背景:尽管以前的研究表明发育护理可以提供良性刺激以促进新生儿的神经发育,关于发展护理的其他临床益处,还需要更多的证据.
目的:评价实施发展性护理对住院时间的影响,改善新生儿重症监护病房的护理实践,以及极低出生体重婴儿的短期结果。
方法:整群随机对照试验。
■从2021年3月1日至2022年3月1日,从中国14个三级新生儿重症监护病房招募了1400名极低出生体重婴儿。
方法:我们将14个新生儿重症监护病房分配给发育护理或标准护理。婴儿的住院时间是在个体水平上分析的主要结果。次要结果是以家庭为中心的护理实践,包括父母的参与,皮肤对皮肤的护理,独家母乳,口服免疫治疗和母乳喂养。还评估了环境管理(噪声和光)和短期结果。
结果:发展性护理组的住院时间是对照组的65%(HR:0.65,95%CI,0.451-0936,p=0.021)。在控制了协变量之后,调整后的HR=0.755(95%CI,0.515至1.107,p=0.150)。与对照组相比,发展护理组更容易获得SSC,发育护理组有22名婴儿(3.8%),而标准护理组有13名婴儿(1.7%)(p=0.013).发育护理组中更多的婴儿以母乳喂养,高于标准护理组(136[23.6%]对9[1.1%];p=0.029)。与对照组相比,在发育护理组中,纯母乳明显更有利(435[75.6%]vs114[15.0%];p=0.001)。即使在调整协变量后,差异仍然显着。然而,两组的口服免疫疗法和父母参与率相似.发展性护理组的平均噪声和光照水平明显低于标准护理组。在调整了混杂因素后,差异仍然显著。各组之间的死亡率和主要发病率没有显着差异。
结论:发育护理可能随着时间的推移对极低出生体重儿的住院时间产生了累积效应。发展性护理的实施可以极大地改善以家庭为中心的护理实践和新生儿重症监护病房的环境。
背景:ClinicalTrials.govNCT05166720.注册日期:3月1日,2021年。
BACKGROUND: Despite previous studies suggesting that developmental care can provide benign stimulation to promote neural development of newborns, more evidence is needed regarding the other clinical benefits of developmental care.
OBJECTIVE: To evaluate the effect of implementing developmental care on the length of hospital stay, the improvement of care practice in neonatal intensive care units, as well as the short-term outcome of very low birth weight infants.
METHODS: Cluster-randomized controlled trial.
UNASSIGNED: From March 1, 2021 to March 1, 2022, 1400 very low birth weight infants were recruited from 14 tertiary neonatal intensive care units in China.
METHODS: We assigned 14 neonatal intensive care units to either developmental care or standard care. The length of hospital stay of the infants was the primary outcome analyzed at the individual level. Secondary outcomes were family centered care practice including parental involvement, the skin to skin care, exclusive breast milk, oral immune therapy and breastfeeding. The environmental management (noise and light) and the short-term outcomes were also evaluated.
RESULTS: The length of hospital stay for the developmental care group was 65 % as long as that for the control group (HR: 0.65, 95 % CI, 0.451-0936, p = 0.021). After controlling the covariables, the adjusted HR = 0.755 (95 % CI, 0.515 to 1.107, p = 0.150). When compared to the control group, the developmental care group had greater access to SSC, with 22 infants (3.8 %) in the developmental care group compared to 13 infants (1.7 %) in the standard care group (p = 0.013). A greater proportion of infants in the developmental care group were fed at the breast, than those in the standard care group (136 [23.6 %] vs 9 [1.1 %]; p = 0.029). Compared to the control group, exclusively breast milk was significantly more favorable in the developmental care group (435 [75.6 %] vs 114 [15.0 %]; p = 0.001). The difference remained significant even after adjusting for covariates. However, the rate of oral immune therapy and parental involvement was similar in the two groups. The average noise and light levels in the developmental care group were significantly lower than those in the standard care group. After adjusting for confounders, the difference remained significant. There were no significant differences among groups in the mortality and major morbidity.
CONCLUSIONS: Developmental care might have developed an accumulated effect over time on the length of hospital stay among very low birth weight infants. The implementation of developmental care can greatly improve family centered care practices and the neonatal intensive care unit environment.
BACKGROUND: ClinicalTrials.govNCT05166720. Registration date: 1 March, 2021.