Approaching NIH guideline recommended care for maternal-infant health: clinical failures to use recommended antenatal corticosteroids.
Approaching NIH guideline recommended care for maternal-infant health: clinical failures to use recommended antenatal corticosteroids.
复制标题
接近 NIH 指南推荐的母婴健康护理：临床未能使用推荐的产前皮质类固醇。
DOI：
10.1007/s10995-009-0480-3
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发表时间：
2010
影响因子：
2.3
通讯作者：
Chassin,MarkR
中科院分区：
文献类型：
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作者：
Howell,ElizabethA;Stone,Joanne;Kleinman,LawrenceC;Inamdar,Sarla;Matseoane,Stephen;Chassin,MarkR
评估 NIH 指南和当地专家推荐使用产前皮质类固醇的临床情况，并描述与未能使用推荐的产前类固醇相关的特征。我们召集了当地专家，通过确定他们同意应始终使用产前类固醇的临床情况来调整 NIH 声明。我们对 2000 年至 2002 年间在纽约市三家医院分娩早产（24-34 周）婴儿的母亲进行的一项队列研究进行了回顾性图表审查，并调查了未使用产前类固醇治疗与母亲、怀孕、分娩和医院特征之间的关系。百分之二十 (101/515) 的符合条件的母亲未能接受指定的产前皮质类固醇治疗。其中，43% 的患者在入院后 2 小时以上分娩，33% 的患者在入院后 4 小时以上分娩，这表明有足够的时间进行治疗。缺乏产前护理、妊娠时间较长、宫颈检查提前以及入院时胎膜完整与未能接受推荐的治疗有关。在我们的样本中，产前类固醇没有得到充分利用。如果我们的结果具有普遍性，那么早产母亲的产前管理质量就有改善的机会。
To assess the use of antenatal corticosteroids in clinical circumstances for which both the NIH Guideline and local experts recommend their use and to describe characteristics associated with failure to use recommended antenatal steroids. We convened local experts to adapt the NIH statement by identifying clinical circumstances for which they agree antenatal steroids should always be used. We conducted a retrospective chart review on a cohort study of mothers who delivered premature (24–34 weeks) infants between 2000 and 2002 at three New York City hospitals and investigated the association of failure to treat with antenatal steroids with characteristics of the mother, pregnancy, delivery, and hospital. Twenty percent (101/515) of eligible mothers failed to receive indicated antenatal corticosteroid therapy. Of these, 43% delivered more than 2 h after admission, and 33% delivered more than 4 h after admission, indicating sufficient time to have treated them. Lack of prenatal care, longer gestation, advanced cervical exam, and intact membranes at admission were associated with failure to receive the recommended therapy. Antenatal steroids were under-utilized in our sample. If our results our generalizable, opportunities for quality improvement in the antenatal management of mothers in preterm labor exist.