Maternal perceived self-efficacy, perceived vulnerability and child health outcome in Ibadan, South-West Nigeria

Objective:The problems associated with child health continue to constitute a global concern,and child morbidity and mortality remain problematic in Sub-Sahara Africa(SSA).Utilizing a community-based survey conducted in Ibadan North Local government,Southwest Nigeria the study examined the influences of maternal perceived self-efficacy(MPSE)and maternal perceived vulnerability(MPV)on child health outcomes(CHO).Methods:The study appraised data from 683 nursing mothers aged 15-45 obtained from 20 major primary healthcare centers in the region undergoing routine health checks for their children.Three regression models were fitted to examine the effects of MPV,MPSE,and confounding variables of maternal preventive actions such as insecticide-treated nets(ITN)usage and child immunization,among other maternal and child sociodemographic attributes on CHO.Results:The study finds that MPV has no correlation with CHO and MPSE but positively correlates with maternal age(r=0.123,P<0.05).However,CHO has a negative correlation with MPSE(r=-0.200,P<0.05)while positively correlated with child age(r=0.134,P<0.05).MPSE has a unique effect on CHO(β=-0.203,P<0.05),maternal preventive action of ITN usage show a positive association with CHO in the study Model 2(β=-0.163,P<0.05),while in Model 3,child's age has a positive association with CHO(β=0.180,P<0.05).The net effect of the study models accounted for approximately 10%of the variance in CHO reported among the children.Conclusion:Overall,MPSE and ITN usage are essential factors for understanding and reducing the potential adverse CHO.Global effort must continue to improve maternal education to support child health and preventive carepractices in SSA.

Impact of Antimicrobial Stewardship Programs on Antibiotic Use and Drug Resistance:Analysis of Data from Maternal and Child Health Care Hospitals in Hubei Province,China

ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).

Prevention of Maternal-to-Child Transmission of HIV: Knowledge, Attitude and Factors Influencing Active Participation among HIV-Positive Men in a Military Health Facility in Lagos, South Western Nigeria

Introduction: Traditionally, Prevention of Maternal-to-Child Transmission (PMTCT) of HIV involves women and excludes men despite their important roles. There is a need for more data on factors influencing male participation in PMTCT programs. Design: This was a cross-sectional, descriptive study of married HIV-positive men receiving care at the adult ART clinic, 68 Nigerian Army Reference Hospital Yaba. Data were collected from March 15 to April 30, 2018. Result: Out of the 366 respondents, 333 (91%) were aware that HIV can be transmitted from mother to child. However, only 43.2% correctly identified that it can be transmitted during pregnancy, while 30.2% stated during labour. Almost all of the respondents (96.4%) would also accept that their positive partners take antiretroviral treatment to protect her unborn baby, 86.9% would support non breastfeeding option after delivery, and 95.6% indicated readiness to buy formula milk for the baby. Similarly, majority believed that a pregnant woman can be tested for HIV without the permission of her partner (Mean = 1.47 ± 0.893), and that men should accompany their spouse to ANC/PMTCT clinics (Mean = 1.86 ± 0.921). Conclusion: This study revealed that despite low knowledge of PMTCT among men, there is a good level of attitude and involvement among them. We recommend further study to fully explore the impact of education on men’s participation.

A Case Study on the Impact of Mother-to-Mother Support Groups on Maternal, Infant and Young Child Nutrition and Care Practices in Habaswein and Wajir South Districts of North Eastern Kenya

Only about 25% of babies are exclusively breast fed until six months of age in developing countries though they are at a greater risk of infection and infant mortality. The Global Strategy for Maternal, Infant and Young Child Feeding (MI- YCF) Strategy developed by WHO/UNICEF in 2002 was to revitalize world attention to the impact of feeding practices on the nutritional status, growth, development, health and survival of infants and children. The data for this case study was collected through key informant interviews, observations and review of Save the Children nutrition programme reports and surveys. This information was then organized to produce a detailed description of the maternal, infant and young child nutrition programme in Habaswein and Wajir South districts or sub-counties. The maternal and infant young child nutrition (MIYCN) programme was launched in Habaswein and Wajir South districts in January 2012. The MIYCN programme followed recommendations of a Knowledge, Practice and Coverage (KPC) survey report in July 2012. To date, the programme has formed 48 Mother-to-mother Support Groups (MTMSGs), which are actively promoting the uptake of the recommended MIYCN practices in the community. MIYCN indicators have been markedly improved between July 2011 and February 2013 when surveys were conducted. The uptake of kitchen gardening has picked up significantly at Meri site and some mothers now have a changed attitude towards unskilled home deliveries and are conducting referrals for skilled births. The marked improvements in the performance of MIYCN indicators between July 2011 and February 2013 inWajir South and Habaswein districts can be partly attributed to the MIYCN programme established in January 2012. However, a randomized community trial is still required to provide conclusive results on the impact of care support groups on maternal, infant and young child feeding in this region.

The Potential Role of a Health and Demographic Surveillance System in Rural Northern Nigeria to Reduce Maternal and Child Deaths

There exist a huge gap between generation of evidence-based research findings and its use to inform policies in most developing countries. Further, it is evident that most developing countries are lagging behind in formulating appropriate policies aimed at improving people’s lives due to lack of evidence-based research findings. We describe the potential of a Health and Demographic Surveillance System (HDSS) in informing appropriate health interventions towards reducing the high maternal and child deaths in rural communities of north western Nigeria through the Verbal Autopsy (VA) data collection. VA data collection involves the use of VA questionnaires—set of open ended and closed ended questions adapted from the World Health Organization (WHO) module— administered to the caregivers, parents or family members of a deceased person to elicit information on signs and symptoms and their durations, and other pertinent information about the deceased in the period before death. VA interviews were conducted by trained VA enumerators on all 2100 deaths reported during the update round 4 of routine data collection (July-December, 2012) and returned forms were checked for consistencies and completeness by a trained research officer. The forms were later coded by trained medical doctors for possible cause of death using the WHO International Classification of Diseases (ICD 10) codes. Fifty cases of neonatal deaths, 1650 cases of infant and child deaths, and 400 cases of adult deaths were reported during the update round 4 data collection. Neonatal sepsis was reported as the leading cause of neonatal deaths (58%) while malaria and intestinal infectious diseases were reported as the leading cause of infant and child deaths and adult deaths respectively (45% and 17%, respectively). The study provides documented evidence of high neonatal deaths due to neonatal sepsis in an area with low hygiene and high home delivery rates. The findings from the VA data collection at Nahuche HDSS inform the intervention study on home distribution of chlorhexidine to pregnant women. The findings from this study call on government and other stakeholders to strengthen research capacity to generate timely data and findings returned to policy makers within the shortest period of time for decision making.

Barriers to Optimal Maternal and Child Feeding Practices in Pastoralist Areas of Somali Region, Eastern Ethiopia: A Qualitative Study

Maternal and child nutrition is critical for child health and survival. Appropriate feeding practices are of fundamental importance for health, nutrition, survival and development of infants and children. In pastoral areas of Ethiopia, barriers related to culture, knowledge, social norms, beliefs, behaviors, decision making in the household and burden of other responsibilities contribute to nutritional status of women and children to deteriorate. Policies and strategies are recommending assessment of barriers for designing programs and interventions to improve maternal and child nutrition practices. This study is aimed to assess barriers of optimal maternal and child feeding practices in Pastoralist areas of Somali region, Eastern Ethiopia. A qualitative community based research method was used involving 17 focus group discussions and 20 in-depth interviews with mothers, grandmothers, health professionals and religious leaders from three districts. Data from FGDs and interviews were transcribed and coded. The agreed upon codes were synthesized and grouped into exhaustive categories. The categories were then merged into themes representing the most common barriers on maternal and child feeding practice that emerged from the FGDs and interviews. We found that traditional beliefs, myths, culture custodian influence, low accessibility and availability of nutritional foods, pattern and burden of other responsibilities, poor knowledge and health seeking behavior, perceived milk insufficiency as main barriers for optimal maternal and child feeding practices. Barriers on optimal maternal and child feeding are very common in the study areas. More work needs to be done to strengthen community-based nutrition with strong social behavioral change communication with emphasis on age-specific counselling on maternal and child nutrition at health facilities, during antenatal and early postnatal visits in the study areas through different media channels, particularly, Somali Region TV and FMs to promote optimal nutrition in the region.

An Exploration of the Relationship between Maternal and Child Factors Contributing to Child Abuse

Background: There are many reports in the mass media and scientific literature about child abuse caused by parents. Medical practitioners also are concerned about child abuse and need to grapple with the prevention and early detection of child abuse when working in medical facilities. Aim: The aim of this descriptive study was to explore the relationship between maternal and child factors contributing to child abuse. Methods: A sample of 50 multiparas (mothers with more than 1 child) in a 48-bed postpartum hospital unit in Okinawa prefecture were asked to fill out an anonymous questionnaire regarding the relationship between mothers and their first child in September, 2007. The questionnaire contained 30 items of physical punishment that are quoted from “The Handbook of Correspondence to Child Abuse” (Ministry of Health, Labor and welfare in Japan), 24 items relating to maternal factors and 22 items to child factors, plus items related to mothers’ satisfaction with the health guidance given in the hospital. Data were analyzed using JMP (ver. 14.2;SAS Institute Inc., Cary, NC, U.S.). The significance level was set at 0.05. Results: Forty-one (82%) questionnaires were analyzed. Of the 41 valid responses, 19 mothers reported abusing their children. Child factors contributing to the abuse included the first child’s regression to infantile behavior, bullying younger brothers or sisters and being rough and violent to their friends. The significant maternal factor leading to abuse was the belief that mothers were irritated by their child. Conclusion: A first child’s developmental difficulties had a significant relationship with the harsh punishment by their mothers. The mothers need to understand their child’s developmental behavior and provide a favorable environment for nurturing young children.

Maternal alcohol consumption during pregnancy and the risk of childhood acute leukemia:a meta-analysis

Objective： The authors used a meta-analytic technique to quantify the evidence of an association between ma- ternal alcohol consumption during pregnancy and childhood acute leukemia （AL）, which provided a basis for the prevention of childhood AL. Methods： Relevant literatures of maternal alcohol consumption during pregnancy were comprehensively searched and screened. Subgroup meta-analysis was conducted according to the type of leukemia. Results of research data of maternal alcohol consumption during pregnancy were tested for heterogeneity. Combined OR values and 95% CIs were statistically calculated with RevMan 4.2 software; Funnel plots were applied to conduct bias analysis for those included litera- tures. Results： Ten related literatures were included after data screening, 4593 cases in AL group and 6157 cases in control group respectively. According to heterogeneity test result （X2 = 16.26, P 〈 0.05）, the combined OR values and 95% CI were calculated with random effects model, which were 1.02 （0.92-1.14）, Z = 0.41, P = 0.68 〉 0.05, indicating that there was no significant difference between maternal alcohol consumption during pregnancy and the risk of childhood acute leukemia （AL）. Subgroup analysis： for the association between maternal alcohol consumption during pregnancy and childhood acute lympho- blastic leukemia （ALL）, the combined OR value and 95% CI were 0.92 （0.84-1.00）, Z = 1.92, P = 0.05, indicating that there was significant difference between two groups; for the association between maternal alcohol consumption during pregnancy and childhood acute non-lymphoblastic leukemia （ANLL）, the combined OR values and 95% CI were 0.82 （0.61-1.11）, Z = 1.30, P = 0.19 〉 0.05, indicating that there was no significant difference between two groups. Conclusion： Maternal alcohol consumption during pregnancy is a risk factor in childhood ALL, but not in childhood ANLL.

Maternal and Fetal Prognosis of Evacuated Parturients in N’Djamena Mother and Child Hospital (Chad)

Introduction: All pregnant women are at risk of obstetric complications leading to high fetal-maternal mortality and morbidity. The aim of this work was to evaluate the maternal and fetal prognosis of evacuated parturients. Patient and Method: we conducted a prospective analytical survey for four months, from April 1st to July 31st, 2018 in the Maternity of N’Djamena Mother and Child Hospital about the maternal and fetal prognosis of evacuated parturients. Any parturient evacuated or referred for obstetric complications was included. Study parameters were epidemiological, clinical, para-clinical, therapeutic and prognosis order. These parameters were analyzed in the SPSS 18 French version software. Results: Evacuated parturients represented 20% of maternity admissions. The average age was 23.9 years, with extremes ranging from 15 and 43 years. They were uneducated in 72.9%, primiparous in 46.8% of cases. The three delays were dominated by the 1st delay, which represented 34.1% of cases. In this series, 26.3% parturients had presented obstetric complications. Preruptive syndrome was the most common complication with 29.3% cases. Predisposing factors to maternal-fetal complications were low attendance antenatal care, late evacuation and distance travelled. The maternal mortality rate was 3%. Fetal complications were observed in 28.3% of cases and the neonatal mortality rate was 24.6%. Conclusion: The maternal and fetal complications of evacuated parturients are a real public health problem in our regions. The suppression of delays, capacity reinforcement of peripheral maternity and the periodic recycling peripheral centers to recognize obstetric emergencies will contribute to improve the maternal and fetal prognosis of evacuated parturients.

Determining Optimal Strategies to Reduce Maternal and Child Mortality in Rural Areas in Western China: an Assessment Using the Lives Saved Tool

China, as a whole, is about to meet the Millennium Development Goals for reducing the maternal mortality ratio (MMR) and infant mortality rate (IMR), but the disparities between rural area and urban area still exists. This study estimated the potential effectiveness of expanding coverage with high impact interventions using the Lives Saved Tool (LiST). It was found that gestational hypertension, antepartum and postpartum hemorrhage, preterm birth, neonatal asphyxia, and neonatal childhood pneumonia and diarrhea are still the major killers of mothers and children in rural area in China. It was estimated that 30% of deaths among 0-59 month old children and 25% of maternal deaths in 2008 could be prevented in 2015 if primary health care intervention coverage expanded to a feasible level. The LiST death cause framework, compared to data from the Maternal and Child Mortality Surveillance System, represents 60%-80% of neonatal deaths, 40%-50% of deaths in 1-59 month old children and 40%-60% of maternal deaths in rural areas of western China.

Marked Improvement in China's Maternal and Child Health

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Maternal Anxiety 16 Months after the Great East Japan Earthquake Disaster Area: First Report

The Great East Japan Earthquake, a magnitude 9.0 quake that occurred on March 11, 2011, left more than 20,000 killed or missing and resulted in more than 400,000 people being displaced. The Fukushima Nuclear Power Plant accident released large amounts of radioactive material into the air. Among the victims of this combined disaster were many pregnant and parturient women, and this study aimed to determine post-disaster anxiety among this specific population and measures for the future. Participants were 259 women (mean age 33.02 ± 4.79 years) who gave birth around the time of the earthquake in Miyagi Prefecture, one of the disaster areas. Sixteen months after the earthquake, we administered survey questionnaires on anxiety. We transcribed questionnaire responses, coded raw data by context, and categorized these codes by commonality. After extracting subcategories of anxiety-related factors, we categorized them into more abstract concepts. Among the participants, 126 (48.6%) reported having no available professionals with whom they could consult about childrearing. Participants reported anxiety in the following 12 categories: “radiation,” “child’s physical and mental growth/development,” “recurrence of earthquake and tsunami,” “financial issues,” “childrearing environment,” “living environment,” “maternal employment,” “stigma,” “familial issues,” “maternal health,” “childrearing,” and “the future”. A beneficial way to reduce maternal anxiety in the 12 areas identified would be to develop support systems that provide continuous support for children’s mental health care needs, psychological guidance, community support for maternal empowerment, outreach for individual support, and professional consultation for mothers who have high anxiety about radioactivity.

全国妇幼保健机构医院感染监测与防控实施现状调查报告

目的 了解全国各级妇幼保健机构医院感染监测和防控措施的实施现状,为优化妇幼保健机构医院感染防控工作提供政策依据。方法 从8个省/自治区的省部级、地市级和区县级妇幼保健机构中分层抽样,设计统一的调查问卷,以“问卷星”的形式开展线上调查。结果 123所妇幼保健机构的数据纳入统计分析。90.24%的妇幼保健机构开展了医院感染综合性监测,开展新生儿监护室医院感染目标性监测、手术部位感染目标性监测、多重耐药菌目标性监测和重症监护病房(非新生儿)医院感染目标性监测的妇幼保健机构比率分别为89.66%、85.96%、80.77%和74.19%,51.22%的妇幼保健机构实现了医院感染病例信息化监测。94.31%的妇幼保健机构开展了手卫生依从性监测工作,90%以上的妇幼保健机构中医院感染高风险部门开展了环境卫生学监测,71.54%的妇幼保健机构由消毒供应中心对复用诊疗器械集中清洗、消毒、灭菌和供应。>90%的妇幼保健机构建立了三级预检分诊制度,86.18%的妇幼保健机构设置了过渡病房。妇幼保健机构对建档孕产妇、高危新生儿、保健人群和长期康复患者等特殊就诊人群普遍采取了建立有效沟通机制、全预约就诊和单独分区就诊的管理模式,但开展互联网复诊的妇幼保健机构比率<50%。结论 妇幼保健机构普遍开展了医院感染综合性监测和目标性监测,信息化监测程度有待提高。手卫生和环境卫生学监测在各级妇幼保健机构中普及程度较高,少数妇幼保健机构复用诊疗器械清洗、消毒、灭菌和供应流程不规范。特殊就诊人群得到有效管理,互联网医疗有待进一步推广。

某妇幼保健院基于RBRVS和DRG方法开展绩效评价的实践

根据国家、省医药卫生体制改革相关文件精神,笔者采用当下比较有效的绩效评价工具RBRVS+DRGs的绩效考核方法,构建具有妇幼专科特色的绩效评价体系,引导临床业务科室在促进业务增长的同时提升业务能力和病种收治质量。通过绩效考核评价机制的改革,促进了医院业务财务融合发展,建立重实绩、重贡献、向优秀人才和临床一线倾斜的分配激励机制,实现医院高质量发展的目标。

基于三级妇幼保健院应用微信公众号开展健康科普传播状况的调查

目的了解我国三级妇幼保健院应用微信公众号开展健康科普传播的现状,为促进各级妇幼保健机构充分利用微信公众号平台开展健康科普宣传,提高新媒体健康传播效能提供参考依据。方法选取2021年参加全国三级妇幼保健机构绩效考核并有微信公众号的274所机构为调查对象。采用自制问卷,于2022年4—6月通过问卷星向被调查机构的微信公众号负责人进行调查。问卷内容涉及负责人基本情况,以及本机构纳入三级妇幼保健院微信公众号科普作品影响力监测的微信公众号建设和管理情况,科普作品的创作、发布和运营情况,针对用户调查情况等。结果274所有微信公众号的三级妇幼保健院中,67.9%的微信公众号为服务号;98.9%的微信公众号具有健康宣教功能;用户注册数超过20万人的微信公众号占29.2%。各机构微信公众号管理人员数量普遍较少,仅为1人的机构占29.2%,37.9%的机构无专人管理。微信公众号负责人所在科室主要为宣传科(38.7%)、健康教育科(27.4%)及院办(13.1%);负责人专业背景为医学相关专业的仅占36.9%;各机构确定科普作品主题的方法主要为配合科普宣传日(94.2%)、各科室提供(90.1%)、热点话题(81.8%)、根据节气/天气变化(59.5%)等,主题确定来源于用户需求调查的仅为37.2%;科普稿源以相关业务科室提供为主(95.3%);94.5%的机构在科普作品发布前有专人审核。发布的科普作品主要通过院内官方宣传媒体(84.3%)和院内自媒体(77.4%)进行推广,经由辖区妇幼体系推广的机构仅占13.1%。微信公众号运营管理人员主要是本机构专职(47.1%)和兼职人员(49.3%);79.6%的机构无运营经费支持;53.6%的机构设定了科普作品发布激励机制,仅有21.2%的机构开展过微信公众号用户调查。结论绝大多数三级妇幼保健院均能通过微信公众号开展妇幼健康科普传播工作,但普遍缺乏用户调查和对公众号运营的支持,应进一步加强对微信公众号的管理,并充分利用微信公众号开展与用户的沟通及需求评估,从而进一步促进微信公众号健康传播能力的提升。

母亲抑郁与幼儿社会适应:母亲的悲伤反应与亲子冲突的中介作用

本研究以上海市两所幼儿园的205名3~6岁幼儿为被试,探讨了母亲抑郁与幼儿社会适应的关系,并考察了母亲对幼儿消极情绪的悲伤反应和亲子冲突在其中的中介作用。结果发现:(1)母亲抑郁可以显著正向预测幼儿情绪问题,显著负向预测幼儿亲社会行为;(2)母亲的悲伤反应在母亲抑郁与品行问题之间起完全中介作用;亲子冲突在母亲抑郁与幼儿多动分心和品行问题之间起完全中介作用,在母亲抑郁与情绪问题之间起部分中介作用;(3)母亲的悲伤反应和亲子冲突在母亲抑郁与幼儿多动分心、情绪问题以及品行问题之间起链式中介作用,但效应量较低。本研究结果进一步揭示了母亲抑郁对幼儿社会适应影响的内在机制。

基于TIG模式的层级培训对妇幼医院急诊护士核心能力及岗位胜任力的影响

目的 探讨基于TIG模式的层级培训对妇幼医院急诊护士核心能力及岗位胜任力的影响。方法 选取2020年6月—2022年5月妇幼医院急诊护士68名,采用随机数字表法分为对照组(34名)和研究组(34名)。对照组采用传统培训,研究组采用基于TIG模式的层级培训。对比两组护士培训结束时理论及操作考核成绩、核心能力及岗位胜任力。结果 研究组护士理论及操作考核成绩与对照组比较均明显升高,差异明显(P<0.05)。研究组护士岗位胜任力评估量表各维度评分与对照组比均明显升高,差异明显(P<0.05)。研究组护士核心能力量表各维度评分与对照组比均明显升高,差异明显(P<0.05)。结论 基于TIG模式的层级培训有助于提升妇幼医院急诊护士理论及操作考核成绩、核心能力、岗位胜任力。

健康生命轨迹计划缘起与发展:社区-家庭-母婴多层面儿童超重与肥胖干预研究队列

健康生命轨迹计划(HeLTI)是由世界卫生组织(WHO)牵头,中国、加拿大、南非、印度等多个国家参与的前瞻性出生队列干预研究。本项目旨在利用HeLTI在个性化健康教育和权威专业健康指导方面的优势,探索建立涵盖备孕期、孕产期、婴幼儿期、学龄前期等多个阶段的社区-家庭-母亲-儿童(CFMC)干预措施,实施连续性多层面的干预,构建国际合作研究平台,实现从生命源头预防肥胖等发育源性疾病的目标。由中国、加拿大共同实施的中加健康生命轨迹计划(SCHeLTI)也称生命树项目,受中国国家自然科学基金委和加拿大卫生研究院共同资助,由国际和平妇幼保健院牵头,与上海交通大学医学院附属新华医院、复旦大学妇产科医院及加拿大舍布鲁克大学等知名大学和机构共同组成研究团队。项目纳入的研究对象主要来自上海市徐汇区、长宁区、闵行区、奉贤区、松江区的妇幼保健院及其管辖的42个社区卫生服务中心。本项目所采用的生命早期多层面综合干预方案将在上海地区乃至全国进行推广,研究结果期待为WHO制定儿童肥胖早期干预指南提供科学依据。

椎管内分娩镇痛安全核查表的制订及其临床应用

目的制订椎管内分娩镇痛安全核查表,积极探索其临床应用的效果;建立椎管内分娩镇痛安全实施策略,保障母儿安全。方法选取东南大学附属中大医院2020年1月—2021年12月实施椎管内分娩镇痛的1072例产妇作为观察组,与2018年1月—2019年12月实施椎管内分娩镇痛的850例产妇作为对照组进行回顾性比较。对照组采取椎管内分娩镇痛常规操作流程,观察组在采取常规流程的基础上,应用东南大学附属中大医院制订的椎管内分娩镇痛安全核查表对椎管内分娩镇痛的各环节进行核查。对比2组产妇椎管内分娩镇痛常见并发症、产妇分娩结局等发生情况,对比2组新生儿不良结局的发生情况,对比2组医务人员在椎管内分娩镇痛各环节操作流程的执行力情况。结果2组产妇椎管内分娩镇痛常见麻醉并发症发生率比较,对照组产时发热发生率为11.18%,观察组为8.21%;对照组尿潴留发生率为10.94%,观察组为6.25%,差异有统计学意义(P<0.05)。2组产妇剖宫产及自然分娩情况比较,对照组剖宫产率为9.53%,观察组为6.06%;对照组自然分娩率为89.65%,观察组为93.47%,差异有统计学意义(P<0.05)。产妇对椎管内分娩镇痛满意度情况的比较,对照组总满意度为98.71%,观察组为99.81%;差异有统计学意义(P<0.05)。2组胎儿窘迫发生情况的比较,差异有统计学意义(P<0.05)。干预前后医务人员操作流程执行规范性的比较,差异有统计学意义(P<0.05)。结论椎管内分娩镇痛安全核查表可有效降低东南大学附属中大医院中转剖宫产率及母儿并发症的发生率,提高医务人员在椎管内分娩镇痛各环节执行的规范性,普及镇痛条件下的自然分娩,推进国内现代化产房的建设,提高孕产妇及家庭的幸福感及满意度。

2016—2021年某妇幼保健院早产儿医院感染影响因素分析

目的 了解早产儿医院感染现状及影响因素,为早产儿医院感染防控提供理论和实践依据。方法 采用回顾性研究方法,对2016年1月—2021年12月某院新生儿病房收治的早产儿进行调查分析,查阅病历,收集早产儿基本信息及住院期间诊疗信息。结果 共纳入早产儿3 559例,其中男1 964例,女1 595例;平均出生体重(2 108.66±631.17)g。发生医院感染109例,发病率3.06%;主要感染类型为下呼吸道感染(44.04%)、血流感染(28.44%)、胃肠道感染(14.68%);检出医院感染相关病原菌38株,其中革兰阴性菌33株(86.84%),革兰阳性菌3株,真菌2株。主要分离病原菌为产气肠杆菌(28.95%)、肺炎克雷伯菌(28.95%)。经单因素、非条件多因素logistic回归分析,羊水污染、出生体重<2 500 g、使用呼吸机、中心静脉插管是早产儿医院感染的独立危险因素(OR值分别为2.424、3.805、3.776、5.412,均P<0.05);剖宫产是早产儿医院感染的保护因素(OR=0.362,P<0.05)。结论 早产儿医院感染风险高,影响因素多,临床应引起重视,积极采取有循证依据的防控措施减少风险因素暴露,保护早产儿健康。