背景:低资源环境中的新生儿低体温普遍存在,并且与高发病率和高死亡率密切相关。我们检查了易于阅读的温度检测器设备是否可以改善健康状况。
方法:在一项描述性研究中,利隆韦三级医院新生儿病房住院1009人,马拉维,分析并分为基线组和试验组。将试验前531例接受标准护理(SC)的新生儿的数据与实施该设备(设备护理=DC)期间的478例新生儿进行了比较。工作人员和护理人员接受了使用该设备以及在体温过低的情况下如何反应的培训。数据是从患者档案中收集的,设备文档表,访谈和焦点小组讨论。体温过低定义为体温<36.5°C。
结果:在试验期间,在整个住院期间获得体温的频率明显更高(p<0.0001).每个新生儿每天的中位温度测量值SC为1.3倍,DC为1.6倍,轻度低温的检测频率更高。在体重最轻的组中避免了中度低温,这可能导致存活新生儿的住院时间明显缩短(p=0.007)。许多护理人员在正确使用和解释设备时遇到困难,报告的颜色中有47%与注册温度不符。与上述相反,与护理人员和卫生工作者进行的问卷调查和焦点小组讨论显示,该装置具有良好的接受度和总体意见.
结论:随着更频繁的体温检查,出生体重较低的婴儿可能受益于实施易于阅读的连续温度指示器,但是低体温率仍然很高。我们的数据和经验揭示了结构性,沟通和一致性/解释缺陷。虽然专为低资源设置而设计,设备的实施需要一个良好的工作和结构化的环境,特别是关于工作人员和护理人员的沟通。
BACKGROUND: Neonatal hypothermia in low-resource settings is prevalent and closely associated with high morbidity and mortality. We examined if an easy-to-read temperature detector device improves health outcomes.
METHODS: In a descriptive study, 1009 admissions to a neonatal ward in a tertiary care hospital in Lilongwe, Malawi, were analysed and divided into a baseline and a trial group. The data of 531 newborns with standard care (SC) before the trial were compared with 478 newborns during the implementation of the device (device care=DC). Staff and caregivers were trained on using the device and how to react in case of hypothermia. Data were collected from patient files, device documentation sheets, interviews and focus group discussions. Hypothermia was defined as a body temperature <36.5°C.
RESULTS: During the trial, body temperatures throughout the hospital stay were significantly more often obtained (p<0.0001). The median temperature measurements per newborn per day were 1.3 times with SC and 1.6 times with DC, and mild hypothermia was more frequently detected. Moderate hypothermia was avoided in the lightest weight group possibly contributing to significantly shorter hospital stays of surviving newborns (p=0.007). Many caregivers had difficulties using and interpreting the device correctly, and 47% of the reported colours did not match the registered temperatures. Contrary to the above, a questionnaire and focus group discussions with caregivers and health workers showed a high acceptance and the overall opinion that the device was beneficial.
CONCLUSIONS: With more frequent temperature checks, infants with lower birth weight possibly benefited from implementing an easy-to-read continuous temperature indicator, but hypothermia rates remained high. Our data and experiences reveal structural, communicational and consistency/interpretation deficits. Although specifically designed for low-resource settings, the implementation of the device needs a well-working and structured environment, especially regarding staff and caregiver communication.