Born too soon: care for the preterm baby.
Born too soon: care for the preterm baby.
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DOI：
10.1186/1742-4755-10-s1-s5
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发表时间：
2013
影响因子：
3.4
通讯作者：
Molyneux L
中科院分区：
文献类型：
--
作者：
Lawn JE;Davidge R;Paul VK;von Xylander S;de Graft Johnson J;Costello A;Kinney MV;Segre J;Molyneux L
作为题为“出生太快”的补充的一部分，本文侧重于早产新生儿的护理。据估计，有1500万婴儿早产，高收入和低收入国家出生的婴儿之间的生存差距正在扩大，每年有100万人死于早产的直接并发症，另有约100万人因早产而死亡，特别是在那些生长受限的人中。大多数早产儿（>80%）在妊娠32至37周之间，许多人因缺乏简单的护理而不必要地死亡。我们概述了一系列护理包，这些护理包以每个新生儿的基本护理为基础，包括支持立即和纯母乳喂养、保暖护理以及卫生脐带和皮肤护理。对于出生时没有呼吸的婴儿，快速的新生儿复苏至关重要。对小婴儿的额外护理，包括袋鼠妈妈护理和喂养支持，可以使体重<2000 g的婴儿的死亡率减半。对有感染迹象的新生儿的病例管理、对呼吸系统并发症的新生儿的安全氧气管理和支持性护理以及对严重黄疸的新生儿的护理都是至关重要的，尤其依赖于合格的护理。高收入环境中的新生儿重症监护室是去强化护理，例如增加使用持续气道正压通气（CPAP），这使得全面的早产儿护理更具可转移性。对于低收入和中等收入环境中的卫生系统，随着设施分娩的增加，地区医院是改善产科和新生儿护理的关键前沿，一些大规模方案现在包括具体的新生儿护理战略。然而，仍有约5 000万人在设施外分娩，因此，母亲和新生儿以及妇女团体的家访对于帮助这些家庭（往往是最贫穷的家庭）至关重要。一个根本性的挑战是改善方案跟踪数据的覆盖面和质量，并衡量无残疾生存率。在高收入国家，父母的声音在引起对早产新生儿的关注方面发挥了重要作用，但在受影响最严重的国家，这一点仍然缺失。这篇文章是由拯救儿童的拯救新生儿生命计划通过比尔和梅林达盖茨基金会和March of Dimes基金会的赠款共同资助的补编的一部分，并与孕产妇，新生儿和儿童健康伙伴关系和世界卫生组织（世卫组织）合作出版。原始文章以PDF格式发表在世卫组织报告“出生太早：早产全球行动报告”（ISBN 978 92 4 150343 30）中，该报告涉及50多个组织的合作。这篇文章已经重新格式化为期刊出版，并根据生殖健康的补充标准流程进行了同行评审，与原始报告相比，内容可能会有一些变化。这份联合出版物以全文格式向社区提供了这篇文章。
As part of a supplement entitled "Born Too Soon", this paper focuses on care of the preterm newborn. An estimated 15 million babies are born preterm, and the survival gap between those born in high and low income countries is widening, with one million deaths a year due to direct complications of preterm birth, and around one million more where preterm birth is a risk factor, especially amongst those who are also growth restricted. Most premature babies (>80%) are between 32 and 37 weeks of gestation, and many die needlessly for lack of simple care. We outline a series of packages of care that build on essential care for every newborn comprising support for immediate and exclusive breastfeeding, thermal care, and hygienic cord and skin care. For babies who do not breathe at birth, rapid neonatal resuscitation is crucial. Extra care for small babies, including Kangaroo Mother Care, and feeding support, can halve mortality in babies weighing <2000 g. Case management of newborns with signs of infection, safe oxygen management and supportive care for those with respiratory complications, and care for those with significant jaundice are all critical, and are especially dependent on competent nursing care. Neonatal intensive care units in high income settings are de-intensifying care, for example increasing use of continuous positive airway pressure (CPAP) and this makes comprehensive preterm care more transferable. For health systems in low and middle income settings with increasing facility births, district hospitals are the key frontier for improving obstetric and neonatal care, and some large scale programmes now include specific newborn care strategies. However there are still around 50 million births outside facilities, hence home visits for mothers and newborns, as well as women's groups are crucial for reaching these families, often the poorest. A fundamental challenge is improving programmatic tracking data for coverage and quality, and measuring disability-free survival. The power of parent's voices has been important in high-income countries in bringing attention to preterm newborns, but is still missing from the most affected countries. This article is part of a supplement jointly funded by Save the Children's Saving Newborn Lives programme through a grant from The Bill & Melinda Gates Foundation and March of Dimes Foundation and published in collaboration with the Partnership for Maternal, Newborn and Child Health and the World Health Organization (WHO). The original article was published in PDF format in the WHO Report "Born Too Soon: the global action report on preterm birth" (ISBN 978 92 4 150343 30), which involved collaboration from more than 50 organizations. The article has been reformatted for journal publication and has undergone peer review according to Reproductive Health's standard process for supplements and may feature some variations in content when compared to the original report. This co-publication makes the article available to the community in a full-text format.