Advances in Neonatal Critical Care: Pushing at the Boundaries and Connecting to Long-Term Outcomes.
Advances in Neonatal Critical Care: Pushing at the Boundaries and Connecting to Long-Term Outcomes.
复制标题
新生儿重症监护的进展：突破界限并连接到长期结果。
DOI：
10.1097/ccm.0000000000005251
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发表时间：
2021
影响因子：
8.8
通讯作者：
Biban P
中科院分区：
文献类型：
--
作者：
Biban P
在过去的50年里，新生儿的护理已经从本质上简单的，轶事和经验过程发展到以证据为基础的，高科技的重症监护医学，伴随着死亡率的急剧下降和许多脆弱的极早产儿的完整存活率的增加，以及围产期窒息婴儿的预后的改善。许多因素对这些改善的结果负责，但它们都源于新生儿学和母胎医学作为其自身临床专业的发展。通过这些组织学科，医生、护士和联合医疗专业人员已经发展成为一个团队，规范化培训、质量控制和模拟程序，以提供高质量、标准化、最先进的护理。然而，尽管在知识方面取得了巨大进步，对新生儿的护理仍然需要在利与害之间取得非常谨慎的平衡。大约在1971年重症医学学会和杂志成立的时候，对新生儿的护理通常是作为妇女产科护理的一部分进行的，对新生儿的兴趣只是慢慢觉醒。由于意外并发症的出现，许多早期改善护理的尝试都举步维艰（表1）。尽管如此，在20世纪，由于引入了更好的人口营养和消毒，新生儿死亡率显著下降（10）。新生儿护理的知情发展的种子已经播下，但可识别的新生儿重症监护出现在这个时候，认识到良好的科学应用和临床试验的使用可以安全地进行。
The care of newborn infants has evolved over the past 50 years from essentially simple, anecdotal and empirical processes to evidence-based, high technology, intensive care medicine, accompanied by a dramatic decline in mortality and increasing intact survival of many fragile extremely preterm infants and improving outcomes for infants exposed to perinatal asphyxia. Many factors have been responsible for these improved outcomes, but they all stem from the development of Neonatology and Maternal-Fetal Medicine as clinical specialties in their own right. Through these organizational disciplines, physicians, nurses, and allied health professionals have developed as teams, formalizing training, quality control, and simulation programs to provide high quality, standardized, state-of-the-art care. However, despite the huge advances in knowledge, care for newborn babies still represents a very careful balance between benefit and harm.Around the time that the Society of Critical Care Medicine and Journal were being formed in 1971, care for newborn babies was usually carried out as part of the woman’s maternity care and interest in the newborn was only slowly awakening. Many early attempts to improve care had floundered when unexpected complications ensued (Table 1). Despite this, dramatic falls in neonatal mortality had occurred over the 20th century associated with the introduction of better population nutrition and antisepsis (10). The seeds for the informed development of neonatal care had been sown, but recognizable Neonatal Critical Care emerged around this time with the recognition that the application of good science and the use of clinical trials could safely proceed.