PDF(Pubmed)
Abstract：
Background: Neonatal hypothermia is a major cause of preventable morbidity and mortality, especially among the world\'s poorest newborns. A heat-producing wrap is necessary when kangaroo mother care (KMC) is insufficient or unavailable, yet there is little published research on such wraps. The Dream Warmer is a wrap designed to complement KMC and has been extensively studied in formal research settings but not in real-world conditions. Objectives: We used implementation science methodology to understand the safety, effectiveness, and functionality of the Dream Warmer (hereafter, \"Warmer\"); its effect on clinical workflows; its interaction with other aspects of care such as KMC; and the Warmer\'s reception by healthcare providers (HCPs) and parents. Methods: We conducted a prospective, interventional, one-arm, open-label, mixed-methods study in 6 district hospitals and 84 associated health centers in rural Rwanda. Our intervention was the provision of the Warmer and an educational curriculum on thermoregulation. We compared pre and post intervention data using medical records, audits, and surveys. Findings: The Warmer raised no safety concerns. It was used correctly in the vast majority of cases. The mean admission temperature rose from slightly hypothermic (36.41 °C) pre, to euthermic (36.53 °C) post intervention (p = 0.002). Patients achieved a temperature ≥36.5 °C in 86% of uses. In 1% of audits, patients were hyperthermic (37.6-37.9 °C). Both HCPs and parents reported a generally positive experience with the Warmer. HCPs were challenged to prepare it in advance of need. Conclusions: The Warmer functions similarly well in research and real-world conditions. Ongoing education directed toward both HCPs and parents is critical to ensuring the provision of a continuous heat chain. Engaging families in thermoregulation could ease the burden of overtaxed HCPs and improve the skill set of parents. Hypothermia is a preventable condition that must be addressed to optimize neonatal survival and outcome.
摘要：
背景：新生儿低体温是可预防的发病率和死亡率的主要原因，尤其是世界上最贫穷的新生儿。当袋鼠母亲护理（KMC）不足或不可用时，需要发热包裹，然而，关于这种包装的公开研究很少。DreamWarmer是一款旨在补充KMC的包装，并在正式的研究环境中得到了广泛的研究，但在现实世界中却没有得到广泛的研究。目标：我们使用实施科学方法来了解安全性，有效性,和梦暖的功能(以下，\“Warmer\”）；它对临床工作流程的影响；它与KMC等其他方面的护理的相互作用；以及医疗保健提供者（HCP）和父母对Warmer的接待。方法：我们进行了前瞻性，介入,单臂,开放标签，在卢旺达农村6个地区医院和84个相关卫生中心进行的混合方法研究。我们的干预措施是提供加温器和温度调节教育课程。我们使用医疗记录比较了干预前后的数据，审计,和调查。研究结果：温暖者没有提出安全问题。它在绝大多数情况下被正确使用。平均进入温度从略低体温(36.41°C)开始升高,干预后恢复到恒温(36.53°C)(p=0.002)。在86％的使用中，患者的体温≥36.5°C。在1%的审计中，患者体温过高(37.6-37.9°C).HCP和父母都报告了与Warmer的总体积极经历。HCP受到挑战，要在需要之前做好准备。结论：Warmer在研究和现实条件下的功能相似。针对HCP和父母的持续教育对于确保提供连续的热链至关重要。让家庭参与体温调节可以减轻过度负担的HCP的负担，并提高父母的技能。体温过低是一种可预防的疾病，必须解决以优化新生儿生存和结局。
