Newborn Resuscitation Skills in Health Care Providers at a Zambian Tertiary Center, and Comparison to World Health Organization Standards
Newborn Resuscitation Skills in Health Care Providers at a Zambian Tertiary Center, and Comparison to World Health Organization Standards
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DOI：
10.1213/ane.0000000000003337
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发表时间：
2018-07-01
影响因子：
5.7
通讯作者：
Bould, M. Dylan
中科院分区：
文献类型：
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作者：
Mistry, Sara C.;Lin, Richard;Bould, M. Dylan
背景：出生窒息是新生儿早期死亡的主要原因。 2013年，赞比亚32%的新生儿死亡是由于出生窒息和创伤造成的。基本、及时的干预是改善结果的关键。然而，世界卫生组织的数据表明，复苏往往没有开始，或者进行得不理想。目前，关于中低收入国家三级中心新生儿复苏质量的数据很少。我们的目的是衡量负责新生儿复苏的临床医生的能力。方法：这项观察性研究在赞比亚进行了 5 个多月。招募了来自麻醉、儿科和助产科的医疗保健专业人员。通过以下方式检查新生儿的技能和知识：（1）多项选择题； (2)通风技能测试； (3) 2 个中低保真度模拟场景。记录了参与者的人口统计数据，包括之前的复苏培训和自我效能评分。主要结果检查了模拟场景中的表现评分，该评分评估了对基本干预措施没有反应的新生儿的护理情况。次要结果指标包括产后呼吸暂停时间和其他评估中的表现。 结果：78 名参与者参加了该研究（13 名麻醉科住院医师、13 名儿科住院医师和 52 名助产士）。在检查无反应的新生儿模拟场景的检查表分数时，观察到跨专业表现的显着差异 (P = .006)。麻醉师的中位（四分位数）检查表得分（满分 18 分）为 14.0 (13.0-14.75)，儿科医生为 11.0 (8.5-12.3)，助产士为 10.8 (8.3-13.9)。需要 14 分或以上才能通过该场景。之前接受过和未接受过新生儿复苏培训的参与者之间的表现没有显着差异 (P = .246)。所有组之间分娩后的中位（四分位数）呼吸暂停时间显着不同 (P = .01)，麻醉医师和儿科住院医师表现相似，分别为 61 (37-97) 和 63 (42.5-97.5) 秒。助产士参与者的呼吸暂停时间明显更长，为 93.5 (66.3-129) 秒。自我效能评分显示置信水平与主要结果之间没有相关性，斯皮尔曼系数为 0.06 (P = .55)。结论：医疗保健专业人员的新生儿复苏技能各不相同。助产士负责大部分分娩，麻醉师和儿科医生仅在手术或高危分娩时在场。因此，助产士通常会开始复苏。尽管如此，与麻醉和儿科住院医师相比，助产士的表现较差。为了解决这种差异，应考虑采用多学科、基于模拟的新生儿复苏计划，并不断强化临床最佳实践。
BACKGROUND: Birth asphyxia is a leading cause of early neonatal death. In 2013, 32% of neonatal deaths in Zambia were attributable to birth asphyxia and trauma. Basic, timely interventions are key to improving outcomes. However, data from the World Health Organization suggest that resuscitation is often not initiated, or is conducted suboptimally. Currently, there are little data on the quality of newborn resuscitation in the context of a tertiary center in a lower-middle income country. We aimed to measure the competencies of clinical practitioners responsible for newborn resuscitation.METHODS: This observational study was conducted over 5 months in Zambia. Health care professionals were recruited from anesthesia, pediatrics, and midwifery. Newborn skills and knowledge were examined using the following: (1) multiple-choice questions; (2) a ventilation skills test; and (3) 2 low-medium fidelity simulation scenarios. Participant demographics including previous resuscitation training and a self-efficacy rating score were noted. The primary outcome examined performance scores in a simulated scenario, which assessed the care of a newborn that failed to respond to basic interventions. Secondary outcome measures included apnea times after delivery and performance in the other assessments.RESULTS: Seventy-eight participants were enrolled into the study (13 physician anesthesiology residents, 13 pediatric residents, and 52 midwives). A significant difference in interprofessional performance was observed when examining checklist scores for the unresponsive newborn simulated scenario (P = .006). The median (quartiles) checklist score (out of 18) was 14.0 (13.0-14.75) for the anesthesiologists, 11.0 (8.5-12.3) for the pediatricians, and 10.8 (8.3-13.9) for the midwives. A score of 14 or more was required to pass the scenario. There was no significant difference in performance between participants with and without previous newborn resuscitation training (P = .246). The median (quartiles) apnea time after delivery was significantly different between all groups (P = .01) with anesthetic and pediatric residents performing similarly, 61 (37-97) and 63 (42.5-97.5) seconds, respectively. The midwifery participants displayed a significantly longer apnea time, 93.5 (66.3-129) seconds. Self-efficacy rating scores displayed no correlation between confidence level and the primary outcome, Spearman coefficient 0.06 (P = .55).CONCLUSIONS: Newborn resuscitation skills among health care professionals are varied. Midwives lead the majority of deliveries with anesthesiologists and pediatricians only being present at operative or high-risk births. It is therefore common that midwifery practitioners will initiate resuscitation. Despite this, midwives perform poorly when compared to anesthesia and pediatric residents. To address this discrepancy, a multidisciplinary, simulation-based newborn resuscitation program should be considered with continual clinical reenforcement of best practice.