Optimizing Therapeutic Hypothermia for Neonatal Encephalopathy
Optimizing Therapeutic Hypothermia for Neonatal Encephalopathy
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DOI：
10.1542/peds.2012-0891
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发表时间：
2013-02-01
期刊：
影响因子：
8
通讯作者：
Mathur, Amit
中科院分区：
文献类型：
--
作者：
Olsen, Steven L.;DeJonge, Mitchell;Mathur, Amit
目的：治疗性亚低温(TH)治疗新生儿脑病已广泛应用于临床。这次合作的目标是创建和实施一种循证的新生儿脑病护理标准方法，提供一致的护理，并优化结果。方法：质量改进过程确定并使用改进模式作为改进工作的框架。这是一次佛蒙特州牛津网络合作，重点是优化TH在新生儿脑病治疗中的作用。通过使用以证据为基础的方法，主题专家开发了潜在的更好的实践，由合作伙伴修改，并在每家医院实施。这些措施包括：及时识别高危婴儿，与转诊医院协调，以确保在出生后6小时内获得TH，对当地和转诊医院的工作人员进行培训，非镇静磁共振，将幅度积分脑电纳入TH方案，以及确保对婴儿进行标准的神经发育随访。每个中心使用这些实践来制定实施矩阵。结果：地方自我评估指导每个中心潜在更好的实践的实施和适应。根据共同确定的障碍开发资源，并在小组之间共享。结论：利用标准质量改进方法实施TH计划，以提高NICU患者护理的一致性是可行的。要成功地将TH等新的干预措施引入NICU文化，需要一个协作的多学科团队，使用系统的质量改进过程，以及坚持不懈。儿科2013；131：e591-e603
OBJECTIVE: Therapeutic hypothermia (TH) for neonatal encephalopathy is becoming widely available in clinical practice. The goal of this collaborative was to create and implement an evidence-based standard-of-care approach to neonatal encephalopathy, deliver consistent care, and optimize outcomes.METHODS: The quality improvement process identified and used the Model for Improvement as a framework for improvement efforts. This was a Vermont Oxford Network Collaborative focused on optimizing TH in the treatment of neonatal encephalopathy. By using an evidence-based approach, Potentially Better Practices were developed by the topic expert, modified by the collaborative, and implemented at each hospital. These included the following: timely identification of at-risk infants, coordination with referring hospitals to ensure TH was available within 6 hours after birth, staff education for both local and referring hospitals, nonsedated MRI, incorporating amplitude-integrated EEG into a TH protocol, and ensuring standard neurodevelopmental follow-up of infants. Each center used these practices to develop a matrix for implementation.RESULTS: Local self-assessments directed the implementation and adaptation of the Potentially Better Practices at each center. Resources, based on common identified barriers, were developed and shared among the group.CONCLUSIONS: The implementation of a TH program to improve the consistency of care for patients in NICUs is feasible using standard-quality improvement methodology. The successful introduction of new interventions such as TH to the NICU culture requires a collaborative multidisciplinary team, use of a systematic quality improvement process, and perseverance. Pediatrics 2013; 131: e591-e603