产医学查房也十分有帮助。本研究中37%的病例是在产前就已经和家属充分沟通,患儿自出生开始就直接接受了临终关怀。57%的患儿最后在新生儿科或儿科重症监护室离世,30%的孩子在产房离世,10%的孩子在家中离世。家长们都十分关心临终关怀的孩子是否会受到病痛的煎熬,我们通常都尽早开始舒缓治疗,可静脉使用吗啡或芬太尼,或口服选用对乙酰氨基酚或水合氯醛。50%的家庭通过联络护士安排了丧葬事宜,所有的家属在回访中均对临终关怀专职联络护士给予的帮助表示感谢。绝大部分家属对在院内临终关怀的相关流程表示满意,占总受访家庭数的90%,他们中很多人带着礼物回访了新生儿病房。10%的家庭认为我们目前的临终关怀工作可以做得更好,比如有的家长认为在周末休息时间与医师的交流不如工作日方便。我们在收到这项建议后,马上就进行了改正安排。富有同情心的专职联络护士对临终关怀工作的开展至关重要。她(他)可以确保医患间沟通渠道的高效畅通,可以解答家属的基本问题,可以跟进进一步的检验或检查,提供丧葬服务的帮助,并且接受家属对临终关怀的反馈。另外需要特别指出的是,每个家庭都对在临终关怀期间可以有一个私密的病房空间表示感谢。优质的临终关怀不仅需要人力资源的投入,也需要病房有足够的物理空间。本研究小组认为本中心的临终关怀工作流程注重细节且高效,但我们的经验来自西方文化体系,是一项回顾性的单中心研究,并不一定适合全球其他地区。     

Palliative care for the newborn in the United Kingdom

Palliative care for the newborn is a developing area. There are more than 2000 estimated neonatal deaths each year in the UK from causes likely to benefit from palliative care. There is an increasing recognition that while the goals of care may be different for dying newborns, they deserve the same high standard of care as those babies who go on to survive. Recent neonatal palliative care guidance is available from the British Association for Perinatal Medicine (BAPM), the General Medical Council (GMC), and ACT (the UK association for children's palliative care). We attempt to answer the question: ‘What does the provision of good neonatal palliative care look like?’ by examining the factors important in the provision of such care.     

儿童舒缓治疗的意义和发展现状

儿童舒缓治疗是对患有危及生命疾病的儿童提供身体、心理和精神等全方面的照顾,同时给予家庭支持,旨在为儿童及其家庭提供最佳的生活质量。我国儿童人口基数庞大,不断增加的舒缓治疗服务需求与相关服务资源的发展不足是我国儿童舒缓治疗领域面临的两大现实问题。该文就儿童舒缓治疗的实施和发展现状等进行了综述,为国内开展儿童舒缓治疗相关工作及研究提供参考。     

Palliative and end‐of‐life care in pediatric solid organ transplantation

End‐of‐life care is a component of palliative care and takes a holistic, individualized approach to patients, focusing on the assessment of quality of life and its maintenance until the end of life, and beyond, for the patient's family. Transplant teams do not always make timely referrals to palliative care teams due to various clinician and perceived family barriers, an important one being the simultaneous, active care plan each patient would have alongside an end‐of‐life plan. Application of findings and further research specific to the pediatric solid organ population would be of significant benefit to guide transplant teams as to the most effective time to introduce end‐of‐life care, who to involve in ongoing discussions, and important ethical and cultural considerations to include in care planning. Attention must also be paid to clinician training and support in this challenging area of health care.     

Palliative care situation in Palestinian Authority

Palliative care is a very new concept in Palestine. In fact, it is still not applicable or provided within the Palestinian health care system. However, Al-Sadeel Society had organized a one day workshop in Bethlehem on November 2008 for the health professionals from the governmental and non-governmental sectors to initiate and introduce the idea of palliative care for the first time in Palestine. The general population of Palestine is approximately 2.4 millions (2007), with a life expectancy of 74.3 years of age, the death rate is 3.7 per 1000 population, having 8,910 deaths a year. Deaths due to cancer were 2,305 in five years (1999-2003), where 5,542 new cases were newly diagnosed in the same period. Health services available for cancer patients are hospital units either in patient or day care units. According to the ministry of health (MOH) statistics there are 75 beds in oncology departments in MOH hospitals; represent 2.7% of the total number of beds available, and 60 beds in daily care departments with an occupancy rate at 231.8%. There is no hospice or bereavement follow up care available for patients or their families. Despite the fact that the Palestinian culture is one of the cultures that respect and care for the elderly, but at the end of life, when the load of symptoms is high, most of the patient are care for at hospitals, and usually dye there, because the families are not able to care for their patients, and as there is no system for home care available for the Palestinian patients, and if it is available it is available in limited places and on private bases that are expensive and not affordable to the majority of patients, gross domestic product (GPD) per capita= 1,100 as 2007 estimates). We conducted a needs assessment survey within the only four facilities that provide care for the oncology patients in the West Bank and were filled by the direct health care providers. The results were expressing the fact that there is no palliative care service available for cancer patients or their families, absence of organizations strategic planning for palliative care, No presence of educational resources for palliative care, No presence of communication or consultation to the clergy man, Absence of bereavement support group, no active follow up for the patient and the family, no standards for palliative care service or training programs in palliative care, no home care service for palliative care, absence of community awareness for palliative care And Absence of national standard for palliative care. The recommendations that we can conclude, depending on the needs assessment that we did, and according to the recommendations that come up through the workshop that was organized by Al-Sadeel Society and was attended by key personnel from the Palestinian MOH who summarized the conclusion, are as follows: 1.?The need for better quality care for the cancer patient.2.?The need for training of health professionals in palliative care.3.?The importance of networking and cooperation between the national NGO's and the MOH.4.?The need for public awareness regarding the early detection for cancer especially breast cancer.5.?The need for national policy and standards for palliative care and opioids legislations.6.?The importance of base line data and research. 7.?The need for interdisciplinary team work in the issue of cancer. 8.?To involve palliative care education within the curriculum of schools of health professions.     

Utilization of palliative care consultations in pediatric oncology phase I clinical trials

Pediatric phase I clinical oncology trials represent a unique cohort of patients who have not responded to standard therapies and remain highly vulnerable to treatment toxicity and/or disease burden. Incorporating a palliative care consultation into the care plan for those with relapsed/refractory cancer where chance of cure is limited is generally recommended. A retrospective chart review of pediatric phase I trials revealed that palliative care was consulted in <20% of patients, most often for symptom management. Efforts to increase the use of palliative services in this population may enhance quality of life for children and families enrolled in phase I studies.     

The National Palliative Care Research Center and the Center to Advance Palliative Care: a partnership to improve care for persons with serious illness and their families

The elimination of suffering and the cure of disease are the fundamental goals of medicine. While medical advances have transformed previously fatal conditions such as cancer and heart disease into illnesses that people can live with for many years, they have not been accompanied by corresponding improvements in the quality of life for these patients and their families. Living with a serious illness should not mean living in pain or experiencing symptoms like shortness of breath, nausea, or fatigue. Yet, multiple studies over the past decade suggest that medical care for patients with advanced illness is characterized by inadequately treated physical distress; fragmented care systems; poor communication between doctors, patients, and families; and enormous strains on family caregiver and support systems. Palliative care is interdisciplinary care focused on relief of pain and other symptoms and support for best possible quality of life for patients with serious illness, and their families. It is appropriate at the point of diagnosis of a serious illness. It goes beyond hospice care to offer patients and their families treatments focused on improving quality of life while they are receiving life-prolonging and curative treatments. Palliative care programs have been shown to reduce symptoms, improve doctor-patient-family communication and satisfaction with care, as well as enhance the efficiency and effectiveness of hospital services. In the last 5 years alone the number of palliative care programs has more than doubled. This growth is in response to the increasing numbers and needs of Americans living with serious, complex and chronic illnesses, and the realities of the care responsibilities faced by their families. In order to ensure that all persons with serious illness and their families receive the quality of care they deserve, palliative care must become an integral part of the U.S. healthcare landscape. Specifically, persons facing serious illness and their families must know to request palliative care, medical professionals must have the knowledge and skills to provide palliative care, and hospitals and other healthcare institutions must be equipped to deliver and support palliative care services. The Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC) are accomplishing this three-part mission by working in partnership to: 1) Develop research to serve as the knowledge base for quality clinical care and the foundation on which to build palliative care programs and systems; 2) Disseminate this knowledge to patients, families, professionals, and institutions throughout the United States and ensure that it is integrated within mainstream healthcare; and 3) Influence and collaborate with policy makers , regulatory bodies, and federal funding agencies to ensure that the healthcare infrastructure supports the continued growth and development of palliative care.     

Pediatric patients receiving palliative care in Canada: results of a multicenter review

OBJECTIVES: To describe the patients who received care from the 8 dedicated pediatric palliative care programs in Canada in 2002 and to estimate the number of children who may have benefited but did not receive services from these programs. DESIGN: Retrospective review of medical records combined with a survey of each program. SETTING: Seven pediatric palliative care programs based in tertiary care settings and 1 freestanding children's hospice. PARTICIPANTS: The programs cared for 317 children during 2002, of whom 123 died during that year. An additional 32 children died by the end of 2003. MAIN EXPOSURE: Pediatric palliative care program. RESULTS: Nearly half (48.6%) of the patients were younger than 5 years, and almost half of these were younger than 1 year. Primary diagnoses were disorders of the nervous system (39.1%), malignancies (22.1%), and conditions arising in the perinatal period or congenital anomalies (22.1%). Most of the children (43.9%) died at home, with those centers reporting more comprehensive home care services having the highest percentage of home deaths. From a national perspective, between 5% and 12% of the children who could benefit from palliative care received services from 1 of these programs. CONCLUSIONS: Pediatric palliative care programs in Canada care for a diverse population of patients with a wide range of age and disease conditions. Only a small percentage of children who die, however, receive services from these dedicated programs.     

Paediatric palliative care in the NICU: A new era of integration

We are entering a new era of integration between neonatal medicine and paediatric palliative care, with increasing recognition that the role and skills of palliative care extend beyond care of only the terminally ill infant. This paper addresses the principles of paediatric palliative care and how they apply in the NICU, considers who provides palliative care in this setting and outlines the key components of care. We consider how the international standards of palliative care pertain to neonatal medicine and how a fully integrated approach to care may be realised across these two disciplines.Palliative care is so much more than end-of-life care, offering a proactive and holistic approach which addresses the physical, emotional, spiritual and social needs of the infant and family. This is a truly interdisciplinary endeavour, relying on a harmonisation of the skills from both the neonatal and palliative care teams to deliver high-quality coordinated care.     

Allocation of health care resources in the neonatal and perinatal area �CCPS Symposium 1996

There have been publically expressed concerns about the costs and allocation of neonatal and perinatal health care resources in Canada and elsewhere for the past 15 years. This paper reports information from a symposium held during the 1996 Canadian Paediatric Society (CPS) annual meeting sponsored by the CPS Section on Perinatal Medicine. Experts in perinatal epidemiology, health care economics, public policy and finance, and consumer perspectives on the outcomes of neonatal and perinatal intensive care explored the following questions: How should the need for health care resources in the neonatal and perinatal area be objectively determined? When there are competing needs between the maternal-newborn area and other areas, how should these be rationalized? What evidence should be used (or should be available) to support the present use of resources? What evidence should be available (or is needed) to change or introduce new uses of resources? The conclusions indicated that there are no generally accepted methods to determine the allocation of health care resources but that considerations need to include population characteristics, desired outcomes, achievable results, values, ethics, legalities, cost-benefit analyses and political objectives. Information from families and adolescents who required the use of high technology and/or high cost programs will contribute individual, family and societal values that complement cost-efficacy analyses.     

Writing a good anticipatory care plan for a child with severe disability

There are increasing numbers of children with severe disability and life limiting conditions living longer in the community. In order for them to have high quality end of life care and choice of place of death there need to be discussions with the child and family about how the child may deteriorate and the pros and cons of the different possible interventions taking into account the priorities and views of the family and the child themselves. Families and professionals are reluctant to talk about the death of a child and there is always uncertainty. Parallel planning for best and worst case scenarios can be helpful and offering families a useful medical emergency care plan for their child is a positive way to start to plan for deterioration and life threatening events. The emergency care plan can include the resuscitation plan and the child and family priorities of care and leads on to further discussions about choices in end of life care including place of death and funeral plans.     

Early integration of pediatric palliative care: for some children, palliative care starts at diagnosis

PURPOSE OF REVIEW: Pediatric palliative care, with its emphasis on symptom management and quality of life, is an important aspect of care of children with life-threatening illnesses. We review recent publications with implications for care of these children. RECENT FINDINGS: Invasive and life-sustaining measures continue to be part of care for many children with life-threatening illnesses, even at the end of life. While these measures may seem reasonable when recovery is possible, they may not fit with a family's preferences for end-of-life care. One possible cause of the prevalence of invasive measures in children at the end of life is that complex illness trajectories in children make it difficult to predict the timing of death. Inadequate communication by clinicians can also lead to poor preparation for the end-of-life period. Early integration of palliative care allows for improved symptom management, parental adjustment, and preparation for the end-of-life care period. Families who have the opportunity to prepare for the end-of-life period, including learning what to expect, are more likely to feel that their care has been of high quality. Bereaved parents also recognize the value of talking about death with their children. SUMMARY: Early integration of palliative care can allow children and families to make decisions about care that fit with their values, and should become a standard of care for all children with life-threatening illnesses.     

End of life in neonatal medicine under the direction of French law]

Two recent laws have significantly reformed the French Public Health Code: the law of March 4th 2002, related to the patient's rights and the quality of the health care system and the law of April 22nd 2005, related to the patient's rights and the end of life. These changes have prompted health care professionals involved in perinatal and neonatal medicine to update their considerations on the ethical aspects of the end of life in neonatal medicine. Therefore, the authors examined the clauses of the law related to the patient's rights and to the end of life, confronting them with the distinctive features of neonatal medicine. In this paper, the medical practices, which are either prohibited or authorized in the course of end of life are considered: prohibition of euthanasia, authorization for alleviating pain at the risk of shortening life, authorization for restricting, withholding or withdrawing treatments. Next, the justifications provided by the legislation to authorize these practices are analysed: prohibition of unreasonable obstinacy and respect for individual wishes. Then, the conditions required by the law to determine and to implement these acts are discussed: consultation with the healthcare staff and justified advice from a consulting physician, consideration of parental opinion, registration of the decision and its justifications into the patient's medical file, protection of the dying patient's dignity and preservation of his life quality by providing palliative care. Lastly, we report the terms of the ethical dilemma which may occur in the area of neonatal medicine in spite of genuine and persevering efforts in order to conciliate legal requirement and ethical responsibility.     

The Madison Clinic: Evaluation of a collaborative outpatient paediatric palliative care clinic

BACKGROUND

A multidisciplinary outpatient clinic at a tertiary care children’s hospital supported and staffed by a children’s hospice was created to enhance and expand the inpatient palliative care services available to families of children with life-limiting conditions. This clinic was created with input from clinicians, program leaders and families in developing the goals and format.

METHOD

The clinic was evaluated with indicators that included program data from palliative care consultations. This information was collected and recorded on a prospective basis.

RESULTS

In the first 29 months of operation, 43 clinics were held, 39 individual patients were seen and there were 59 visits. The majority of visits were for pain and symptom management (75%), while 20% were for assessment for the hospice program. The hospice-palliative care team also provided telephone support, videoconference support and inpatient consultations. Patients reported overall satisfaction with their experiences at the clinic.

DISCUSSION

A major benefit of this outpatient palliative care clinic is its ability to offer continuity of care for patients and their families. It also serves as a preliminary introduction to palliative care, particularly significant for families who are not yet ready to learn about or engage in the full hospice program.     

The role of palliative care in advanced muscular dystrophy and spinal muscular atrophy

OBJECTIVE: This study examines the potential role for palliative care services in the care of individuals with muscular dystrophy and spinal muscular atrophy, and the support of their families. METHODOLOGY: Semistructured interviews were conducted in South Australia with nine bereaved and four current family members of individuals with muscular dystrophy or spinal muscular atrophy. Issues explored during interview included: (i) the family perceptions of the difficulties in caring; (ii) the psychological and physical resources which were available to assist them; and (iii) family recall of the management of the terminal phase of the illness. RESULTS: Significant issues identified included: (i) a lack of coordination of care and access to skilled, competent carers; (ii) a lack of support for siblings; (iii) inadequate bereavement care; and (iv) limited discussion of options of ventilatory support and advance directives. CONCLUSIONS: The terminal care for individuals with muscular dystrophy and spinal muscular atrophy and their families requires improvement. Although many individuals with these conditions will die following an acute event, palliative care services may be appropriate for those who require a period of terminal care at home.     

Symptomatic palliative care for children with neurodisability

Paediatric palliative care and neurodisability are two relatively new, evolving paediatric sub-specialities that have increasing relevance in the current paediatric landscape. For many people palliative care has been synonymous with end of life care, but in paediatrics it encompasses much more and is for all children with life-threatening or life-limiting conditions, from the point of diagnosis. This breadth of focus is demonstrated well through the interface between paediatric palliative care and paediatric neurodisability. In this article we explore this unique interface through the three domains of complex symptom management, advanced care planning and end of life care. We describe the practicalities involved in all three areas and highlight the importance of early referral and the process of “dual” or “parallel” planning. We cover in more depth the specific management of the symptoms: dystonia/abnormalities of muscle tone, seizures, pain, agitation, secretions, respiratory failure, and gut failure.     

Pediatric palliative care: a comprehensive model of care for children with life-threatening conditions and their families

The present article reviews aspects unique to pediatric palliative care: the attitudes of medical staff toward pediatric death and life-threatening conditions, distinct patterns of pediatric deaths, the causes of suffering in children with life-threatening conditions and their families, and the features that make palliative care a challenge for children, families, medical staff and society. Concepts of pediatric palliative care and various approaches are described. In addition, Universal Principles of Pediatric Palliative Care are presented. Special attention is paid to approaches that start palliative care at diagnosis of a life-threatening conditions, do not require a short-term life prognosis and do not exclude curative or life-prolonging therapies since these approaches can benefit both children who survive life-threatening conditions and those who die, as well as their families. The need for certain changes through education and research is proposed to improve the quality of life of children and families who currently suffer, satisfaction and cohesion among medical staff, and healthcare quality.     

Issues related to providing quality pediatric palliative care in the community

The medical practitioner in the community is in a unique position to assist children and their families from the time of diagnosis with a life-threatening condition through to the end of life. The purpose of this article is to inform medical practitioners who care for children with complex, chronic, and life-limiting conditions about pediatric palliative care in the community. It is intended as a guide to improve understanding about (1) the misconceptions and barriers surrounding the provision of care in the community for children with chronic, complex, and life-limiting conditions; (2) the availability of services for care in the community; (3) challenges concerning out-of hospital do-not-attempt-resuscitation orders for children; and (4) reimbursement issues that impact the provision of care.     

Evaluation of a pediatric palliative care educational workshop for oncology fellows

BACKGROUND: Recent efforts have focused on improving pediatric palliative care to relieve physical and psychological suffering throughout the course of illness, as well as to improve care at the end-of-life (EOL). One area of attention has been medical training, as healthcare providers have often reported feeling ill-equipped to manage EOL issues. As a pilot study, we developed and evaluated a daylong educational workshop on pediatric palliative care for oncology fellows. PROCEDURE: Fellows (N = 32) from 20 hospitals participated in one of two workshops covering palliative care topics, such as pain/symptom management, communication, ethics, and bereavement. Training, knowledge, behavior, and attitudes regarding pediatric palliative care were assessed before the workshop, and knowledge was re-assessed immediately afterwards. RESULTS: Fellows reported a general lack of training in EOL care, and only 41% rated their education as at least "somewhat" adequate. Colleagues and personal experience were more often sources on EOL care, rather than formal classes or textbooks. Although fellows reported open attitudes toward palliative care, such as involving adolescents in decision-making, only half felt comfortable in the presence of a dying person. Fewer than half felt comfortable providing EOL care, managing families' expectations, or knowledgeable enough to discuss hospice with patients/families. Following the workshop, knowledge of palliative care increased significantly from 75 to 85% correct. CONCLUSIONS: Fellows reported open beliefs about palliative care, but acknowledged weaknesses in their training and level of competence. The workshop showed efficacy in improving knowledge, but additional research is needed to evaluate larger educational initiatives and their long-term impact on clinical services and family satisfaction.     

Impact of training of traditional birth attendants on the newborn care

Objective  To study the impact of training of Traditional Birth Attendants (TBAs) on the Newborn care in resource poor setting in rural area. Methods  A community based study in the Primary Health Center (PHC) area was conducted over one year period between March 2006 to February 2007. The study participants were 50 Traditional Birth Attendants (TBAs)who conduct home deliveries in the PHC area. Training was conducted for two days which included topics on techniques of conducting safe delivery and newborn care practices. Pre-test evaluation regarding knowledge and practices about newborn care was done. Post-test evaluation was done at first month (early) and at fifth month (late) after the training. Analysis was done by using Mc. Nemer’s test, Chi- square test with Yates’s correction and Fischer’s exact test. Results  Pre-test evaluation showed that, knowledge and practices about newborn care services provided by the previously trained TBAs and untrained TBAs were poor. Early and late post-test evaluation showed that, there was a progressive improvement in the newborn care provided by both the groups. Preintervention period (one year prior to the training) and postintervention period (one year after the training) showed that, there was a statistically significant (p<0.05) reduction in the perinatal deaths (11 to 3) and neonatal deaths (10 to 2) among the deliveries conducted by TBAs after the training. Conclusion  Training programme for TBAs with regular reinforcements in the resource poor setting will not only improve the quality of newborn care but also reduces perinatal deaths.