江苏省28家医院胎龄<32周早产儿早期稳定管理状况调查

A survey of early management strategy for premature infants with gestational age<32w in 28 hospitals of Jiangsu province

目的调查江苏省三级妇幼保健院和综合性医院胎龄<32周早产儿早期稳定管理方案,为胎龄<32周早产儿早期稳定管理质量改进提供依据。方法采用问卷调查方式,在2021年11~12月向江苏省新生儿复苏临床研究协作组内同时设有产科和新生儿科的三级医院新生儿重症监护室负责人发放并回收问卷,根据收回的问卷分析胎龄<32周早产儿早期稳定管理状况。结果共发放问卷32份,回收28份(87.5%)。结果如下:(1)围产期管理:28家医院中26家(92.9%)成立了新生儿复苏团队,22家(78.6%)制定了早产儿复苏流程。(2)复苏设备配置:产房复苏中,28家(100%)医院均配备脉搏氧饱和度监测仪,24家(85.7%)配备T组合复苏器,21家(75.0%)配备心电监测仪,19家(67.9%)配备空氧混合仪,14家(50.0%)配备气体温湿化仪;院内转运时,13家(46.4%)医院使用暖箱,10家(35.7%)医护直接抱入,5家(17.9%)使用婴儿床,15家(53.6%)配备T组合复苏器/呼吸机,5家(17.9%)配备空氧混合仪,4家(14.3%)配备气体温湿化仪。(3)产房复苏实施:28家(100%)医院均开展脐带延迟结扎,26家(92.9%)使用聚乙烯膜包裹新生儿进行保暖,23家(82.1%)常规监测脉搏氧饱和度,18家(64.3%)以≤30%的氧浓度开始复苏,15家(53.6%)常规使用T组合复苏器或类似设备进行正压通气,2家(7.1%)常规使用心电监测仪。(4)复苏后管理:27家(96.4%)医院对需要肺表面活性物质治疗的早产儿在其进入新生儿重症监护室后给药;23家(82.1%)对无创通气的早产儿开展低侵入性肺表面活性物质使用技术;24家(85.7%)预防性使用咖啡因;27家(96.4%)在脐静脉置管前进行外周静脉置管,并及时给予静脉输注葡萄糖和营养液。结论江苏省28家三级医院基本遵循新生儿复苏指南和现有循证依据进行胎龄<32周早产儿早期稳定管理,但产房和院内转运过程中的设备配置仍不足,早期处理细节及质量仍有待提高。

Objective To study the early management strategy for premature infants with gestational age(GA)<32w in tertiary women and children hospitals and general hospitals in Jiangsu province and to provide evidence for the quality improvement of early stabilization for premature infants.Methods From November to December 2021,questionnaires were sent and collected to the directors of NICUs from Jiangsu Multicenter Study Collaborative Group for Neonatal Resuscitation.The early stabilization management strategy of premature infants<32w was analyzed using the collected questionnaires.Results A total of 32 questionnaires were sent and 28 were collected.The results were as follows:(1)Perinatal management:26 of the 28 hospitals(92.9%)set up neonatal resuscitation teams and 22(78.6%)developed premature infant resuscitation protocols.(2)Resuscitation equipment:during the delivery room resuscitation,28(100%)hospitals were equipped with pulse oxygen saturation monitors,24(85.7%)were equipped with T-piece resuscitators,21(75.0%)were equipped with ECG monitors,19(67.9%)were equipped with air/oxygen blenders and 14(50.0%)were equipped with heated humidifiers.During intrahospital transport,neonates were carried directly to NICU in 10(35.7%)hospitals.13(46.4%)hospitals were equipped with incubators,15(53.6%)were equipped with T-piece resuscitators,5(17.9%)were equipped with air/oxygen blenders and 4(14.3%)were equipped with heated humidifiers.(3)Delivery room resuscitation:all NICUs practiced delayed cord clamping(DCC);26(92.9%)used polyethylene wrap for thermoregulation;23(82.1%)routinely monitored pulse oximetry;18(64.3%)initiated resuscitation with FiO2≤30%;15(53.6%)used T-piece or similar equipment for positive pressure ventilation(PPV)and 2(7.1%)routinely used ECG monitors.(4)Post resuscitation management:27(96.4%)administered pulmonary surfactant(PS);less invasive surfactant administration(LISA)technique was performed in 23(82.1%)for preterm infants with non-invasive ventilation.24(85.7%)used prophylactic caffeine;27(96.4%)inserted peripheral venous before umbilical vein catheterization and infused glucose and parenteral nutrition in time.Conclusions Generally,the 28 tertiary hospitals in Jiangsu Province have followed the neonatal resuscitation guidelines and the evidence-based interventions to achieve early stabilization in premature infants with GA<32w.The facilities in the delivery room and during intrahospital transport are still insufficient.The details and the quality of early management of preterm infants with GA<32w need to be improved.