通过质量提升项目改善NICU极低出生体重早产儿入院低体温的临床分析

doi:10.11852/zgetbjzz2019-1411

中国儿童保健杂志 ›› 2020, Vol. 28 ›› Issue (11): 1263-1266.DOI: 10.11852/zgetbjzz2019-1411

通过质量提升项目改善NICU极低出生体重早产儿入院低体温的临床分析

杨春燕¹, 申青华¹, 李丛¹, 刘凤敏¹, 马静², 许平¹, 杨巧芝¹, 宋晓岩³

1 聊城市人民医院儿科NICU,山东聊城 252000;
2 聊城市人民医院科研处,山东聊城 252000;
3 美国华盛顿国家儿童医学中心,华盛顿 20010

收稿日期:2019-11-11 修回日期:2020-01-30 发布日期:2020-11-10 出版日期:2020-11-10
通讯作者: 许平,E-mail:1686504672@qq.com
作者简介:杨春燕(1980-),女,山东人,副主任医师,研究生学历,主要研究方向为新生儿危重疾病。
基金资助:
山东省重点研发计划项目(2018GSF118173);山东省医药卫生科技发展计划项目(2017WS218);聊城市人民医院院级青年科研基金资助项目(LYQN201933)

Clinical analysis of improving hypothermia of premature infants in NICU by quality improvement program

YANG Chun-yan¹, SHEN Qing-hua¹, LI Cong¹, LIU Feng-min¹, MA Jing², XU Ping¹, YANG Qiao-zhi¹, SONG Xiao-yan³

1 Neonatal Intensive Care Unit,Shandong 252000,China;
2 Scientific Research Department,Liaocheng People's Hospital,Liaocheng,Shandong 252000,China;
3 Children's National Medical Center,Washington DC 20010,USA

Received:2019-11-11 Revised:2020-01-30 Online:2020-11-10 Published:2020-11-10
Contact: XU Ping,E-mail:1686504672@qq.com

摘要/Abstract

摘要： 目的分析质量提升项目(QI)方法对新生儿重症病房(NICU)极低出生体重早产儿的低体温发生率的影响,为改善早产儿临床结局提供依据。方法选取2017年1月1日-2019年1月31日出生后30 min内入住聊城市人民医院NICU的极低出生体重早产儿(胎龄＜32周和/或出生体重＜1 500 g)为研究对象,低体温的诊断标准为入院时肛温低于36.5℃。其中,2017年1月1日-12月31日收治的早产儿为对照组(128例),采用常规的体温管理措施;2018年2月1日-2019年1月31日为干预组(120例),通过QI采用综合性体温管理措施,对围生期相关情况、低体温、颅内出血和病死率等进行比较。结果干预组早产儿入院体温为(36.6±0.7)℃,明显高于对照组(35.9±0.8)℃(t=4.54,P＜0.01),低体温发生率从92.5%降低至40.5%,干预组早产儿入院后低血压(43.4%)、颅内出血发生率(43.3%)、肺表面活性物质的应用(26.1%)、脓毒血症发生率(24.0%)均显著低于对照组(29.5%、32.9%、65.6%、41.0%,χ²=3.56、5.99、7.56、12.15,P＜0.05)。结论以循证医学为依据的QI的实施可以显著降低极低出生体重早产儿入院时的体温过低,改善临床结局。

关键词: 质量提升项目, 低体温, 早产儿

Abstract: Objective To analyze the effect of quality improvement item (QI) on the incidence of hypothermia of very low birth weight premature infants in Neonatal Intensive Care Unit (NICU),in order to provide evidence for improving the clinical outcome of premature infants. Methods The very low birth weight premature infants (gestational age＜32 weeks and/or birth weight＜1 500 g) admitted to NICU in Liaocheng People's Hospital were enrolled in this study from 1st January,2017 to 31st January,2019.Infants whose annal temperature was lower than 36.5℃ were diagnosed with hypothermia.Infants admitted in this hospital from 1st January,2017 to 31st December,2017 were enrolled in control group(n=128),and received typical measures controlling temperature.And infants admitted in this hospital from 1st February,2018 to 31st January,2019 were selected as intervention group(n=120),whose temperature was administered through quality improvement program.The rates of prenatal conditions,hypothermia,intraventricular hemorrhage and morbidity were compared between the two groups. Results The rate of hypothermia in very low birth weight premature infants decreased from 92.5% to 40.5% during the intervention period,and the temperature of intervention group at admission was significantly higher than that of control group[(36.6±0.7) ℃ vs.(35.9±0.8)℃,t=4.54,P＜0.01)].The incidence of hypotension(43.4%) and intracranial hemorrhage(43.3%),the application of pulmonary surfactant (26.1%) and the incidence of sepsis(24.0%)in intervention group were significantly lower than those in control group (29.5%,32.9%,65.6%,41.0%,χ²=3.56,5.99,7.56,12.15,P＜0.05). Conclusion The implementation of quality improvement program based on evidence-based medicine can significantly reduce hypothermia of very low birth weight premature infants at admission and improve their clinical outcomes.

Key words: quality improvement, hypothermia, premature infants

中图分类号:

R722.6

杨春燕, 申青华, 李丛, 刘凤敏, 马静, 许平, 杨巧芝, 宋晓岩. 通过质量提升项目改善NICU极低出生体重早产儿入院低体温的临床分析[J]. 中国儿童保健杂志, 2020, 28(11): 1263-1266.

YANG Chun-yan, SHEN Qing-hua, LI Cong, LIU Feng-min, MA Jing, XU Ping, YANG Qiao-zhi, SONG Xiao-yan. Clinical analysis of improving hypothermia of premature infants in NICU by quality improvement program[J]. journal1, 2020, 28(11): 1263-1266.

参考文献

[1] De Almeida MF,Guinsburg R,Sancho GA,et al.Hypothermia and early neonatal mortality in preterm infants[J].J Pediatr,2014,164(2):271-275.
[2] Fatsman BR,Howell EA,Holzman I,et al.Current perspective on temperature management and hypothermia in low birth weight infants[J].J Newborn Infant Nurs,2014,14(3):50-55.
[3] De Siqueira Caldas JP,Ferri WAG,Marba STM,et al.Admission hypothermia,neonatal morbidity,and mortality:evaluation of a multicenter cohort of very low birth weight preterm infants according to relative performance of the center[J].Eur J Pediatr,2019,178(7):1023-1032.
[4] Pinheiro JM,Boynton S,Furdon SA,et al.Use of chemical warming packs during delivery room resuscitation is associated with decreased rates of hypothermia in very lowbirth-weight neonates[J].Adv Neonatal Care,2011,11(5):357-362.
[5] Bhatt DR,White R,Martin G,et al.Transitional hypothermia in preterm newborns[J].Adv Neonatal Care,2010,10(Suppl 5):15-17.
[6] Pinheiro JM,Furdon SA,Boynton S,et al.Decreasing hypothermia during delivery room stabilization of preterm neonates[J].Pediatrics,2014,133(1):e218-e226.
[7] Perlman JM,Wyllie J,Kattwinkel J,et al.Neonatal Resuscitation Chapter Collaborators.Part 7:Neonatal Resuscitation.2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations[J].Circulation,2015,132(16 Suppl 1):204-241.
[8] Cramer K,Wiebe N,Hartling L,et al.Heat loss prevention:a systematic review of occlusive skin wrap for premature neonates[J].J Perinatol,2005,25(12):763-769.
[9] Brown A.Applying the care group model to tuberculosis control:findings from a community-based project in Mozambique[J].Int J Tuber Lung Dis,2017,21(10):1086-1093.
[10] Yip WY,Quek BH,Fong MCW,et al.A quality improvement project to reduce hypothermia in preterm infants on admission to the neonatal intensive care unit[J].Int J Qual Health Care,2017,29(7):922-928.
[11] Reilly MC,Vohra S,Rac VE,et al.Randomized trial of occlusive wrap for heat loss prevention in preterm infants[J].J Pediatr,2015,166(2):262-268.
[12] Singh A,Duckett J,Newton T,et al.Improving neonatal unit admission temperatures in preterm babies:exothermic mattresses,polythene bags or a traditional approach?[J].J Perinatol,2010,30(1):45-49.
[13] Lee HC,Ho QT,Rhine WD.A quality improvement project to improve admission temperatures in very low birth weight infants[J].J Perinatol,2008,28(11):754-758.
[14] Lyu Y,Shah PS,Ye XY,et al.Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks' gestation[J].JAMA Pediatr,2015,169(4):e150277.
[15] Drassinower D,Friedman AM,Obi an SG,et al.Prolonged latency of preterm premature rupture of membranes and risk of neonatal sepsis[J].Am J Obstet Gynecol,2016,214(6):743.e1-e6.
[16] Miller SS,Lee HC,Gould JB.Hypothermia in very low birth weight infants:distribution,risk factors and outcomes[J].J Perinatol,2011,31 (Suppl 1):49-56.
[17] Billimoria Z,Chawla S,Bajaj M,et al.Improving admission temperature in extremely low birth weight infants:a hospital-based multiintervention quality improvement project[J].J Perinat Med,2013,41(4):455-460.

通过质量提升项目改善NICU极低出生体重早产儿入院低体温的临床分析

Clinical analysis of improving hypothermia of premature infants in NICU by quality improvement program

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

[1]	谢海霞, 罗洪霞, 刘海霞, 邵琴楠, 冯国隽, 文亚兰. 组织学绒毛膜羊膜炎对早产儿并发症及1岁时神经发育的影响[J]. 中国儿童保健杂志, 2024, 32(9): 947-952.
[2]	王银妃, 殷勤, 曾思洁, 孙蕾, 严琴慧, 盛晓静. 早产儿和足月儿母乳外泌体miRNA差异表达的研究[J]. 中国儿童保健杂志, 2024, 32(4): 377-383.
[3]	于晗澍, 孙瑞珍, 杨燕玲, 苏月华, 付中英. 深度水解蛋白配方奶治疗早产儿喂养不耐受的效果分析[J]. 中国儿童保健杂志, 2024, 32(4): 456-459.
[4]	王晓康, 梁翼飞, 朱艳萍. 胎龄≤34周早产儿视网膜病的发病情况及相关危险因素分析[J]. 中国儿童保健杂志, 2024, 32(2): 187-190.
[5]	陈蝶, 彭文涛, 唐孟言, 刘孝美. 转乳期早产儿喂养困难现状及其影响因素[J]. 中国儿童保健杂志, 2024, 32(1): 21-25.
[6]	宁月, 罗丽艳, 段江, 谢云波, 齐志业, 张彩营, 杨丽, 钟庆华. 不同强化喂养方式对早产极低出生体重儿营养代谢及生长速率的影响[J]. 中国儿童保健杂志, 2024, 32(1): 84-88.
[7]	张丹, 张军, 杨钰荣, 曹咪, 闫敬敏, 朱璐阳. 肠道菌群与早产儿脑发育及神经认知行为关系的研究[J]. 中国儿童保健杂志, 2023, 31(7): 756-759.
[8]	冯骁, 陈凌, 赵红缨, 黄蕊, 林辰曦, 庄丽娟. 不同脐带挤压方式对极早产儿结局的影响[J]. 中国儿童保健杂志, 2023, 31(7): 794-798.
[9]	郑亭玉, 张春宇, 杨飞, 郑芳, 张梦霞, 夏露萍, 徐孙超. 营养支持小组管理模式对早产儿生长发育及免疫功能的影响[J]. 中国儿童保健杂志, 2023, 31(5): 555-558.
[10]	夏正龙, 宋燕燕. 支气管肺发育不良早产儿神经发育研究[J]. 中国儿童保健杂志, 2023, 31(4): 390-394.
[11]	李静兰, 孙文强, 朱雪萍. 早产儿支气管肺发育不良相关预测模型研究[J]. 中国儿童保健杂志, 2023, 31(4): 395-398.
[12]	王娜, 李晓莺. 早产儿神经发育评估的进展[J]. 中国儿童保健杂志, 2023, 31(4): 404-407.
[13]	任力, 黑明燕, 齐宇洁, 靳绯, 翁景文, 董世霄, 沈艳华, 姜敏. 早产儿喂养对坏死性小肠结肠炎发病的影响[J]. 中国儿童保健杂志, 2023, 31(4): 438-441.
[14]	陈峰, 张宇. 多胞胎和单胞胎早产儿神经发育的回顾性研究[J]. 中国儿童保健杂志, 2023, 31(4): 451-456.
[15]	王晶, 项思嘉, 鲁莹, 杨蕾, 胡小沙, 钱君, 池霞, 张敏. 早产儿3周岁体格生长及体成分分析[J]. 中国儿童保健杂志, 2023, 31(4): 457-460.